Telephonic Case Management (TCM) provides benefits relative to cost-effective early intervention, removal of geographic restrictions, and reduced travel and wait time costs.
Upon notification of injury and referral, a Telephonic Case Manager will immediately begin working with the treating physician and facility, if hospitalized, while keeping the employer and claims professional informed of all pertinent matterrelated to the injured worker and their injury. They notify all appropriate parties, while assisting medical staff with the coordination of treatment. The Telephonic Case Manager will provide weekly reports, progress telephone calls and email updates. Using their clinical experience and Case Management expertise in conjunction with evidence-based guidelines, they will make recommendations and coordinate with all parties for safe and effective return to work.
- Allows a Case Manager to efficiently manage multiple files for injured workers from any location in the United States.
- Can reduce costs compared to traditional Field Case Management (FCM) by eliminating expenses associated with travel, appointments, and wait time.
- The cost savings associated with this service is substantial and can be performed while meeting the objectives established on the file.
Recommended TCM Referral Markers
- Spinal injuries, fractures & sprains, musculoskeletal/ repetitive motion injury, mental/substance abuse
- Medical reserves of $5,000 and over
- Lost time claims – when the claimant reaches 5 days of lost time and there is not a specific return date set by the medical provider
- 30 days of medical restriction Multiple treating providers Surgery recommended
- Current monthly RX cost > $1,500
- Moderate dose opioid (> 40 MED) prescribed for 90 continuous days
- Opioids > 120 MED
- Concurrent long acting opioids
- No improvement of medical condition within first 30 days
- Consider nurse case management under the following conditions
- Psychological treatment
- Non-compliance with treatment plan
- Multiple claims or pre-existing conditions
- Medical restrictions that do not match the injury or recovery guidelines
- Prolonged conservative treatment without progression
- Co-morbid conditions that may impact recovery
- Significant change in a medical diagnosis or condition which is not consistent with the injury
- Addition of new body part(s) to the original injury
- Socio-economic indicators such as pre-existing emotional, family or financial problems
- Poor job performance or recent notification of layoff/termination
- Multiple treating physicians Secondary gain factors such as MVAs
If you would like additional information on ADM’s Telephonic Case Management program and how we may further assist your claim, please call 866-491-5199, ext. 100 and we will be glad to address your questions.