Medical Management and Cost Containment

Blue Leaf Services, LLC, a member of the Blue Leaf Group, provides managed care services for Blue Leaf Claims, Inc. and its clients. These services are provided in conjunction with our workers compensation adjusting and claim administration services.

Blue Leaf Services provides comprehensive managed care services to assist the client in facilitating the injured employee’s return to work in the shortest time possible and using the most effective, cost-efficient medical care available. We work with the Client to establish a workflow that will meet the Client’s goals and requirements.

By choosing Blue Leaf Services, the Client will obtain several benefits:
+	Paperless workflow capabilities by allowing Blue Leaf Services to be the client’s single hub for bill review, utilization review, and medical case management/utilization review.
+	Various ways to receive bills, e.g. paper, e-mail capabilities for priority work or scanned document workflow.
+	Blue Leaf Services can retain scanned data on behalf of their clients with Internet access to check the status of bills.
+	Avoidance of paying for unauthorized services by bill review analysts reviewing the notes from the nurse case managers, utilization review staff, any UR protocols, ancillary providers and authorized treatment plans.
+	Automatic checking for duplicate bill submission.
+	Superior responsiveness and support. Flexible and detailed reporting capabilities.
+	Five day guaranteed turnaround time.

All services are provided in accordance with the applicable Workers’ Compensation Act.

Medical Bill Review
Medical bill review process fully interfaced with the claim management system. All bill review analysts are certified based on the standards set by the appropriate State Department of Insurance.
+	Fee schedule review.
+	Usual and customary review.
+	Desktop and retrospective bill audit offers a comprehensive approach to containing validated and related costs and identifying non-validated and unrelated costs through audit of Provider bills.
+	Preferred provider discounts.
	- Non-hospital
	- Hospital inpatient
	- Hospital outpatient
	- Ambulatory surgery centers

Utilization Review
A Utilization Management cost containment program developed to assess the medical necessity and appropriateness of proposed treatment plans while maintaining quality of care. Licensed nurses perform all reviews. Physicians who serve as advisors are licensed and board certified and have experience as practicing physicians and in the managed care/medical management field.
+	Utilization Review provides prospective, concurrent and retrospective review of inpatient and/or outpatient services.
+	Pre-authorization of admission and treatment.
+	Concurrent review.
+	Second surgical opinion.
+	Discharge planning.
+	Peer review.
+	Physician level review.

Case Management & Return-to-Work Programs

Telephonic and on-site case management of the medical treatment process of a workers’ compensation claim for the purpose of supporting employee, employer, and health care provider in assembling and executing a treatment plan and, where necessary, a return to work plan for the claimant.

Triage Case Management

Triage case management allows for screening and identification of medical case management issues. Admissions and/or services are reviewed and evaluated to identify potential case management for claims that would benefit from telephonic and/or field case management services.

Pharmacy Benefit Program
+	Integrated Pharmacy Benefit and DME products.
+	A nationwide pharmacy benefit program designed specifically for workers’ compensation.
+	Injured workers can access the pharmacy network 24/7 immediately after being injured with enrollment on-line, by toll free telephone, first fill at the pharmacy, or automated claim file enrollment.
+	Processed prescriptions electronically with no out-of-pocket expense for the injured worker and with no requirement to use a pharmacy identification card.
+	Injured workers receive their prescriptions faster, avoid out-of-pocket expenses, and are able to return to work in a timely fashion, yielding a 15% to 20% reduction in pharmacy costs.

Vocational Rehabilitation

Vocational rehabilitation services for injured employees as identified by Client, including assessment of the functional capacity and transferable skills of employees, identification of appropriate jobs and assistance in the placement of employees in suitable replacement jobs.

Other Services
+	Medicare Set-Aside Arrangements.
+	A disability prevention program providing critical incident stress debriefing to individuals who have been victims of, or witnesses to, workplace violence.
+	Independent Medical Examinations (IME) conducted by a comprehensive network of prescreened, board certified Health Care Professionals.
+	In-House Nurse Consultants.
+	Legal Nurse Review.
+	Catastrophic Case Management.
+	Life Care Cost Projection Services.
View a printer-friendly overview of Blue Leaf Services' Medical Management and Cost Containment Service service.

info@blueleafclaims.com