Services

Managing cases: What’s necessary? What’s reasonable? Where are the savings hidden?


Effective case management asks the same questions over and over:

Is care being delivered appropriately? Is the claimant getting the full benefit of treatment? Can several services be delivered simultaneously? Is the proposed procedure medically necessary? Is continuing medical care necessary and reasonable?

It’s exactly these kinds of questions that ICS case management experts constantly address. The goal is to find the fast track to maximum medical improvement (MMI) or return-to-work (RTW), while identifying and documenting cost savings at every step in the process.

Our approach includes:

  • Early Intervention and Care Planning, ensuring that all claimants move through the process as quickly and cost-effectively as their treatments allow
  • Constant Communication between and among the claimant, the claims agent, and all medical providers, to arrange the best possible path to a return-to-work outcome
  • Information Availability, with all activity reported and accessible online
  • Comprehensive Medical History, updated in realtime, maintained and available to address disputed claims
  • Expert Consultation with physician advisors on treatments that fall outside accepted standards and clinical criteria

Telephonic Case Management

Most of our cases are managed over the telephone. We get involved as early as possible and encourage communications at each step in the process, including:

  • First Notice of Injury — The claimant informs the carrier, employer, or third-party administrator of an accident. The carrier records preliminary information and refers the claimant to the ICS Medical Management Program
  • Case Initiation — The carrier forwards case information to ICS. ICS assigns a nurse as case manager. This nurse opens a new case in the ICS system
  • Initial Contact — ICS gets in touch directly with the claimant and immediately begins outlining possible treatment paths
  • Treatment Plan — ICS confers with treating providers to establish an optimal treatment plan, factoring in all regulations, state requirements, and policy language

Utilization Management

ICS is an experienced provider of utilization reviews that track and analyze treatment progress — through notes, findings, and diagnostic tests —to assess the necessity and/or reasonableness of treatment plans.

The aim of our reviews — whether prospective, concurrent, or retrospective — is to eliminate, wherever possible, the costs associated with unnecessary treatments.

Our services feature:

  • RN nurse reviewers averaging 10-plus years’ experience
  • Pre-certification review
  • Detailed reporting of decision-making criteria, including clinical rationale and treatment guidelines
  • Board-certified and licensed Peer Reviewers available for disputes and appeals

Field Case Management

In certain cases, telephonic management isn’t enough. If the case is especially severe, or if it requires ongoing vocational rehabilitation, we sometimes need to assign special case managers, trained in disability and catastrophic injury management.

We send these managers into the field to consult personally with the claimant, the providers, the carrier, and the claimant’s employer.

Our field case managers provide the following services:

  • Case assessment
  • Cost projections
  • Discharge planning
  • Physician visit scheduling
  • Rehabilitation placement
  • Home care review
  • Stabilization of treatment