Clinical Case Triage Services

MediCall's triage program can facilitate application of the right resource at the right time to avoid unnecessary medical costs. We collaborate with your team to develop triggers to identify your costliest claims for clinical triage review.

• Intake. Early clinical intervention based on preliminary claims facts from FNOI
  
• Mid-Case. Capture of claims for review when certain thresholds are reached
  
  • Length of disability
  • Medical paid
  • Physical therapy visits
  • Chiropractic visits
• Pharmacy alerts
  
  • Generic conversion
  • Home delivery conversion
  • Step therapy to divert from overused costly narcotics
  • Review for relatedness

This service will identify red flags that can prevent timely medical resolution, compare length of disability to Official Disability Guidelines (ODG) best practice guidelines, document review findings and expected medical course of treatment in your claims system. The triage nurse will also make recommendations to your claims staff for further clinical intervention, including Telephonic Case Management, Utilization Review, Field Case Management or Peer Review.

Copyright © 2009 MediCall. All right reserved.