Managed Medical Care
Medical Case Management
Effective medical case management incorporates medical triage procedures and directives, including the channeling of claimants to network providers for medically reasonable and necessary treatment. FutureComp utilizes all in-house medical case managers who work in conjunction with our adjusters on the same claim platform.
FutureComp’s in-house utilization review specialists help our clients meet state mandates and manage the care of injured workers with the most appropriate and accepted medical protocols.
Our utilization review procedures include pre-certification, concurrent and retrospective reviews, and physician reviews. As a critical element of successful claims management, FutureComp’s utilization review process is overseen by a tenured medical director.
Medical Bill Re-Pricing
In the area of medical bill re-pricing, we employ successful cost-containment practices for our clients. Our state-of-the-art technology reviews all submitted bills, flagging opportunities for fee schedule and usual and customary reductions.
This sophisticated bill review process entails a comprehensive analysis for usual and customary treatment, proper coding, bundling and unbundling, and code violations.
Additionally, FutureComp utilizes nurse audits for a detailed review of complex medical bills. This service, in tandem with the utilization of FutureComp’s preferred provider organization (PPO) network, achieves enhanced savings for our clients, outpacing many other TPA results.
Preferred Provider Networks and Prescription Benefit Management
FutureComp provides a behind-the-scenes comprehensive PPO for our clients. Through our PPO network, we offer pre-negotiated provider discounts of 5% to 35%. We offer state-approved networks that benefit clients in the initial treatment of injured employees.
Additionally, FutureComp offers a prescription benefit management (PBM) program for our clients. Through this innovative program, claimants are administered prescription cards at the onset of a claim to facilitate access to approved medication. FutureComp’s PBM also provides a first fill program to expedite access to necessary medication for work-related injuries.