Innovative Claims Reporting
CorVel knows that behind every workers’ compensation claim is something incredibly valuable, an injured worker who needs attention from the very first moment an incident occurs. Connecting patients with appropriate, quality care is the cornerstone of CorVel’s Enterprise Comp Solution. We have a proprietary, in house advocacy model that is completely integrated with our risk management system to offer immediate first aid advice, referral to telehealth or appointments with a medical doctor. Our immediate intervention and nurse triage promotes an environment focused on advocacy, while reducing costly lag times of First Notice of Loss (FNOL) reporting.
24/7 Nurse Triage
Immediately following a workplace injury, employees can call to speak with a registered nurse who will evaluate the incident. Our nurses specialize in occupational injuries and connect injured workers with the quality care they need. After speaking with a 24/7 triage nurse, employees are given the option to connect with a provider instantly via telehealth, facilitating expedited prescriptions and referrals for physical therapy treatment. By addressing the case when it first occurs, CorVel’s program provides quick and accurate care intervention, often preventing a minor injury from becoming an expensive claim.
Every incident and injury is run through CareMC, our proprietary healthcare platform, where they are analyzed by our system’s rules engine. Smart triage reviews and prioritizes claims based on codified data elements. Conducting continuous claims management, the system flags claims that need additional detail or information, which allows our associates to know which claims need attention before they become complex.
A Care Advocate reviews claims identified by CorVel’s system to validate complexity. Used as an additional resource, this extra layer of expertise examines the information collected during triage, as well as the claim file. The Care Advocate actively investigates whether the flags are warranted by contacting the physician, patient and/or employer as needed to make a conclusive complexity determination. Based on the Care Advocate’s findings, they may make a recommendation to the Adjuster to assign a Case Manager for further medical management.