A Better Process from Injury to Recovery
Timely and Appropriate Initial Care
We want employees who are injured on the job to get appropriate and timely care with minimal delays and/or unnecessary treatment. To help ensure this, we offer a range of services to be responsive to the severity of the injury:
Nurse Triage Services* (premium $250k and above) – for less severe injuries, our nurse triage services can help your employee get directed to the appropriate facility, telemedicine, or self-care, depending on the level of care necessary.
Nationwide Telemedicine – for times when face-to-face care with a physician is necessary, but physical access is not possible.
Catastrophic Claim Protocols – our highly experienced Technical Claim Professionals will start handling any catastrophic claims immediately by helping find appropriate care and assigning a Field Nurse for additional support if needed. They will partner with our in-house Medical Director or our team of Medical Resource Nurses as needed.
Medical Excellence Team – serves as personal healthcare assistants to injured workers. They strive to get them to high-quality doctors and top-rated medical facilities no matter the severity of their injuries. They connect them to trusted doctors matched to their condition and their needs. Our team’s main focus is to make navigating healthcare within the workers compensation system easier.
A Focus on Quality Treatment
Medical Provider Network – we are selective and focus on ensuring our MPN comprises the best providers experienced in treating workplace injuries in California.
Our Medical Director – in addition to leading our Medical Excellence team, our Medical Director is a residency-trained and board-certified Occupational Medicine Physician who provides input on our complex and catastrophic claims.
Intelligent URSM – we want to ensure the delivery of timely and seamless medical care, so we partner with trusted providers to enable recovering workers to accomplish more in a single visit. We have a custom Express CareSM program with Kaiser On the Job® as well as other network providers.
Claim Professionals – this team is committed to ensuring we are delivering compassionate care to recovering workers throughout the claims process.
Medical Resource Nurses – work hand in hand with our Claim Professionals to ensure we are looking out for medical issues and helping coordinate a full and timely recovery.
Comprehensive Cost Management
Medical Bill Review Team – we use our own certified coders to deliver a best-in-class bill review service. That includes pre-negotiated rates, detailed review/adjustment of complex bills, and effective price negotiations on non-fee schedule items.
Intelligent URSM – in addition to using prospective and retrospective UR intelligently, our in-house team of UR nurses and other medical professionals’ can approve appropriate treatments quickly and escalate complex or questionable requests to our network of doctors for review. Our approach is cost-effective and ensures medically necessary treatment is provided at the appropriate time for the injury.
BHHC Pharmacy Management – our pharmacy prescription program focuses on utilizing a customized network of pharmacies and an injury-specific formulary to ensure prescriptions are filled without delay. We started our program years before California introduced a formulary and combined it with our UR and Bill review.
This allowed us to spot and address issues early:
- We identified the abuses with compounds much sooner than the rest of the industry, saving recovering workers from questionable and expensive treatment, and we continue this diligence today.
- With our MPN, BHHC pays 25% less than other participants total with our overall medical spend.
Lower Medical Cost Containment Expenses – our approach to medical management helps us achieve superior claim outcomes, at a lower cost. Our medical cost containment expenses are about half of the rest of the industry.
Returning to Work
Our goal is to help recovering workers get back to health and back to work. To help facilitate this we offer:
- Claim Professionals and Client Service experts that can work with clients to help them understand work restrictions and ways they might accommodate the worker.
- A variety of transitional work programs, if the employer is unable to accommodate certain restrictions.
BerkTotalCare™ gives employers the peace of mind knowing we are an advocate for them and their employees when an injury occurs, providing timely and appropriate care with a focus on quality treatments while ensuring comprehensive cost management, which is significantly lower than the rest of the industry; helping to achieve superior claim outcomes at a lower cost.
Property and Casualty
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