• A unique WC claims early alert system on a cloud-hosted SaaS application
• Uses an automated email algorithm to link/integrate various Claims & Client roles
• Triggered by the decision for medical treatment
• Initiates both alerts and notifications to authorize medical treatment, report work status and notify claims of actionable events at the workplace...on the day of injury

Imagine if all the claims team and client roles were connected in a smart technology that sends alerts and notifications to the specific person(s) that needs to know when certain situations arise.

Now think of all the events and situations that occur on the day of injury: medical treatment, authorizations, work status outcomes, suspicious claim circumstances, problem employee issues, completion of required forms and service needs to support return to work and medical case management.

Early Claim Alert designed an email system that engages all the stakeholders and all the situational events into a single Roles & Rules system. Think of it as a set of interlocking gears of individual roles that are locked in to respond to various situational events occurring on the day of injury.

EARLY CLAIM ALERT: Medical Event Report

Complete the following to trigger the notification system.

Employee Name (Last, First, Middle):	,
Location:	Main Office: Custodial
Job Site
Occupation
Date of Injury	(MM/DD/YYYY)
Date Reported to Employer	(MM/DD/YYYY)
Brief Description of Injury	Andy slipped on a puddle of water on the bathroom floor, fell, and hurt his left arm.
Medical Treatment Type	Urgent Care (Clinic/Physician)
Provider	Westside Urgent Care Clinic

Automatically sent by fax or email, to selected provider. Provides medical authorization, contact and billing information and specific employer instruction regarding treatment and return to work.

Account: Kleen Maintenance Co. > Main Office > Custodial
Claim: Adams, Andy A.
DOI: 05/02/2016
Reported: 05/02/2016 by Briggs, Barbara B. <bbriggs@example.com>
Provider: Westside Urgent Care Clinic

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Medical Treatment and Work Status Update

Medical provider (Westside Urgent Care Clinic) has been provided an authorization for treatment.

Employee was treated on: (MM/DD/YYYY)
Employee declined treatment

What was the result of employee's medical treatment? The physician's decision was:
Full Duty | Modified Duty | Off Work | Hospitalized

Effective date: (MM/DD/YYYY)

Do you want to send the Employee Medical Treatment Survey?
Yes: Employee's email:
No

Next medical appointment date (if known): (MM/DD/YYYY)

Date returned to work: (MM/DD/YYYY)

Situational Assessment: Are any of these conditions present? Check all that apply. (Each condition checked requests the indicated service.)

Known employment problem (e.g., excessive absenteeism, performance issues)

Employee concerns re: injury/medical treatment

Case management notified re: contact physician

RTW assistance to coordinate modified duty

Case management/RTW coordinator notified re: modified duty. Urgent Request.

Suspicious incident circumstances

The RTW Tool is designed to service every industry with Modified Assignments created from our extensive database. Its ease of use and flexible design allow the user to easily select the appropriate occupational classification and receive a minimum of seven (7) modified assignments for the specific occupation. Each of the Modified Assignments are customizable for the specific claim or account.

Primary Standard Occupational Classification (SOC):

Secondary Standard Occupational Classification (SOC):

Modified Assignments:

Title
SOC ..
Summary
Employee will perform light maintenance services on equipment and building/facilities within assigned skilled trade. Task requires troubleshooting/diagnostic skills, and knowledge of assigned skill area. Maintenance/service calls can be assigned within employee's work restrictions.

N: None (no requirement)
S: Seldom (0-6% of assigned shift)
O: Occasionally (7-33%)
F: Frequently (34-66%)
C: Constantly (67-100%)

	N	S	O	F	C	Comments
Standing
Sitting
Walking
Lift/Carry
Push/Pull
Bending
Kneeling/Crouching/Crawling
Reaching/Handling
Climbing
Driving

Psychological Restrictions
Comments
Self-paced activity. Employer willing to work with all work restrictions. This task requires specific skills/abilities. Assignment is based on employee meeting task requirements. Assignment to this task is limited to regularly assigned personnel in this work area.

Title

Describe the modifications made to the existing job to comply with the medical provider's restrictions. For each restricted physical demand, select the appropriate level of restriction and add any clarifying comments. Use comments box at bottom to add case specifics.
X: No Limitation / No Restrictions
N: None (no requirement)
S: Seldom (0-6% of assigned shift)
O: Occasionally (7-33%)
F: Frequently (34-66%)
C: Constantly (67-100%)

	X	N	S	O	F	C	Comments
Standing
Sitting
Walking
Lift/Carry
Push/Pull
Bending
Kneeling/Crouching/Crawling
Reaching/Handling
Climbing
Driving

Psychological Restrictions
Comments
Work restrictions will continue for next 10 days; expect full work release at next medical appointment on 5/13.

• Provides a Complete RTW Solution for Case Management
• Documents Service Requests, Creates Numerous RTW Options
• Adapts to Every Industry, Claim and Account
• Can Be User-Restricted, Claim User or Claim-Client User

INTRODUCTORY OFFER

$1,000 per account*, annual subscription basis

ENROLLMENT FEES WAIVED

*Limitations on number of locations and claim volume may apply

Enrollment

• Each account is custom enrolled by our staff; we set-up who gets notified and when
• Initial medical provider information is loaded for each reporting Client location to send Medical Authorization
• Account-specific training using live-recorded webinars

Automated Alert and Notification Services for treatment, work status, service requests and service evaluation

• All major Claims roles/individuals for claims processing and case management services are linked to the Client's workers' compensation roles/individuals.
• All alerts and notifications are timed to receive follow-up reminders if there is no response.
• Optional notifications include timed reminders to complete FROI, OSHA notification and Supervisor's Report.

Optional Features

• RTW Tools for modified assignments and modified regular job
• Satisfaction Surveys to measure employee & client opinions
• Event dashboard to monitor performance

Early Claim Alert delivers stunning results. These are the measurable ROI events:

• Enhanced best practices: reducing lag times, better reporting
• Saving time with a collaborative system connecting Claims, Client and Medical Provider
• Capturing opportunities for early RTW, medical case management and solving issues when they occur
• Lowering average cost per claim with timely response, less problems, less litigation
• Competitive advantage to attract new clients, retain current ones (priceless)
• Saving time for claims team staff (priceless)

A Compelling Case for Client Compliance

• "In Control" from the outset
• Responsible for providing actionable information that lowers costs
• Saves time by their participation, using an automated alert/notification system
• Provides the initial medical-treater critical information regarding authorization, organization specific guidelines and billing instructions before employee arrives for treatment
• Improves their internal comp process to build a stronger alliance/collaboration with the claims group

A No-Brainer for Claims

• Higher & earlier level of service response on the day of injury
• Documented actionable events initiated by Client
• Adds new tools to aid RTW
• Improves current processes linked to Client performance; builds retention
• Saves valuable time on the day of injury with early alerts of important situations
• Ease of adoption, no technology hurdles
• High ROI, low annual cost

Account: Kleen Maintenance Co. > Main Office > Custodial
Claim: Adams, Andy A.
DOI: 05/02/2016
Reported: 05/02/2016 by Briggs, Barbara B. <bbriggs@example.com>
Provider: Westside Urgent Care Clinic

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Employee Medical Treatment Survey

Your opinion about the quality of medical services that you received regarding your recent work injury is valuable. Please assist us in determining the quality of medical treatment you received.

By moving the slider, answer each question on a scale of 1 to 10, with 10 being the best or most favorable response, and 1 being the worst or least favorable. (The rating you choose will appear in the box to the right of the slider.)

How would you rate the medical services that you received (10 = excellent ... 1 = very bad)?
 

What was the waiting period to be seen (10 = seen immediately, ... 1 = excessively long delay)?
 

How satisfied were you with the physician's explanation of your injury and the overall treatment plan (10 = very satisfied ... 1 = very dissatisfied)?
 

Rate the overall experience at the medical provider/clinic (10 = excellent ... 1 = very bad).
 

Comments:
Clinic was very quick to see me and very helpful in explaining my injury condition. I expect a full recovery soon.

I decline to take this survey.