RCCA understands the workers’ compensation environment in California based on the decades of our management team’s experience implementing and managing claims programs. Our qualified executive team, highly trained claims experts, Claims Management Best Practices, and state-of-the-art technology have been diligently designed to achieve the best possible claim outcomes. RCCA’s Claims Management Best Practices are established to mitigate costs at every level of the claim process. Our proactive approach begins with the first report of injury and continues through settlement and claim closure.
Initial Three Point Contact
Immediate contact with the injured worker, supervisor, and treating physician to determine facts of the case.
Medical Case Management
Comprehensive medical management including the channeling of cases to select PPO/MPN providers, and assigned Nurse Case Managers.
1st level and subsequent utilization reviews to determine the medical necessity or appropriateness of care.
Comprehensive Bill Review
Comprehensive review of workers’ compensation medical bills and an expert staff for manual reviews and coding audits.
Proactive protocols to manage temporary and permanent disability, including return to work, and reasonable accommodations if necessary.
Litigation guidelines to ensure strict monitoring of the litigation process to reduce costs and achieve an optimal outcome.
Active pursuit of loss recovery with RCCA’s litigation support.
Claims Management Best Practices utilizing red flag indicators to identify benefit abuse or insurance fraud.
MEDICAL CASE MANAGEMENT
Effectively managing an integrated process, providing the injured worker timely and appropriate medical treatment
RCCA’s Medical Case Management establishes a coordinated treatment plan that is medically appropriate, and implements cost containment through efficient case management, utilization review, and medical bill review.
We are committed to improving the quality of care and controlling costs while managing treatment to ensure optimum case results.
Controlling unnecessary treatment is usually considered the primary goal of utilization review, however, timely and appropriate medical provider treatment has proven to achieve better outcomes.
Whether telephonic or in the field, Nurse Case Managers are tasked with being proactive in moving the treatment plan forward to get the maximum benefit for the injured employee. We employ critical thinking in Case Management, with our nurses analyzing treatment plan to reach positive outcomes.
Pharmacy Benefits Management
RCCA offers control of your pharmacy costs through pharmacy networks which provide tight formulary control, monitoring the use of opioids, and Drug Utilization Review (DUR). With the DUR process, peer physicians work with the primary prescribing physician to find alternatives to heavy opioid use or other addictive medications.
Medical Bill Review
RCCA offers bill review software that is fully integrated with UR and claims management platforms. Our bill review program uses the latest software and technologies to provide quick turnaround and other built in efficiencies.
24/7/365 days per year a licensed nurse is available at the time of injury. This service is designed to take the pressure off of the supervisor and identify what to do with the injured employee, while giving the injured employee the immediate medical expertise their injury warrants.
Delayed Recovery/Early Intervention Program
Developed around the three point contact (employee / employer / medical provider), RCCA uses a proprietary algorithm which asks specific questions designed to document a cohesive three point contact to identify outliers that will result in the injured employee spiraling out of control within the workers’ compensation system. Multi-disciplinary approaches can be brought to surround the injured employee with the right type of treatment and support.
Return to Work Program
Our Nurse Specialists will work with you to provide RTW options for the injured worker, either on a modified duty or full duty basis. All lost time cases will have a RTW Nurse Specialist assigned, and will discuss the restrictions placed on the injured employee by the physician with both the employer and employee.
Our goal is to develop a clear understanding of the work restrictions so the injured employee can heal and get back to full duty.
Our claims management, case management and bill review systems are state-of-the-art software, which allow for specific field captures to be data mined, and reports to be generated that can measure actual outcomes with benchmarks. This functionality allows us to provide claims best practices based on your specific data, and proactively manage claims for better outcomes and reduced claims costs.
An important component of any California workers’ compensation medical cost containment strategy is the use of an effective Medical Provider Network (MPN). RCCA has the experience and knowledge to create, implement, and administer an MPN which includes a mix of providers specializing in work-related injuries, as well as providers with expertise in general areas of medicine.
RCCA will manage all aspects of the MPN, including the providers, assisting injured employees to locate appropriate physicians, and create any state mandated notices and postings. We provide MPN reporting to our clients that measures MPN usage and cost savings. RCCA works with our clients to ensure employees are directed into the MPN for treatment by providers who offer high-quality, cost-effective treatment.
Our commitment to partnership and proactive program management to drive performance success
Through our Client Services department and your designated Client Services Specialist, you receive the responsive and regular communication needed to deliver the highest level of account management.
RCCA creates tailor-made services to fit the workflows of your organizations. Our mission is to provide the services necessary to meet your risk management needs by offering regular claims reviews and total loss and cost analyses.
Our commitment is to provide you with consistent and timely communication in regards to all aspects of your workers’ compensation program, with the information and answers you need when you need them, and friendly, personalized assistance you can count on.
Expert specialty solutions for complete workers’ compensation program management
- Implementation for existing or new self-insured employers and group programs
- Extensive experience in managing take-over and run-off claims programs
- Proven workflow transition processes
- Claim inventory review and analysis
- Detailed case transfer reports
Our goal is to be your trusted resource, offering added value to all of your risk management needs.
State-of-the-art technology driving efficiency and accuracy
RCCA offers the newest and most advanced system for complete claims management.
- Web-based claims management system with full imaging capabilities
- 24/7/365 client access
- Data exchanges with other claim management systems
- Online new loss reporting
- Online real time loss data retrieval with automated and ad hoc reports
- Customized, account-specific business rules
Our claims management system is fully integrated with utilization review and bill review to ensure accuracy of data and to create efficient workflows for our claims examiners.