productivityedge managed care services
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1 productivityedge managed care services
2 AIG Domestic Claims, Inc. (AIGDC) offers customers a distinct advantage in combating workers compensation costs Productivity Edge.
3 Productivity Edge provides companies with access to high-quality medical care while helping them reduce their medical expenses and better control indemnity costs. Our approach integrates five key medical management areas: productivityedge 1 Pre-injury management Value-added services that help our customers begin controlling costs even before an injury occurs. We focus on early reporting, effective return-to-work programs and coordination of all medical management services with the employer. Medical expense management A broad range of programs that helps our customers control medical costs and expedite treatment. Telephonic case management Early intervention and medical coordination with the customer, employer and physician to ensure timely and appropriate treatment. Utilization management Proven methodologies used by AIGDC to evaluate health care on the basis of appropriateness, quality and necessity of the treatment rendered. Field-based case management Face-to-face, active and ongoing coordination with injured employees and their treatment teams to facilitate early return to work and maximize medical improvement. Together, these programs focus on the areas of the claim process that most impact our customers ultimate cost aggressively managing the cost and quality of medical treatment and expediting the injured employee s return to work. A Quick Start AIGDC provides a toll-free hot line and online claims reporting, making it simple to report claims promptly. The faster an injury is reported, the sooner we can begin working with our customer to help control costs and return the injured employee to work. Medical Management Immediately upon receipt of the first notice, registered nurse telephonic case managers work with physicians, the injured employee and the employer to coordinate medical treatment. As a team, this group focuses on returning the injured employee to work quickly and in the most productive capacity possible. Telephonic case managers follow treatment plans designed specifically for workers compensation. Emphasis is placed on breaking inefficient patterns of care. By utilizing the most effective treatment standards and guidelines, we help keep costs down and expedite the injured employee s return to work. With its tightly controlled system of medical care delivery, Productivity Edge can also help lower our customers litigation expenses, speed case resolution and reduce overall claim costs.
4 2 productivityedge What is Transitional Employment? Transitional employment is the use of work tasks to help an injured or ill employee remain productive until he or she can return to full duty. These programs are personalized according to type of injury or illness, job specifications and the capabilities of the injured worker. Transitional employment is designed to ease the pivotal period from recovery to full, safe and productive employment.
5 Accessible, Specialized Medical Care productivityedge 3 Through alliances with the nation s leading workers compensation disability management organizations, AIGDC provides Productivity Edge customers with a national network of easily accessible occupational health specialists. With experience in treating workers compensation-related injuries, these physicians are skilled in helping companies control costs. In addition, our network includes accredited and fully licensed hospitals, diagnostic imaging, rehabilitation and outpatient surgery centers. Returning the Employee to Productivity Ensuring the employee s prompt return to employment is critical to controlling lost time costs. To this end, AIGDC pre-injury consultants partner with medical experts and the insured to facilitate the injured employee s return to the workplace. Their efforts include: Educating employers about modified duty and transitional employment Assisting employers in developing effective return-to-work programs Visiting employers facilities to identify alternative positions Reducing or eliminating sources of recurrent injuries Managing for Results Productivity Edge also includes: Provider bill audits to ensure that payment is made for only authorized and appropriate services An online medical provider network with mapping capabilities that allows users to access preferred providers in their area or in customer-specific locations A Pharmacy Benefits Management Program designed to save customers time and money while providing an easy-to-use system for injured workers to receive their injury-related prescriptions A broad-based Preferred Provider Organization (PPO) network comprised of national and regional major managed care organizations Specialized network focusing on diagnostics, dental and other ancillary services Negotiated bill processes to assure payment of bills to protect the financial resources of our insureds Diagnostic networks that provide online scheduling and significant savings below fee schedule On-site provider bill audit nurses to review high-dollar bills and ensure quality control Utilization review services including pre-certification, concurrent, retrospective reviews and peer reviews Catastrophic care programs designed to meet the requirements of the most severe cases
6 4 productivityedge Our Customers Commitment is Key to our Success AIGDC s customers play an essential role in the success of Productivity Edge. They can make an impact by ensuring that the program is properly implemented and thoroughly communicated throughout their organization; that injuries are reported promptly; and that the workplace accommodates employees return to transitional duty. A Commitment to Care Productivity Edge medical management services are provided through the nation s leading managed care organizations, whose networks of physicians, hospitals, medical professionals, ancillary services and healthcare facilities are selected for their dedication to quality and efficiency. All providers must meet credentialing criteria and maintain compliance with our program guidelines. For more information on how our Productivity Edge services give your company the edge in controlling workers compensation costs, please call your local AIGDC marketing representative or us at mms@aig.com.
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8 Executive Offices 70 Pine Street New York, NY Services Provided by Members of American International Group, Inc CS/ 10M 8/07 Rev
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