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Catastrophic Case Management

  • Amputation of every extremity
  • Brain damage
  • Burn injury needing hospitalization
  • Electrocution requiring hospitalization
  • Stroke, swing, or coma
  • Damage calling for hospital stay
  • Paraplegics/Quadriplegics
  • Patient transportation by ambulance or life-flight
  • Reflex sympathetic dystrophy syndrome (RSD)
  • Really serious spinal cord accidents

1. Initial Consumption Work Flow

Instantly contact Excel to report a unique reduction using the following options.

Phone/Fax During Normal Company Hours

888 464 0044 phone
916 944 0211 fax
Make reference to Excel >

Referrals after 5:30 pm: Direct to Steve Smetana
916 276 1033 phone

2. Information Required By Excel Managed Care

Catastrophic Case Definition

  • Amputation of any extremity
  • Injury calling for hospital stay
  • Patient title
  • Personal security number
  • Date of damage (DOI)
  • Date of beginning (DOB)
  • Residence address
  • Residence phone
  • Employer title
  • Company contact
  • Name and phone number of hospital and/or treater
3. If extra information is necessary, the nurse situation manager will get in touch with the adjuster.

Excel Nurse Case Control Responsibilities

  • React to all catastrophic recommendations with an onsite stop by at a medical facility by the nursing assistant Case management (NCM) as quickly as possible but no later than 24 hours after recommendation.
  • Communicate all referrals not only to the NCM additionally towards NCM Supervisor plus the Excel healthcare Director. This initial triage guarantees medical supervision to all or any aspects of the claim.
  • Supply a Post browse and Day 4 written report also daily dental /email reports into Claims Staff.
  • Work with the adjuster to present contact and medical advice to the family and company to aid, aid, and comfort.
  • Maintain ongoing connection with health staff, injured employee, family, workplace, and claims staff through the period of every hospital stay.
  • Provide release preparing proper toward patient’s requires, and coordinate durable health equipment (DME), pharmaceuticals, alongside ancillary services as needed through client’s community providers.
  • When needed, do a home assessment prior to the patient’s release and report the conclusions into the claim expert.
  • Establish and keep maintaining an effective working commitment with parties – including the healing physician, through the extent of aftercare treatment, supply dental reports anyway considerable milestones during data recovery, and supply monthly written reports every thirty day period until closure.
  • Offer all assistance and control towards the events to completely evaluate the first and a lot of appropriate way of coming back the staff member to either modified, alternative short-term, transitional, or fulltime work.
  • Conduct a 60-90 time roundtable program with supervisor and adjuster.
  • Ready a month-to-month administration report that catches the time associated with referral plus the title of patient, adjuster, and nurse and sort of damage and year-to-date (YTD) cost savings.
Source: www.excelmanagedcare.com
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