PRESENTATION FOR STATE OF NEW JERSEY RFP: 08-X-38489 Managed Care Workers

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CLIENT GUIDE
Managed Care for Workers Compensation
Corporate Office 119 Littleton Rd Parsippany,
NJ 07054 Tel[phone] PA Office 500
Office Center Drive, Ste 400 Fort Washington, PA
19034 Tel [phone]
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General Information

• Incorporated in 1979.
• Specializing in workers compensation medical
  management for insurance companies, self-insurers
  and insurance funds.
• Licensed as managed care organization in New
  Jersey 1993.
• Goal is to facilitate superior healthcare while
  minimizing healthcare and indemnity costs
  nationwide.

www.FIRSTMCO.com
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Services Include

• 24/7 First Report of Injury Intake
• Medical Case Management
• Return to Work Programs
• Bill Review Services
• Proprietary PPO Network
• Out of Network Negotiations
• IME and Audit Services

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The System

• Web-based, allowing both internal staff and
  remote offices to access system
• Transactions are performed online and in
  real-time
• Real Time PPO Network lookup
• Automated bill review process with little to no
  manual intervention required
• Can accommodate Electronic Billing (837 Format)
  as well as manual input
• Minimal amount of time and effort
• Initial bills scanned/imaged
• Bills available to user by 730am next morning

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(cont.) The System

• Downloadable Nurses notes
• Re-pricing System will accommodate Workers
  Compensation, PIP-Auto and Healthcare
• Majority of standard forms and letters are
  generated from system and sent via email, fax,
  and/or mail per account preference
• Lease-able System

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Program Outcomes

• National PPO network, allowing clients to access
  multiple PPO medical provider groups for
  optimized savings
• Decreasing injury reporting time, by developing a
  day one return to work program.

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Solutions for
Case Management System
Workers Comp

• Initiate FROI
• - By calling
• [phone]
• ltorgt
• -Submit Claim
• Online
• ltorgt
• -Fax in Claim

• Bill Review
• PPO Applied
• Negotiate Out-of-Network Fee
• Utilization Management

• FROI Completed
• Claim Sent to Med Provider
• Pharmacy Established

• Medical Intervention MMI Establishment
• RTW Protocol Establishment

• Establish 4 Point Contact
  -Employee -Employer -Doctor
  -Adjuster

Case Management Assigned
Return To Work Initiated
Bill / Claim Review
Case Management
First Report Of Injury

Injury Occurs

• Vocational
• Telephonic
• Field

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www.FIRSTMCO.com
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Thank You!!