Managed Care Components
BSAI has one objective in mind – to evaluate claims, review cases, process bills, and apply network discounts, providing managed care services that allow our clients to achieve positive outcomes through cost effective solutions.
In partnership with a leading national provider of managed care services, BSAI offers customized managed care, medical bill review, and integrated service programs. Our comprehensive quality management program permits us to continually evaluate and improve medical service quality, provider network coverage, and application processing.
Every step in our review, examination, and service process is evaluated to ensure that we meet or exceed our clients’ needs, including regulatory, legislative and accrediting body standards.
Medical Bill Review
BSAI provides medical bill review services through a variety of delivery options that include standard service bureau processing, dedicated units, client on-sites, or on-site/service bureau combinations that utilize scanning and image transfer. BSAI will customize interfaces to transfer claim data, bill data, and images of EORs and/or bills and notes to meet customer specifications.
The following components make up our Medical Bill Review process:
- Fee Schedule & UCR Application
- Nurse Audit and Review
- PPO Application
- Specialty Review
- Out of Network Negotiated Discounts
- Standard Reporting
- Pre-certification/Utilization Review
In our continued efforts to address rising medical costs while ensuring quality medical care Brentwood Services Administrators, Inc. provides a review of procedures and treatments to assure these are medical necessity. We are URAC compliant, and we utilize Registered Nurses who are experienced in Utilization Review for the initial review of all services .BMM uses the Official Disability Guidelines as the criteria for usual and customary care for all proposed medical services. Any request for services not meeting these guidelines are referred to a Medical Director who is board certified or board qualified in the specialty of the provider requesting authorization for services.
Utilization review services include:
- Concurrent Review
- Retrospective Review
- Extended Cost Estimates
Brentwood Medical Management also provides extended cost estimates to assist in reserve setting on files. Registered Nurses who are experienced and certified in case management perform extended cost estimates. These documents outline a cost assessment of care and equipment needed for an injured worker over his or her lifetime as they relate to a work injury. They can be obtained to help identify the future exposure on a claim based on the ultimate medical needs of the individual in order to assist in setting reserves and/or evaluate a file for potential settlement. An extended cost estimate can also assist in mitigating risk and help in determining claim exposure with regard to reinsurance requirements. These documents are less expensive than a life care plan while providing the same information that is typically included in a life care plan. Life care planning should still be used when needed as evidence in a settlement trial.
Medical Case Management
Medical case management refers to the planning and coordination of health care services appropriate to achieve the optimal goal of medical rehabilitation and timely return to work. Our case management team consists of professionally licensed nurses who are educated in the area of workers’ compensation.
Our “Best Practice” Case Management Goals are:
To ensure timely and appropriate communication between adjuster, employer, injured worker and medical providers.
To facilitate the recommended treatment plans so that appropriate medical care is provided
To assess alternative medical services for appropriateness and cost effectiveness based on established medical standards
To encourage and monitor injured workers to follow prescribed medical and rehabilitation plan
To focus medical plans towards return to work in a safe and timely manner, taking into consideration any restrictions or residual functional limitations.
CASE MANAGEMENT/UTILIZATION REVIEW REFERRRALS: 1-877-BRENTWOOD
Pharmacy Benefits Management
Brentwood Services Administrators, Inc. has partnered with a leading national Pharmacy Benefits Management Company to provide a comprehensive pharmacy benefit management (PBM) program. Prescription drugs for injured workers can make up anywhere from 10% to 20% of total workers' compensation medical costs, making management of these costs an important component of a complete managed care program.
Our PBM program provides:
- Retail pharmacy discounts at over 60,000 network pharmacies
- Electronic adjudication
- First-fill programs
- Formulary management
- Drug Utilization Review (DUR)
- Generic substitution
- Mail order conversion