Workers' Compensation Services . . .

Case Management & Medical Cost Containment

Case Management:
The process starts at HealthFirst TPA with a team analysis of each claim and early referral to one of HealthFirst TPA's nurse case managers. Our experience has been that costs are decreased and the employee returns to work earlier when a nurse case manager gets involved quickly.

It is the aggressive telephonic and field case manager that to help direct appropriate medical treatment. The case manager conveys vital information to the adjuster immediately following a doctor's appointment. The speed of communication eliminates lag time often associated with doctors' dictation and the written report arriving on the adjuster's desk. This proactive coordination of information can guide the claim to a quicker resolution.

The case manager is cross-trained and works closely with the HealthFirst TPA Medical Director to facilitate pre-authorization. Case managers enter updates directly into the claim file to provide adjusters and the client with the most current information.

HealthFirst TPA has raised the bar with our integrated approach to case management.

Medical Cost Containment:
Our integrated services are structured for extraordinary results. These services include medical bill audit and payment and pre-authorization services by a Registered Nurse.

We recognize the cost of healthcare as the driving force in the workers' compensation system. All aspects of claims are coordinated by the director with a risk management background and a supervisor with an extensive background in Workers’ Compensation. This provides a level of sophistication unique to HealthFirst TPA.

The HealthFirst TPA Workers' Compensation Services department is certified by the Texas State Department of Insurance.