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As healthcare costs continue to rise, now more than ever an integrated approach to case management is a valuable tool in lowering medical costs. Case Management is a collaborative process of assessment, planning, and coordination of care. Our highly credentialed and experienced staff aggressively manages each case, from early intervention through field case management services. TRISTAR Managed Care provides our clients with experienced, credentialed medical case managers who maintain communication with employees, providers, and claims professionals to control the use of medical care, encourage better employee compliance with treatment protocols, and expedite the return to work. We are committed to working as a team to ensure optimum outcomes.
TMC's Case Management programs provide the following services
- Prospective, Concurrent, and Retrospective Utilization Review
- Early Intervention
- Expedited Review
- Field Case Management
- Telephonic Case Management
- Pre-Certification with Discharge Planning
- Peer Review
- National coverage with matched specialty review
- Specialty Case Management
- Catastrophic Medical Management
- Disease Management- Cardiac, Diabetes, Respiratory, Oncology
- High Risk Maternity
- Behavioral Health
- Disease Management
- Customized Wellness Programs
- Healthy Living Program
- Customized Return to Work Programs
- Customized programs to meet individual employer needs
The goals of our case management services include
- Assisting employees through the medical treatment process
- When injury or illness occurs, providing proactive and aggressive case management
- Promoting early return to work
- Closing claims expeditiously to reduce the total cost of the medical claim and lost time costs
- Assisting employees and employers to maintain a healthy and productive workplace
Early Intervention Case Management
TRISTAR works to provide the best possible solution to medical cost containment including providing an option of setting up a Toll Free 24/7 First Notice Triage option. This would allow for initial reporting of claims directly into TRISTAR's specially–trained triage team where an assessment of the injury severity will be made and the provision of recommendations as to the best course of action. The service is provided 24 hours a day, seven days a week to ensure necessary treatments are obtained right away. Prompt treatment guidance such as this provides for the avoidance of costly emergency room and clinical visits while providing timely direction as to the level of care needed. If off-site care is needed, a referral to the appropriate recommended provider is given.
TRISTAR believes that Early Intervention Case Management is an effective tool to provide successful outcomes early in the case and ultimately direct the outcomes of the claim. The common goal is to achieve successful return to work, increase communication with the injured employee, avoid unnecessary treatments to decrease medical costs, disability, and litigation costs.