TeamCOMP

WellComp’s TeamCOMP approach brings medical experts into the claim on day one — helping to ensure lower workers’ comp costs and faster claims resolution.

What claims manager during file review has not heard — usually from someone blessed with the gift of perfect, 20/20 hindsight — the following about a claim gone wrong? “What we needed on this claim was better medical management.” Such hindsight, although often glaringly true, also comes with a very high price tag.

WellComp believes that foresight is a much smarter approach than hindsight, and that it delivers infinitely better outcomes. That is why we have launched TeamCOMP, our integrated claims outcomes management program. This comprehensive approach ensures that, from day one of every claim, medical professionals address the medical aspects and claims experts address the adjudication components.

The straightforward logic of such an approach is undeniable. Yet, among the leading claims management providers, WellComp is one of the few giving clients the option to build it into every workers’ compensation claim. The value of the results is also undeniable: significant reductions in the duration and overall cost of claims.

HOW IT WORKS
In the traditional approach to claims management, the medical expert, usually a nurse, is brought into the process late, which means medical information critical to the claim may have gone unrecognized, or may have been diluted or lost. In addition, the medical expert often works for an organization other than the claims management provider and may not share the same level of commitment to the client’s goals.

WellComp has eliminated the potential for such problems with the TeamCOMP approach. Based on a clearly established set of criteria applied to every claim, a nurse and a claims adjuster come together to form a collaborative team to administer each claim from the first report of injury through successful resolution. They share three-point contact responsibility. The adjuster makes initial contact with the injured worker and the employer, and launches any necessary investigations. The nurse contacts the medical provider to determine and document the diagnosis, treatment plan and current disability status; and to review and monitor next steps, which are established following pre-set guidelines, such as the need for telephonic case management. They then follow a closely integrated process to ensure that all information is shared, that medical management goals are met, and that the claim is resolved as quickly and efficiently as possible.

THE RESULTS
WellComp’s integrated, collaborative approach ensures that claims and medical expertise are applied precisely when and where they’re needed. The adjuster and the nurse work as a team — reporting to the same organization, using the same information systems, and focusing on the same goals and client service levels.

Claims outcomes become more predictable. Treatment and disability planning improves. Injured workers receive the most appropriate care and they return to work at the earliest possible date. Costs become easier to manage and control. Simply put, medical outcomes are optimized, and claims lifecycles and overall costs are reduced.


Enhanced Treatment and Disability Planning

Faster, easier access to more complete and better information from start to finish:

  • Ensures a more informed and in-depth review by both medical and claims experts 
  • Enables more precise claims certifications, and treatment and disability plans 
  • Improves claims triage, treatment and disability expectations, and review of case management criteria
  • Helps establish better reserves and action plans


Improved Medical Outcomes
Compliance with medical treatment and disability guidelines:

  • Helps resolve medical issues faster, facilitates authorization decisions, and reduces treatment cycles and disability durations
  • Increases PPO network penetration, and enhances network utilization through soft and hard channeling
  • Provides better evidence to defend medical management decisions
  • Contributes to faster return-to-work and improved patient satisfaction 

Additional Benefits
WellComp’s TeamCOMP approach also:

  • Enhances communication and partnership, and ensures that each service area is committed to the overall success of the program
  • Ensures early intervention with case management referral decisions based on pre-defined criteria, not individual discretion
  • Defines clear roles and responsibilities between the nurse and the claims adjuster, so each can focus their expertise where it is most needed and valuable
  • Promotes informed decision making from day one

LOOKING FOR A SMARTER APPROACH TO MANAGING CLAIMS?
Put WellComp’s team of claims and medical experts on your side, and resolve claims the smart way through knowledge, teamwork and a total commitment to a common set of goals—yours!