Customized communication database
Connects the claims team with various client roles
Monitors events and situations specific to individual claims:
Early Claim Alert captures early intervention opportunities, notifying the right person, for the right solution, at the right time.
Want to send a medical authorization to the clinic before the employee arrives? We can!
Client: want reminders to complete:
Complete the following to trigger the notification system.
|Employee Name (Last, First, Middle):||,|
|Date of Injury||(MM/DD/YYYY)|
|Date Reported to Employer||(MM/DD/YYYY)|
|Brief Description of Injury|
|Medical Treatment Type|
MEDICAL TREATMENT AUTHORIZATION
This notification authorizes the initial medical treatment for a reported work-related injury.
Employee and Incident Data
Name: Adams Andy A.
Date of Injury: 5/2/2016 Date Reported to Employer: 5/2/2016
Andy slipped on a puddle of water on the bathroom floor, fell, and hurt his arm.
Medical Provider: Westside Urgent Care Clinic
Address: 1122 N 33rd Street
Anyville, OR 97000
Fax: (541) 555-1234 Email:
Please provide the employee with a copy of any treatment recommendation and their curent work status report prior to the employee leaving your facility.
RETURN TO WORK PROGRAM
This employer has an early return to work program and can accommodate most temporary work restrictions. Please detail the work restrictions in your work status report. We look forward to working with the physician and assisting our employee with a speedy recovery.
Employer Contact Information
Organization: Kleen Maintenance Co.
Address: 4321 Washingtion Ave.
Anyville, OR 97000
Workers' Compensation Contact: John Smith
Phone: (541) 555-2345 Email: email@example.com
Billing Contact Information
Insurer: Example Mutual Insurance
Address: 123 Commercial St.
Anytown, CA 90000
Phone: (123) 555-9876 Email: firstname.lastname@example.org
Account: Kleen Maintenance Co. > Main Office > Custodial
Claim: Adams, Andy A.
Reported: 05/02/2016 by Briggs, Barbara B. <email@example.com>
Provider: Westside Urgent Care Clinic
Medical provider (Westside Urgent Care Clinic) has been provided an authorization for treatment.
Employee was treated on:
Employee declined treatment
What was the result of employee's medical treatment? The physician's
Full Duty | Modified Duty | Off Work | Hospitalized
Effective date: (MM/DD/YYYY)
Do you want to send the Employee Medical Treatment Survey?
Yes: Employee's email:
Next medical appointment date (if known): (MM/DD/YYYY)
Date returned to work: (MM/DD/YYYY)
Situational Assessment: Are any of these conditions present? Check all that apply. (Each condition checked requests the indicated service.)
Known employment problem (e.g., excessive absenteeism, performance issues)
Employee concerns re: injury/medical treatment
Case management notified re: contact physician
RTW assistance to coordinate modified duty
Case management/RTW coordinator notified re: modified duty. Urgent Request.
Suspicious incident circumstances
|05/02/2016||Initial Medical Treatment||Completed|
|05/02/2016||Authorization of MedicalTreatment||Completed|
|05/03/2016||Modified Duty Notification||Completed|
|05/03/2016||Case Mgmt. Request - RTW||Completed|
|05/04/2016||Case Mgmt. Followup - RTW||Completed|
A communication tool to bridge the gap on the day of injury
Customizable to every organization, claim & client
No hurdles technology-do you have internet? Use email?
Inexpensive, annual subscription
More Info? Go to the Contact panel on our website.
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