Known as the premiere workers’ compensation preferred provider network, FirstHealth® is our partner of choice offering occupationally oriented providers,
national coverage and a service driven approach to continually enhance network
capabilities and ensure provider/facility active practice status and credentialing.
All employer groups contracted with Hewitt Coleman have access, via our web
site, to electronic directories and Worksite Posters to locate participating
providers.
Find a PPO Provider
If the providers you currently utilize are not participating members,
complete the following form and First Health will initiate discussions regarding
provider membership.
Nominate a Provider
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Provider Bill Adjudication
Electronic Bill
Adjudication and Billing History
To Ensure Medical Payment Accuracy
Centrally located within our Corporate offices, our Billing Analysts initiate
bill review by entering the line by line detail into our proprietary data
system. Electronic records are transferred to First Health where multiple edits
result in the adjudication of each bill. Electronic files are returned and
populated to the appropriate claim file. Provider checks are generated with an
accompanying explanation of review for provider accounting.
Our bill review program produces an average of 33% cost savings from that of
the Gross Charges Billed.
Savings reports are generated monthly, with quarterly, semi-annual, and
annual roll-ups and a detail analysis of
- number of bills processed by provider category
- percentage of providers contracted with the First Health
PPO
- percentage of savings per edit category
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Pharmacy
Management Program
Through strategic partnering with EXPRESS SCRIPTS, Hewitt Coleman has
implemented a pharmacy management program to establish cost containment and drug
utilization parameters for workers’ compensation beginning with the first
prescription. The benefits include:
- pharmacy management of all medications
- control from the point-of-prescription-fill by a list of approved
medications
- assurance the injured employee receives prescribed medications with
no out-of-pocket expense
- Increased compliance with medical treatment plans
- Decrease in litigated cases due to disgruntled employees
- Utilization review of pharmacy program by a Clinical Pharmacist in
conjunction with the TCM nurse
- Discounts on medications prescribed
- Detail reporting by Employer Group, by employee, by medication, and by
prescribing physician
- Online medication reference
Click here to
Look up a
Medication
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Nurse Case Managers
At the center of Every Workers’ Compensation Claim
is an Injury Event.
We believe medical expertise teamed with our adjusters
is crucial to a positive outcome.
Who's Managing Your Claims?
Our in-house
nurses:
-
either
possess or are eligible to sit for national rehab certification
-
include
bilingual Spanish-English nurses
-
have at
least 3 years in the field of workers' compensation
-
are all
Registered Nurses
-
achieve a
Return-To-Work outcome on 92% of all cases
We offer medical expertise to
partner with our adjusters. Each claim is reviewed by a Registered Nurse to
identify barriers to recovery.A plan is essential to success. From the
medical review, an action plan is formulated and communicated to all parties
with the collective focus of communicating goals with the injured worker and
their families; involving the injured worker and their support system;
decreasing the disability duration, optimizing functionality and achieving a
successful return to work outcome.
We believe when the right thing is done,
everyone wins.
Our Goal: Helping to put the pieces
back together again.
To make a referral, click:
Managed Care Referral
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Nurse Negotiator
Catastrophic Claims ,
Prosthetics, Orthotics,
Chronic Pharmacy and Out-Of-Network
Claims
Can Amass Millions $$$$$$$$$$$
Let us HelpWe have a team of aggressive, skilled nurse negotiators who will
address the challenge of containing medical fees for Catastrophic and
Out-Of-Network billings. Our goal is to maintain costs savings without
compromising the delivery and/or quality of medical care.
Direct provider negotiations have
produced significant savings ranging from 20%-60% reduction from Gross Billed
Charges.
To make a referral, click:
Managed Care Referral
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Utilization Review
Was that procedure
medically necessary?
Was there objective data and
diagnostics
to support the service?
Did it meet Plan
Stipulations or W/C Guidelines?
Let us ask the right
questions BEFORE the check goes
out.
A Registered Nurse reviews a provider's request to deliver
medical services in order to determine the medical necessity
and appropriateness of the intended medical service and that
of the Group Health plan stipulations and/or workers'
compensation guidelines. Certification Reviews include
inpatient admissions, outpatient services and or procedures.
The types of reviews are as follows:
-
prospective: before the service is
rendered. "Pre-Certification"
-
concurrent : during a course of
care that is currently ongoing
-
retrospective: after the care is rendered.
To make a referral, click:
Managed Care Referral
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Short-Term
Disability Management
Employee Benefits, Production Costs,
Temporary Staffing and
Plan Over-utilization can translate into a Major Expense.
Are your employees
confused about FMLA vs. STD?
Let our nurses manage your Short Term
Disability Plan per plan intent. Let us become an “Added Benefit” for your
employees.
Short Term Disability and Absence management is offered to
employers who do not currently manage their STD programs from a disability
standpoint. Program flexibility allows TCM to offer disability management
services for an entire workforce or on a case by case basis.
Employers participating in our Short Term Disability
management programs have seen
as much as a 43% reduction in over-utilization, a decrease in disability
durations and dramatic reductions in lost production revenues.
Our services quickly pay for themselves. If your STD
Plan is being over-utilized with repeat absences and claims, we can help.
To make a referral, click:
Managed Care Referral
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Short Term Disability Consult to Pay
If you just want our opinion regarding a
Short Term Disability Application,
then this is the service for you…
Not all submissions for short-term disability benefits are valid. To ensure
that benefits are utilized as intended and are limited to qualifying conditions,
the consult-to-pay service is offered to specifically address each submission's
uniqueness. The medical diagnosis is reviewed for compliance with the client's
specific plan design attendant with the projected disability duration.
To make a referral, click:
Managed Care Referral
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Large Case Management
Catastrophic, Terminal, and Complex Disease
Claims
need special attention.
We
can tie the loose ends together.
Our Registered Nurses
coordinate the medical care for the more complex, chronic, or terminally ill
individual. Services may include negotiation of fees for medical services,
alternative treatment arrangements, air ambulances, transplant coordination,
Home Health care, medical equipment, and chronic pharmacy management. The nurse
case manager will work closely with the stop-loss carrier and employer to
continue cost containment efforts while preserving treatment integrity.
To make a referral, click:
Managed Care Referral
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