Managing Care in Workers’ Compensation
Anthem Workers’ Compensation (AWC) is one of the nation’s most comprehensive Workers’ Compensation managed care network solutions. The provision of quality in health care is a key component of our Workers’ Compensation network program. The actions we take to help provide access to safe, appropriate medical care include, among other components, provider credentialing and our nationally accredited Utilization Management program. In addition, Anthem Workers’ Compensation is the single point of contact for launching a Workers’ Compensation program in multiple states.
The Anthem Workers’ Compensation Solution
The AWC solution directly addresses key Workers’ Compensation issues facing American industries:
- Provider expertise and accountability are key benchmarks of our proven PPO network.
- Bill Review and PPO Repricing options streamline the claims administration process.
- Full spectrum of Medical Management services delivers appropriate, effective medical care with a timely return to work.
The Anthem Workers’ Compensation Difference
Workers’ Compensation PPO Networks
- Competitive, contracted rates through our proven PPO networks and actuarial analyses of medical cost trends.
- Full range of providers (primary treating physicians, occupational clinics, specialists, facilities) credentialed according to NCQA standards.
- Providers contracted to refer in-network and cooperate with Medical Management protocols.
- Provider Efficiency Program – provider profiling, outcomes management and predictive modeling.
- Web-based tools – provider finder, customizable directories, customizable MPN.
- Toll-free Customer Service with dedicated Workers’ Compensation experts.
Bill Review/Service Bureau
- Scanned or paper bills accepted.
- State-of-the-art software enables pricing to all state fee schedules or U&C database.
- Ability to negotiate non-network/non-fee schedule provider bills.
- Electronic submission of EORs and processed bills to customer claim systems via secured FTP process.
Electronic PPO Repricing
- Customer completes initial pricing to state fee schedule or U&C database and submits bill for PPO pricing.
- All bills go to Anthem Workers’ Compensation to maximize PPO penetration.
- Supports fully secure, encrypted ANSI Standard 837-file submission.
- Allows pre- and post-edits to ensure a clean bill the first time. No lost or pended bills.
- Includes application of any lesser of PPO and fee schedule language per provider contracts.
- Supports request for re-evaluation when PPO rate is at issue.
Medical Management Services
- URAC-accredited Utilization Review for Workers’ Compensation.
- Telephonic Case Management (TCM). Services include a traditional approach until return to work is achieved or interventional case management.
- Based on nationally accepted, evidence-based guidelines, including American College of Occupational and Environmental Medicine (ACOEM), McKesson Interqual Criteria, WellPoint medical policy and technology, ODG and Pressley Reed Medical Disability Guidelines.
- Proprietary, specialty-matched physician advisory panel.
- Web-based tools support customer online Medical Management services.
Anthem Workers’ Compensation –
Workers’ Compensation Experts
- Full-time staff of Workers’ Compensation professionals, including a National Medical Director, registered nurses and certified Workers’ Compensation bill review specialists.
- Proprietary physician advisory panel.
Anthem Workers’ Compensation
We speak the language. We understand the marketplace.
877.232.8440 • www.anthemwc.com
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