Specialized Management Services

Carolina Case Management has spent almost 20 years building relationships with its clients and staff as well as expanding its portfolio. Our capabilities are among the most varied and skilled in the industry. In addition to standard medical case management, CCM proudly offers many unique and customized services to meet the needs of a broad range of situations:

Long & Short Term Disability

Intervening as early as possible, the case manager contacts the disabled worker, the healthcare provider and the employer to define the disabling condition, coordinate medical care and assist the employee in the recovery and return to work or re-employment process. Medical and vocational case management skills are utilized to facilitate appropriate care and evaluate return to work activities.

Medicare Set-Aside Allocation(MSA)

A Medicare Set-Aside Allocation is an agreement that takes place at claim settlement for “qualified” individuals. It prevents the shifting burden for future injury-related medical expenses from the insurance carrier, or responsible party, to Medicare. CCM has certified professionals that can assist you with this complex and challenging issue.

  • What is needed to get started?smsinternal
  • Initial Notice of Injury
  • Medical records regarding initial treatment following injury
  • Health Care provider’s consults and office notes
  • Independent Medical Exams (IMEs)
  • Complete hospital records
  • Maximum Medical Improvement (MMI) and percentage of impairment documents
  • Center for Medicare and Medicaid Services (CMS) or Social Security
  • Documentation
  • Medical portion of the claim’s payment history (specifically the past 3—5 years and should reflect payment dates and names of providers)
  • Medication/DME listing (listing should reflect type, amount and cost)
  • Current health care provider’s medical report

Life Care Planning (LCP)

Life Care Planning includes the methodology utilized to project the future care needs of a disabled person and the costs associated with both the medical and non-medical needs over the projected term of disability. This is usually one’s statistical lifetime. The Life Care Plan is the document that is created which sets forth these needs and the costs to provide for them. CCM has certified professionals that can assist you with this service.

Medical Bill Review / Audits

Carolina Case Management, through strategic partnerships specializing in medical cost containment, offers medical bill review and repricing solutions for workers’ compensation insurers, self-insured employers and third party administrators. Our goal is to increase savings by reducing bills to state fee schedule, access the best PPO networks for further savings, audit bills for appropriate and/or duplicate charges, speed up bill review turnaround time and reduce lost bills. We can create an electronic data interface with your claims system to save time and money.

Pharmacy Management and Prescription Services

Carolina Case Management, through strategic partnerships specializing in medical cost containment, offers pharmacy management and prescription services which include online pharmacy administration, enrollment cards, no out-of-pocket expenses for injured workers, drug utilization review, cost effective formularies, screening for prescriptions within the scope of the injury and by physician and enhanced reporting.

National Network

Local Service on a National Level… By establishing strategic alliances with privately owned rehabilitation companies possessing compatible philosophies and quality assurance standards, the National Network is capable of offering consistency of service and results throughout the United States. We believe that utilization of this approach is superior to that of national firms. Through the National Network, customers can now utilize the”local” companies known for excellent, personalized service.

The selection of network members is based on a variety of factors. Selection characteristics include geographical coverage, compatible approach to doing business, commitment to customer service and recognized leadership. Ideally, our network is comprised of the “best of the best.”

Customized Services

In addition to the standard services described herein, CCM will make every effort to accommodate individual needs through customized services. We work with you to define, develop and implement these custom services.

Examples include:

  • Electronic invoicing and reporting
  • Customer specific account handling guidelines
  • Injury reporting assistance
  • Continuing education courses