ClaimsCLEAR®
“Scientific solutions for complex situations.”
The ClaimsCLEAR® program untangles complex or post-award cases with significant medicals, long-term narcotic use, unending pain management, multiple prescription drugs and complex medical facts. The primary objective of ClaimsCLEAR® is to lower your future medical costs by applying the latest scientific-based medical evidence.
OMCA provides ClaimsCLEAR® services to carriers, third-party administrators and self-funded employers. These programs are also effective for excess/reinsurance carriers and prior to the offering of buyouts, MSAs or loss portfolio transfers.
Complex Case Review Nurse reviewers provide a written review of the medical history and current treatment plan. Issues of concern are identified, and recommendations are provided to assist in the medical management of the claim. Optional services include referral to a ClaimsCLEAR© physician advisor, or intensive nurse case management.
Physician advisors provide a written review of medical care and treatment recommendations based on national evidence-based guidelines. The ClaimsCLEAR® physicians will make supportable recommendations to improve outcomes while reducing unnecessary costs to the payor.
Peer-to-Peer The best way to modify ineffective treatment plans and ultimately control medical costs is to have the provider voluntarily change his/her pattern of treatment. Whether it be prescription drugs, extended pain management or unnecessary surgeries, providers can and do change their minds.
Often it is helpful for our physician advisor to contact the treating provider directly. These conversations can be very productive and can result in a change in the treating provider’s reatment protocols.
Early Intervention FirstCLEAR is a scientific, evidence-based medicine program designed to provide early identification of claims, which if left unchecked, will become catastrophic. Virtually all catastrophic claims have points throughout their continuum that present opportunities to dramatically improve the outcome of the case.
The easily understood FirstCLEAR matrix helps identify those claims. FirstCLEAR nurse case managers and physician advisors then intervene with adjusters and treating providers to maximize the likelihood of improved outcomes and minimize the likelihood of the runaway,catastrophic case.
For more information about Workers’ Compensation services, contact OMCA at (800) 633-5960 or info@omca.biz.
