Workers’ Compensation TPA Services

The National Council on Compensation Insurance Inc. (NCCI) reports that medical services now represent 60 percent of workers’ compensation claim costs. In the past, indemnity costs made up the biggest part of the workers’ compensation claim. From provider networks to medical audits, there are a number of measures available to help companies contain costs. UPMC WorkPartners provides comprehensive services to employers looking to control costs associated with workers’ compensation claims.

UPMC WorkPartners is a licensed third party administrator in Pennsylvania. We have been providing workers’ compensation third party administrator (TPA) services to public and private clients of all sizes since 1997. We employ experienced claims adjustors, nurse case managers, physicians, vocational rehabilitation counselors, and safety personnel to reduce costs and effectively manage claims for our clients. We have developed strong client partnerships with a proven track record of success in these areas and have maintained a 100 percent client retention rate since our founding. Our commitment to program management incorporates the “best practices” used in the adjudication of occupational injury and illness claims.

Workers' Compensation

UPMC WorkPartners delivers not only expert third party administrative services but also a customizable medical delivery network designed to meet each client’s workers’ compensation needs, including:

  • Panel providers with expertise in occupational medicine who have access to UPMC’s world-class specialists
  • A comprehensive pharmacy network with the ability to create a customized formulary design
  • A rehabilitation network and MRI/specialty network with convenient locations, easy access, and significant cost savings
  • Aggressive claims management strategies that connect the employee with the right resources at the right time to safely return the employee to work

Our philosophy of complete program management as opposed to simple claims processing helps to effectively reduce claims, costs, and future liabilities. Our focus on return to work and the creation of a safe work environment has led to reductions in time away from work that positively improve productivity. In addition, we offer discounts below the Pennsylvania Fee Schedule for a variety of medical services.

As your workers’ compensation third party administrator, UPMC WorkPartners offers:

  1. Complete program management — We attribute our success to our complete program management philosophy and the high standards against which we measure our performance. On every claim, our adjusters and nurse case managers focus on strong medical case management, reliable and thorough claims management, and aggressive return-to-work strategies.
  2. Creative cost-containment strategies — Our imaging, physical therapy, pharmacy, rehabilitation services, and other provider networks form a comprehensive, statewide medical delivery system to complement our internal team. We integrate cost-containment strategies and statewide panel providers to meet program needs and deliver quality care with preferential pricing. These extensive medical delivery services are offered below the Pennsylvania Fee Schedule to provide additional cost savings.
  3. Safety management and risk control services and injury prevention — The best way to effectively manage workers’ compensation costs is to prevent injuries. We partner with our clients to analyze injury trends, injury types, and accident causes. We identify key cost drivers and provide strategic data to develop and enhance an effective safety and loss prevention program.
  4. Experienced team of adjusters — Our UPMC WorkPartners staff includes experienced in-house claims and medical professionals who deliver a consistent and aggressive approach to workers’ compensation claims. With an average case load below required maximums, our expertise is put to work analyzing, assessing, investigating, and managing claims to bring them to closure.
  5. Dedicated medical case management — Our model for medical case management follows several medically driven principles: a focus on restoring wellness and a safe return to work; the use of meaningful and objective performance measures; and effective management of restrictions. Our adjusters are supported by a dedicated medical staff of physicians and nurse case managers with extensive workers’ compensation experience.
  6. Escalated case review — We quickly escalate complex cases to our physicians, enhancing our ability to positively impact case resolution. Our medical directors provide peer-to-peer interaction with employee physicians, identify cost-saving opportunities, and collaborate on customized program components and formularies to improve return-to-work timeframes.
  7. Performance measurement and analysis — Robust reporting enables us to measure our performance and deliver timely and relevant reporting to our clients. We have developed industry-leading data analytics to support our clients’ workers’ compensation cost-containment strategies and evaluate overall and specific program performance. We provide reports including loss runs, injury trending, adjuster performance, and other key measurements. We use industry best practice security technologies and the power of the world’s leading independent risk management information system and claims management solution to process, manage, and analyze claims and track incidents.

Service Highlights

Claims Management:

  • Dedicated team of claims professionals averaging 20 years of experience
  • Investigation of all workers’ compensation claims
  • Medical bill evaluation
  • Payment and denial of workers’ compensation claims in accordance with state regulatory statutes
  • Coordination of loss adjustment services
    • Surveillance
    • Medical case management
    • Vocational rehabilitation
    • Independent medical evaluation
    • Utilization review
    • Impairment rating evaluation
  • On-site educational services for your supervisors
  • MMSEA Section 111 reporting
  • Excess insurance reporting requirement

Medical Cost-Containment:

  • Comprehensive medical network
    • Provider networks
    • Physical therapy and rehabilitation networks
    • Imaging network
    • Discounts below fee schedule
  • Pharmacy benefit management and customized formulary
  • Nurse case management
    • Assistance with on-boarding and pre-employment process
    • Support of workplace safety programs and health and wellness education
    • Effective management of occupational and non-occupational periods of disability
    • Proactive coordination and monitoring of the medical portion of a claim
    • Assistance in restoring employees to appropriate gainful employment
  • Escalated case review
    • In-house medical director with access to UPMC specialists

The UPMC WorkPartners’ claims team has an average of 25 plus years in the workers’ compensation industry, providing service to dedicated accounts and building client relationships to manage the claims process to comprehensively manage the claims process.

This website describes general services available from UPMC WorkPartners, and is not intended to provide employee benefits, tax, or legal advice. If you have questions regarding any of the integrated health and productivity solutions described on this site, UPMC WorkPartners recommends that you consult with your benefits, tax, and/or legal advisors.

Copyright 2017.

UPMC WorkPartners

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