Aggressive claims management focuses
on
getting workers back to work, controlling costs
SFM's claims management and cost-control services reduce the costs of claims significantly. They help control employers' workers' compensation premiums.
Employers receive these services with their SFM package of coverage and services; no need to buy duplicative services elsewhere.
Our knowledgeable claims staff specializes in serving Minnesota, Wisconsin and South Dakota employers. They are experienced in each state's workers' comp laws.
They work within teams specializing in specific employer groups. For employers and injured employees, that means responsive attention and effective services.
Claims specialists are available by phone, fax and email. They return all calls within one business day or less.
Medical issues generally arise from three places:
At SFM, these medical issues are managed by teams
The claims representative drives the process. The issues are managed at different layers depending on what's needed.
Available to bring in to help manage a claim through to resolution are in-house nurses, in-house consulting physicians, and in-house attorneys along with the treating physician, the employer and, when necessary, the agent.
The 80-20 rule applies: Roughly 20 percent of cases account for roughly 80 percent of overall costs because they involve significant employee or treatment problems. The most intensive team management efforts generally go into those cases so they are resolved expeditiously and costs are minimized.
Medical case managers
SFM's in-house nurses and occupational therapists work directly with all injured employees who are facing long-term treatment or have already missed two weeks' work. The nurse is a liaison between the injured employee, the employer and the medical provider, working to keep treatment on track and safely return the employee to health and productivity.
- SFM's medical case managers produce substantial "hard" savings through early return-to-work--dollar amounts that SFM is happy to share with the policyholder. They also produce uncalculated "soft" savings by influencing changes to more effective or less costly medical treatments.
Physician advisors
SFM's in-house consulting physicians provide another level of medical management. In certain cases, they review the treating physician's assessment and treatment plan: Is the injury work-related? Is the treatment reasonable and necessary? Is the proposed diagnostic testing and surgery appropriate? Are disability ratings accurate? This level of work comp physician expertise oftentimes produces better care.
- It also produces impressive savings, both hard and soft. For instance, more accurate disability ratings alone save hundreds per case. Substantial other savings come throughout the course of care.
Provider networks
A way to raise the quality of care and lower its cost. SFM's arrangement with the CorVel preferred provider organization offers policyholders a PPO network through which they can receive medical care at discounted rates from providers who've met standards of quality. SFM's arrangement with ExpressScripts offers access to a wide network of pharmacies that fill prescriptions at discounted prices.
- More than half of prescriptions are being discounted through the ExpressScripts network.
Certified Managed Care
SFM partners with CorVel Corporation to provide managed care services to its South Dakota employers. Since 1993, workers' compensation insurers in South Dakota are required to provide managed care services through a certified organization.
Medical bill review
SFM's primary, secondary and tertiary levels of bill review ensure that providers are paid fairly--no more, no less.
It's a thorough, highly cost-effective system that applies state laws effectively and reviews from the first dollar billed. It produces results across the board: from applying state fee schedule limits to correcting billing oversights to applying bill reductions to providers outside Minnesota and Wisconsin.
- Medical bill review this year has produced impressive savings of nearly 30 percent off billed amounts.
Specialized in-house attorneys
Carefully investigated claims means we're litigating the right issues. Our subrogation recoveries from third-party liability in claims reached record highs over the past few years.
Zero tolerance for fraud
Dedicated staff actively pursues offenders and seeks criminal prosecution, with the goal of recovering financial loss and deterring future fraud.
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