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Managed Care Services

Extend your care management expertise with our network of medical professionals

Sometimes you can’t be sure the specific medical care recommended or already provided to an injured worker is appropriate and necessary. That’s why there’s the Mitchell Utilization Review Services—for those times when you need additional expert decision-making help at your side.

Our medical professionals work closely with healthcare providers to determine the appropriateness and quality of requested medical care. They carefully examine each service, reviewing whether the diagnostic tests, treatments, or medications are supported by established evidence-based criteria—and provided at the right time at the best possible cost and outcome for each injured worker.

In addition, our services are supported by enriched analytical software so that our medical service professionals can keep you up-to-date on the services that are approved or recommended for denial or modification. This continuous knowledge share is a better way for you to manage the care for improved outcomes.

Some clerical functions of the Mitchell International, Inc. URAC-accredited workers' compensation utilization management program are being performed at an offshore location. 

Services include:

  • Prospective, Concurrent and Retrospective Review to optimize treatment at any stage of a claim
  • Compliance assistance with individually mandated state and URAC guidelines and timetables
  • State reporting of Utilization Review Services where required
  • Through integration with SmartAdvisor™UR Decision Manager, UR decisions are automatically enforced in the SmartAdvisor bill review system, improving the investment made in utilization review

Depending on the situation, our professionally licensed utilization review staff can perform any or all of the following services where allowed or mandated by state laws:

Adjuster Authorization

This subset of UR is based on your predetermined list of services. It is primarily handled by support staff with nurse consultation if needed. A determination letter is sent and data is captured for auditing purposes.

First Level

This is a pre-certification of treatment not requiring physician review. The review is completed by a licensed health care professional, who evaluates the requested service and all submitted documentation. The licensed professional may certify requests or forward the request to Second Level-Physician Review.

Second Level Physician Review

Utilized in conjunction with First Level UR when treatment is not within guidelines, or a higher level of review is needed by a physician.


Case Management

Managing an injured worker’s timely rehabilitation and return to work is a team effort. Mitchell Case Management is a critical component in the success of any return-to-work program. The qualified medical professionals of our Case Management Services team act as patient advocates, and help protect the interests of all parties by coordinating the efforts of healthcare providers, insurance adjusters, the employer, and the injured worker.

Case managers:

  • Assure medically appropriate care is given
  • Injured workers are properly motivated to work on their recovery and return safely to the job
  • Costs are effectively managed to facilitate treatment plans
  • Provide clear communications with the worker in an effort to avoid litigation

Mitchell Case Management Solution helps you:

  • Maintain documentation of scheduled contact with each injured worker, promoting a timely return to work
  • Detect an injured worker who may be exhibiting destructive or fraudulent behavior patterns
  • Evaluate the appropriateness of treatment provided by physicians
  • Assess the progress of the injured worker and notify the insurance adjuster, employer and healthcare providers of any barriers that might impede a timely return to work
  • Defend your decisions with evidence-based, nationally recognized criteria that comply with regulatory standards of care
  • Reduce claims costs by assuring physicians provide appropriate medical care for the industrial injury

Pharmacy Intervention

Opiate addiction, particularly in the arena of Workers’ Compensation, is costly and dangerous. Mitchell Pharmacy Intervention extends our Managed Care capabilities to cover this fast-growing healthcare threat:

  • Nurses work directly with primary treating physicians and patients to establish weaning programs, drug testing, goal setting, and any clinical medical necessity.
  • Our proven methodology has shown a measurable decrease in opiate dependency and an overall savings in medical costs

Field Case Management

Mitchell Field Case Management extends your claim management expertise to face-to-face meetings with claimants at designated medical events ranging from doctor visits to surgeries, treatments, and home visits.

Nurse case managers:

  • Act as liaisons to expedite proper diagnosis, treatment and return-to-work
  • Assist to move treatment plans in malingering patients
  • Provide full patient and family support in critical injury cases

Clients who have adopted Field Case Management have seen a simplified solutions for their adjusters and significant overall cost savings from a single vendor partner who:

  • Oversees field case management activities, billing practices, and documentation standards
  • Provides integration with UR, claim notes, and billing, among others

Press

Mitchell Adds New Medical Bill Review Tools With SmartAdvisor™ 7.0

Solution delivers increased compliance, cost containment, connectivity, and ease-of-use to workers’ comp claim processes

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Articles

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If you need a reason to adopt email in your marketing program.

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Webinars

Senate Bill 863 Webinar

Senate Bill No. 863 was lauded as a major reform of California’s $16 billion Workers’ Compensation system. In this sho...

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