Actief Case Management, Inc. is a nurse consulting/case management
company. We specialize in Workers’ Compensation but will
consider other consulting requests. Nurse consultants review
treatment plans, then coordinate and facilitate authorized care,
thereby making the claims process easier for all participants.
Some of the ways in which we can direct questions, initiate
tasks or approach problems are:
Meet with the claimant. We can meet the claimant to take
a history, update status, discuss treatment goals and
identify any impediment to recovery.
Meet with the medical provider. We can meet the medical
provider to ask questions, update the claimant’s
status, clarify any request for treatment and obtain any
documents needed for utilization review.
Review complex files. We can help you get up to speed by providing a chronological
synopsis of treatment to date, locating missing diagnostic
reports and identifying the proposed treatment plan of
all medical providers on the claim.
||Single event consult-surgery.
We can assist with locating and obtaining services, i.e.
home health, DME and transportation, before and after the
surgical event. The nurse can maintain contact with the
patient and family during the immediate pre and post operative
phase. The nurse can coordinate authorized services for
the patient and family. Claims mangers have found this service
especially useful over weekend and holiday events when they
might not be available.
||Single event consult-specialty
appointment. We can review records for completeness, order
and legibility prior to sending medical data to the specialty
physician (QME, IME, AME) for review. The nurse can determine
which diagnostic tests should be included pertaining to
that specialty provider. A completed referral package will
prevent a delay in the medical opinion while additional
records are sought.
||On-site field case management.
These are assignments that are anticipated to extend beyond
a few visits. The nurse can meet the claimant with the medical
provider to update status, discuss treatment options, obtain
work status and documents necessary to facilitate precertification,
contact the employer to update and discuss work restrictions,
facilitate care and follow up to confirm adherence to the
treatment plan. Claims managers are updated within 24-48
hours of a field visit. Our nurses are encouraged to close
files as soon as consultation is no longer needed.
||Telephonic Case Management.
Actief Case Management, Inc. nurses can provide case management
monitoring and coordination of services telephonically if
on-site consulting is not desired.
||Bill review and utilization review; we currently
outsource these services and will refer you to established
competent providers as a courtesy at no charge.
We enjoy creative problem solving and our services are not
limited to the tasks described above. For example, if you need
to locate a specialist and secure an appointment, we will be
happy to research options for your claimant. Whenever you need
medical resources or additional clinical information please
feel free to give us a call.