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.