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Partner. It’s more than a part of our name. It’s how we do business.


It all started with a simple idea... Partner with employers, the medical community and payers to get injured employees the best possible care in the shortest amount of time. It’s the right thing to do. Doing these things gets injured employees back to work sooner. Turns out it also saves money for employers and payers. CompPartners’ portfolio of services is based on this simple yet powerful philosophy. We have proven it works time and time again since our company was founded in 1998. We have established a solid reputation for excellent service and quality results. Our services provide customers with peace of mind and lower overall costs. It’s quality you can measure. Now CompPartners has expanded beyond workers’ compensation into group health and other insurance services all with the same goal: Excellent service to our customers and to their customers. With CompPartners, partner is more than just a part of our name. It’s how we do business.


NETWORK MANAGEMENT SOLUTIONS The CompPartners approach to network management reduces costs, ensures the timely return to work of injured employees, and reduces litigation. How do we do it? We create strategic partnerships with clients like you who are committed to return to work and with the medical community. These two elements are critical to successful claim outcomes. We get everyone focused on returning to work, expedited delivery of medical services and quality care. It’s all about partnership. We work with you to design a custom network and offer a conscientious approach to managing workers’ compensation injuries.

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We start by partnering with the medical community. Studies show medical professionals who specialize in occupational medicine have the greatest success treating work-related injuries. Physicians and specialists who are experienced in treating occupational injuries understand the importance of expediting appropriate care. They also understand the need for communication and setting attainable goals. We have contractual relationships with leading national networks. Having access to the best physicians and allied professionals in the country allows us to customize a network solution that fits your specific needs. The bottom line is that experience translates to lower costs, higher return-to-work rates, satisfied employees and less litigation.

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Next, we partner with our employers. Customers who are committed to early return to work

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Finally, we partner with payors to design unique network solutions.

reduce the overall costs of work-related injuries. We get everyone focused on the same common goals. How? By streamlining communication and offering rapid and succinct communication with all stakeholders.

Through a complete array of leading national networks, physicians and specialists experienced in occupational injury and illnesses are available to you and your injured employees. We work with you to design a customized network based on our exclusive network management model. Ours is the most effective network management approach available in the industry. Why? Because we focus on careful selection of network providers specifically for your business. Our exclusive network management model was developed expressly for workers’ compensation with a keen focus on expediting delivery of medical services to injured employees. Our model accelerates the communication process, helps gain prompt access to medical treatment for injured employees and allows efficient claims handling for claims administrators.

Network solutions available:

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Medical Provider Network MPN-California) Health Care Organization (HCO-California) certified since 1998 Health Care Network (HCN-Texas) An Array of National Network Contracts Pharmacy PPO Network with access to over 50,000 pharmacies nationwide


UTILIZATION REVIEW When it comes to Utilization Review, CompPartners has learned that our customers are most concerned about: timeliness, cost savings, communication and quality. Our UR service integrates the clinical experience of our highly qualified nursing staff plus URAC-certified Peer Review. Our UR service addresses medical necessity and appropriateness of treatment by delivering timely review and recommendations for treatment. What can you expect from CompPartners utilization review?

Timeliness. In many states, UR timeframes are mandated by state regulations. CompPartners has developed a system to ensure that every review is completed timely and follows state mandates.

Cost Savings. The UR process helps achieve cost savings, while ensuring that injured employees receive appropriate medical care.

Communication. Our process includes communication tools to relay timely communication to all parties i.e. adjusters, providers, treating facilities, and injured employees.

Experienced Nursing Staff. Our highly qualified team of registered nurses receives ongoingtraining and continuing education on compliance and regulatory changes.

Medical Director Oversight. Medical Director oversight and training of UR services ensures that accurate decisions are made based on evidence-based medicine and appropriate guideline application.

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The Utilization Review program addresses medical necessity and appropriateness of treatment for: • Prospective Review • Concurrent Review • Retrospective Review • Second Opinion Review

Utilization Review services are used when you need to take a “snapshot” of a particular aspect of a claim to ensure everything is on track. For example, a review is done on a requested medical intervention, looking at appropriateness of treatment based on evidence-based medical guidelines.


PHYSICIAN PEER REVIEW CompPartners offers unbiased, independent peer review services utilizing a standardized process and an aggressive quality assurance program. As a URAC-accredited Independent Review Organization, CompPartners enjoys business relationships with some of the most prestigious insurance carriers, self insured employers, and third party administrators in the country. Our peer review program maintains excellent quality standards in the areas of timeliness of reports, satisfaction, and appeals overturn rates. What can you expect from CompPartners Peer Review? • National network including hundreds of medical specialists and allied professionals representing essentially every medical specialty. • Timely, accurate recommendations • Specialty-matched reviews within 48 hours • Determinations and recommendation supported by evidence based medicine • Defensible reports that meet URAC standards • Superior communication and customer service • Compliance with state regulations

CompPartners physician peer review services includes the following: • • • • •

Workers’ Compensation STD/LTD Medical/Legal Opinions Group Health Auto Liability

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ACCREDITED INDEPENDENT REVIEW ORGANIZATION


MEDICAL CASE MANAGEMENT CompPartners takes a different approach to case management. In the best interest of our customers, we provide medical case management services only in cases where we feel we can truly impact the outcome of the claim. Our nurses have the expertise to identify the most appropriate intervention, deliver the best outcome and provide faster return to work. What can you expect from CompPartners Case Management? • Return to work is addressed from the beginning of the claim • Case management only on the claims we can dramatically impact or per your request • Our nurses are patient advocates, ensuring appropriate care and timely treatment • Nurses use evidence-based guidelines to identify appropriate treatment as well as disability durations • Nurses streamline the communication process, communicating to all interested parties (claims administrator, treating physician, employer, injured employee) • Nurses have access to our Peer Review network for determining appropriate treatments • Return to Work is coordinated for your injured employees by our skilled team of professional case managers • Experienced nursing staff — our highly qualified team of registered nurses receives ongoing training and continuing education on compliance and regulatory changes • Increased employee satisfaction • Reduced litigation • Our system warehouses a job bank of all modified duties available with the employer • Case Managers coordinate the successful return to full or modified duty by acting as an intermediary between the treating physician, the appropriate employer representative, and the injured worker • Bi-lingual capability

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Case Management services are used when you need management of treatment, expedited delivery of medical services and premium quality care for injured employees.


INTEGRATED MEDICAL MANAGEMENT CompPartners offers a comprehensive solution for all your workers’ comp needs. From prioritizing claims from the onset of injury to payment resolution to getting employees back to work, CompPartners is with you every step of the way. A completely integrated medical management system helps you understand your risks and allows you stay ahead of the curve when it comes to controlling your workers’ comp costs. This program is tailored to your specific business and maximizes your ability to control claims costs.

Services include:

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First Notice of Injury Claim prioritization / referral management Custom network solution designed especially for your business Network management services Comprehensive medical management services focusing on Return to Work Telephonic case management services Utilization review services Physician peer review services Medical bill review services

What can you expect from the CompPartners Integrated Medical Management service system?

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More control over your program Less administrative burden and related costs Lower overall claims costs Expedited Return to Work for your injured employees Proactive communication with all stakeholders Regulatory compliance Improved employer-employee relations

CUSTOM NETWORK SOLUTION PHYSICIAN PEER REVIEW

MEDICAL BILL REVIEW

UTILIZATION REVIEW FNOI MEDICAL CASE MANAGEMENT

Integrated Medical Management Solves Your “Return To Work Puzzle”


MEDICARE SECONDARY PAYER ACT CompPartners’ new CompProjections division offers a comprehensive suite of products designed to support compliance with Medicare’s Secondary Payer Act in case settlements and projection of future medical costs for worker’s compensation claims, including Medicare Set-Aside Analyses, Future Medical Cost Projections, and Drug Utilization Reviews. Medicare’s ever changing demands can cause confusion and uncertainty in claims settlements, thus it is imperative that you entrust a well-qualified company with the task of handling your Medicare needs. CompProjections provides a complete range of services to make certain that both Medicare and the Employer/Insurer’s best interests are considered.

Our services include:

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Medicare and Social Security Disability Eligibility Verification Medicare Set-Aside Analysis Report (MSA) Submission of Medicare Set-Aside to CMS for Approval Future Medical Cost Projections (FMCP) Physician Peer Review/Drug Utilization Review

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What can you expect from CompProjections’ Medicare Set-Aside Analysis and Future Medical Cost Projection services?

• Unsurpassed Customer Service Discussion of MSA referrals with knowledgeable staff able to assist you in determining what is needed in terms of services and documentation in each case

• Exceptionally fast turnaround times MSAs completed and returned to you within 10 working days; expedited MSAs, within 3 to 4 working days

• Thorough, organized, carefully researched reports Clear and concise information presented consistent with CMS requirements and defensible medical cost projections utilizing fee schedules and CMS historical determinations

• Customized services according to your particular requirements MSAs, FMCPs, and DURs designed according to your company’s specific needs

• Electronic or Paper-based medical records collection Acceptance of required medical record and payout history documents electronically via email/FTP or onsite retrieval and copying by one of our knowledgeable staff

CompProjections is dedicated to providing the necessary evaluations and reports to assist in the effective resolution of all claims. And while Medicare Set-Asides have primarily been utilized to resolve Worker’s Compensation claims, many payers are now beginning to utilize them for Liability claims as well.


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