Pub. 3 2021 Issue 3

M embers of the NHADA Workers’ Compensation Trust are privileged to be part of the Windham Group Managed Care Program. Being part of this network gives injured workers access to the best occupational health providers and specialists in New Hampshire. In personal medical circumstances, you may wait days or weeks to get in to see a specialist; but with participation in our managed care program, injured workers in most cases can be seen the same day by an occupational health provider or specialist. When an employee is hurt at work, we ask that you call us for assistance with a referral to an in-network provider. If the injury is a life-or-death emergency, you should always call 911 or seek treatment at your closest emergency room. During this call, we will gather the initial information on the nature of the injury so we can make the referral to the most appropriate provider. Sometimes, before we have had a chance to make medical provider suggestions to members, occasionally they want to send their injured worker to an out-of-network provider or to the ER because it’s convenient or they know someone who has been treated there before. Here is a review of the reasons we make the suggestions we do during this call: • Participants in the Windham Group Managed Care Program are required to treat within the managed care network. There are some exceptions to this rule; if an injured worker has been treated for the same or similar condition in the past six months, they may see that provider. If the specialty that is needed is not available in the network, they may see an out-of- network provider that offers that specialty. If an injured worker chooses to treat out of network, we will put them on notice, and their bills with the out-of-network provider may not be covered by workers comp. • Providers that are in the network offer the highest level of specialty care for our injured workers. Treating with the appropriate provider from the start means working toward a resolution of the injury in a timelier WhyThis Provider and NotThat Provider: MANAGED CARE, SPECIALISTS, MEDICAL RECORDS, BILLING MARTA SILAKKA RN, BSN, CCM, COHN-S NHADA WCT NURSE CASE MANAGER D R I V E 12