Pub. 3 2021 Issue 3

manner. The medical care of the injured worker is our highest priority. If an injury is to the eye, an eye doctor is the best place to start. If the injury is orthopedic, then starting out with an orthopedic doctor may be appropriate. For most occupational injuries starting out with an occupational specialist is the best first step, and the network has these throughout the state, offering same-day appointments. • Much of the management of a claim depends on the gathering of information. We gather information through interviews with the injured worker, the employer and witnesses. Probably one of the most important pieces of information we gather is from medical records. Medical providers are required to submit their medical records in a timely fashion when treating an injured worker. Network providers understand the need to do so, whereas some providers do not abide by these rules. If we do not have the medical records needed to review a claim, it can lead to a claim being denied pending their receipt. These delays can waste valuable time — treating with network providers helps us ensure we will get the information we need. • Another vital part of claims management is the billing for medical treatment. As the bills for medical treatment of the injured worker are received, they are reviewed along with the medical records and either processed for payment or denied. In-network providers understand the need to submit billing and documentation timely. Unfortunately, some providers will either not submit their billing in a timely fashion, or when they do submit it, they fail to attach the required medical records. These steps all delay the process and keep claims open much longer than after the last treatment date. • Preferred providers often offer a discount on their billing. The best medical care is a priority but containing costs is a close second. • A common misconception in medical care is that the ER is the best place to seek medical treatment for any injury. The ER is the best place to treat “emergencies,”; which means life-threatening injuries or illnesses. Presenting to an ER with non-life-threatening injuries can delay care for others that may need it. It can clog up an ER; and delay the care for your injured worker. Time away from work to treat an injury can be significantly longer when treatment is sought at an ER. Typically, a co-worker may drive the injured worker to the ER and wait with them while they get treatment; now, you have two employees missing time from work. • ER treatment is costly. If it’s necessary, then it’s worth it; but if someone presents to the ER for a non-life- threatening reason, the cost is not justified. A simple laceration repair at an occupational medicine clinic may run approximately $300-$500. The same repair at an ER could run upward of $3,000. This is not money or time well spent. Remember to always give us a call prior to sending the injured worker for medical care when it is not life- threatening; we will assist you with the most appropriate specialty referral. Although the clinic or ER might be right next door, it doesn’t always mean it is the best choice. If you have any questions on our managed care program, or if a specific provider is in the network, please contact Marta Silakka at 603-224-2369 or via email at msilakka@nhada.com . N E W H A M P S H I R E 13