The Managed Care Program NHADA WCT utilizes is Windham Group Work Injury Network (WIN). WIN provides us with a network of specialized doctors and health care providers. These providers are considered the best in New Hampshire in their fields of expertise. As part of a Managed Care program, the injured worker must be treated within the Managed Care network. There are exceptions to this, as stated by the Department of Labor in the Labor Regulation LAB 700. An example would be if someone has been treated for the same or similar condition within the last six months. In that case, if their physician was not in the network, they could choose to continue to be treated by that physician. Other exceptions can be discussed directly with the NHADA WCT nurse case manager. Using the Managed Care network of providers allows the injured worker to access medical care with a specialist right away, as opposed to personal medical issues, where, in most cases, they must first be seen by their primary care provider to obtain a referral. This is a great benefit and provides the injured worker with medical care specific to their injury as quickly as possible. If an injured worker refuses to be treated within the Managed Care network, they may be responsible for paying their medical bills. Employees and NHADA WCT members must remember to call the NHADA WCT nurse case manager, Marta Silakka, immediately after an injury occurs so that she can help the employee choose the best network provider based on the injury. When injured workers are aware of Managed Care and the workers’ compensation process, they can have their injuries promptly treated with the most appropriate specialty provider, which results in faster healing and prompt return to work and normal activities. Marta Silakka can be reached at (603) 224-2369 or msilakka@nhada.com. Scan this QR code for the Managed Care trifold. https://4829685.fs1.hubspotusercontent-na1.net/ hubfs/4829685/managed%20care%20trifold.pdf Scan this QR code for the Managed Care poster. https://4829685.fs1.hubspotusercontent-na1.net/ hubfs/4829685/Managed%20Care%20Poster.pdf Scan this QR code for a sample letter to send to your employees. https://4829685.fs1.hubspotusercontent-na1.net/ hubfs/4829685/XYZ%20MC%20ee%20ack%20letter.doc.rtf As part of the NHADA Workers’ Compensation Trust (NHADA WCT), you are part of our mandatory Managed Care program. In New Hampshire, Managed Care has been proven to help control workers’ compensation costs. Reducing this cost helps lower the premium employers pay for workers’ compensation coverage, and for NHADA WCT members, it increases the money available for rebates. The time to find out you are a participant in Managed Care is not the date of injury. Employees need to be trained in advance of an injury so that they know they are participants in a formal Managed Care program and they need to know what to do when an injury occurs. Employees must be provided with the NHADA Managed Care trifold at the time of hire and the NHADA Managed Care poster should be posted in clear view of all employees. Workplace injuries must be handled differently from personal health conditions. The employees’ primary care physician is there to treat non-work-related conditions. Our Managed Care network physicians understand the importance of prompt treatment and prompt referrals to specialty providers to maximize healing and resumption of activities in and out of work. Emergency rooms must be reserved for life-threatening injuries; most injuries can be treated at urgent care centers such as Convenient MD, and if necessary, they will refer to the emergency room or a higher level of specialty. A call to our nurse case manager, Marta Silakka, immediately after an injury occurs is the best way to begin the workers’ compensation process. A common misconception in medical care is that the emergency room is the best place to seek medical treatment for any type of injury. The emergency room is the best place to treat “emergencies,” which means life-threatening injuries or illnesses. Presenting to an emergency room with non-life-threatening injuries can delay care for others who may need it. It can clog up an emergency room 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 emergency room. It may take much longer to get the medical records to determine if the claim is compensable; therefore, we may deny the claim until we receive the medical records. Treatment at emergency rooms is costly compared to that at an occupational medicine clinic. It also takes months, if not longer, to receive the billing, which means claims stay open longer. DO YOUR EMPLOYEES KNOW ABOUT MANAGED CARE? BY MARTA SILAKKA NURSE CASE MANAGER, NHADA WCT 16
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