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Healthcare Solutions' specialty services program is not just about delivering products at the lowest cost, it’s about providing the highest quality service and removing administrative burden from the process.  Our specialty networks provide ancillary healthcare services to injured patients in need of durable medical equipment and supplies, home healthcare, diagnostic imaging, physical medicine, transportation and language services. From catastrophic care coordination to home based delivery, Healthcare Solutions prospectively coordinates services and expedites access across the entire continuum of care while simplifying the administrative process.

Durable Medical Equipment (DME) and Supplies (back to top)

The Industry's First Technology-Enabled DME Formulary Program

Healthcare Solutions provides DME and medical supplies to injured patients through a nationwide network of credentialed providers to ensure ample coverage and price competitiveness in every geographic area. With an extensive product catalog (10,000+ suppliers with over 35,000 products), our DME and supplies program includes standard and specialty/custom orders, durable medical equipment (beds, commodes, walking aides), electrotherapy (TENS, muscle/bone stimulators), orthotics/prosthetics (braces, artificial limbs), medical supplies (wound care, hearing aids), and respiratory/IV (pain pump, enteral nutrition, oxygen, CPAP).

The typical five step process consists of:

  1. Referral Intake.  Healthcare Solutions’ dedicated DME and supplies unit is staffed to accept referrals/orders, contact appropriate vendors, place orders and answer and questions from the adjuster, case manager or patient. Options for submitting referrals include phone, fax, web and OrderTrax™, a desktop application that can be loaded on the adjuster/case manager’s computer to help expedite the order process. Ease of placing referrals/orders saves adjuster/case manager administrative time.
  2. Order Confirmation.  Online orders receive immediate email confirmation; phone and fax orders receive verbal confirmation.
  3. Order Processed.  Product is ordered same day and confirmation sent to adjuster or case manager to confirm order has been placed. The adjuster or case manager has access to check latest status of order(s) online through Sequoia™.  Every process step is documented and reported.
  4. Product Delivered.  All orders receive an additional communication when the products are delivered. Most orders (95%) are delivered to the patient within one business day of the order. This quick turnaround time helps decrease patient wait time for materials, enabling the DME/supplies to be used sooner and potentially increasing return to work.
  5. Receipt and Delivery of Report.  Contact is made with the adjuster or case manager within one day of delivery to confirm order receipt and service satisfaction.

The primary goals of Healthcare Solutions’ DME and supplies program are to provide the lowest net price products to injured patients in a timely manner; reduce administrative burden on adjusters and case managers placing orders; and, provide the lowest possible cost overall. Program benefits include:

  • Full visibility of DME and supplies rendered across entire book of business. Out-of-network bill re-pricing ensures bills are paid at fee schedule or at the usual and customary (U&C) rate for non-fee schedule items. This process provides clients complete visibility into the volume of services not being scheduled through Healthcare Solutions’ network.
  • Increased number of claims prospectively managed through in-network providers. Network utilization is maximized through soft channeling to specialty networks.
  • Application of consistent processes and preferred rates across higher volume of claims. Average savings is 20% -30% off of fee schedule or U&C rate. Stewardship reporting provides a forum to measure program successes, review key metrics and program accomplishments and identify new opportunities.

Contact a Healthcare Solutions representative to learn more about our Durable Medical Equipment (DME) and Medical Supplies.

 

 

Home Healthcare and Catastrophic Care Services (back to top)

Healthcare Solutions provides in-home skilled nursing, rehabilitation therapy, IV infusion therapy, wound care, injections, blood draws and non-medical nursing aids coordinated through our national network of home health service providers. Our home healthcare services are differentiated in the market by our staffing of registered nurses with experience in workers’ compensation and auto/PIP medical cases who are knowledgeable in various jurisdictional regulations for proper triage of patient care.  All ancillary services are coordinated with hospital discharge planners and case managers.

An interdisciplinary team of nurses and medical specialists coordinate with the payer’s adjusters and case managers to coordinate optimal care for the catastrophically injured.  Specialized catastrophic care coordination includes, but is not limited to neurological, spinal and closed head injuries; burn care; wound care; and, crushing injuries.   For catastrophic and medically complex cases where client nurse case managers (NCM) are assigned to coordinate the patient’s medical services, Healthcare Solutions offers clinical nursing resources who engage in peer-to-peer discussions regarding the patient’s care. 

The typical six step process consists of:

  1. Referral Intake.  Options for submitting referrals include phone, fax, web and OrderTrax™, a desktop application that can be loaded on the adjuster/nurse case manager’s computer to help expedite the order process. Incoming calls to unit are triaged according to specialty and experience. Coordination by Healthcare Solutions’ nurses provides clinical oversight for patient; provides for better explanation of status and treatment to assigned client adjuster/nurse case manager; and, prevents unnecessary therapy sessions saving client time and money.  Ease of placing referrals/orders with Healthcare Solutions saves adjuster/nurse case manager administrative time.
  2. Initial Contact.  Authorization is obtained from the client and services date and patient availability are confirmed.
  3. Appointment Scheduling.  Scheduling process begins within 2 hours of authorization. Home health nursing/therapy appointments are scheduled within 24 hours.
  4. Follow Up Patient Communications.  Client is notified of the appointment and is given the name of the home health provider. Interdisciplinary teams include case manager, pharmacists, therapists, physician groups and other health care providers.
  5. Reporting.  Ongoing monitoring and patient follow up. Progress notes are sent to the adjuster or nurse case manager weekly. Adjuster or nurse case manager has access to check latest status of patient care online through Sequoia™. Every process step is documented and reportable.
  6. Quality Check.  Client is called after service is complete for final quality check. Active process management assures adherence to ODG, ACOEM and other state mandated clinical guidelines.

Contact a Healthcare Solutions representative to learn more about our Home Healthcare and Catastrophic Care Services.

 

 

Diagnostic Imaging Services (back to top)

Healthcare Solutions’ proprietary network of free-standing diagnostic centers serve patients in need of medical imaging and other radiology procedures – offering exceptional quality in clinical services and imaging which are critical to determining the plan of care. Use of free-standing clinics allows us to pass the greatest savings and scheduling availability to our clients. In addition, all diagnostic centers meet rigorous standards and are American Academy of Radiology (ACR) credentialed with board certified specialists. The highly trained experts ensure an exceptional standard of patient focused care.

Healthcare Solutions’ diagnostic imaging services consist of magnetic resonance imaging (MRI or MR), computed tomography (CT Scan), ultrasound, X-ray, bone density, nuclear medicine, neurodiagnostic testing and functional capacity evaluations.  Each referral/order is handled by Healthcare Solutions’ diagnostic unit, with oversight by a team lead who ensures that every referral makes it through the process seamlessly and the right amount of attention is given to every patient, adjuster/case manager and clinic.

The typical five step process consists of:

  1. Referral intake.  Options for submitting referrals include phone, fax, web and OrderTrax™, a desktop application that can be loaded on the adjuster/case manager’s computer to help expedite the order process. Ease of placing referrals/orders saves adjuster/case manager administrative time. In-house clinical expertise allows Healthcare Solutions to manage appropriateness of exam request compared to diagnosis and chronisity of injury.
  2. Initial Patient Contact.  Confirms demographics and scheduling availability.
  3. Appointment Scheduling.  Appointments are scheduled with clinic within one day of authorization decreasing wait time for patient diagnosis. Geo-mapping is utilized to ensure appointment is made within close proximity of the patient. Healthcare Solutions coordinates transportation/translation services to complement the diagnostic/radiology referral when needed, eliminating another call for the referral source and easing administrative burden.
  4. Follow Up Patient Communications.  Injured worker is notified of appointment. Reminder calls are made prior to appointment. Imaging occurs within two business days from referral.  Adjuster or nurse case manager has access to check latest status of patient care online through Sequoia™. Every process step is documented and reportable.
  5. Receipt and Delivery of the Medical Report.  Follow up with clinic after appointment. Medical report is obtained from clinic and provided to the referral source within two business days of imaging completion. This quick turnaround time enables treatment to begin sooner, expediting maximum medical improvement, return to work and permanent and stationary status.

Healthcare Solutions offers best in class service guarantees for scheduling and receipt of comprehensive medical reports upon completion of the procedure.  Age of injury reports are available in addition to standard diagnostic reports. Our extensive network of diagnostic centers is well-positioned to accommodate all diagnostic imaging needs.

Contact a Healthcare Solutions representative to learn more about how you can leverage our premier Diagnostic Imaging Services.

 

 

Physical Medicine (back to top)

Healthcare Solutions’ physical medicine services consist of physical, occupational and speech therapy, as well as chiropractic services and functional capacity evaluations.  These services are provided on an outpatient (non-home) basis. Home based rehabilitation services are provided through Healthcare Solutions’ home healthcare service offering.  Healthcare Solutions’ transportation, translation and DME services are an ideal pairing with physical medicine services in order to ensure patients make outpatient appointments and receive necessary supplies (i.e., neck/leg braces) as part of the rehabilitation therapy process.
Physical, occupational and speech therapies strictly follow the ODG, ACOEM and other state regulatory guidelines for treatment. Adherence to active process management and clinical oversight minimizes palliative/passive modalities.

The typical six step process consists of:

  1. Referral Intake.  Options for submitting referrals include phone, fax, web and OrderTrax™, a desktop application that can be loaded on the adjuster/case manager’s computer to help expedite the order process. Ease of placing referrals/orders saves adjuster/case manager administrative time.
  2. Initial Patient Contact.  Introductory call to confirm services, date and availability.
  3. Appointment Scheduling.  Scheduling process begins within 2 hours of authorization and appointments are scheduled within 24 hours.
  4. Follow Up Patient Communication.  Patient is notified of appointment and reminder call is made prior to the appointment.
  5. Reporting.  Progress notes sent to the adjuster or case manager to ensure therapists are following appropriate treatment guidelines. Clinical oversight provides for better explanation of status and treatment.
  6. Quality Check.  Patient is called after service is completed for a final quality check in compliance with ODG and/or state specific guidelines.  If treatment is determined to be excessive, PT center documentation is requested to prove medical necessity.

Coordination of physical medicine and rehabilitation therapies by Healthcare Solutions not only provides clinical oversight for patients but also allows for better explanation of status and treatment to the adjuster/nurse case manager.  The result: avoidance of unnecessary therapy sessions that saves the client time and money.

Contact a Healthcare Solutions representative to learn more about our Physical Medicine/Rehabilitation Therapy Services.

 

 

Transportation and Language Services (back to top)

Healthcare Solutions offers non-emergency and emergency transportation services nationwide to ensure patients get to all injury-related appointments in a timely manner. Transportation services include cars, assisted ambulatory, wheelchair vans, stretcher vans, basic and advanced life support ambulances and airlift ambulance services. Long distance day or overnight trips are available. All transportation providers carry at least $5M auto liability coverage.

In conjunction with transportation, Healthcare Solutions offers translation and interpretation in over 250 languages and dialects via an extensive interpreter network as well as TTY phone translation. Interpreters and translators receive special training and certification in medical, technical and legal fields.

The typical six step process consists of:

  1. Referral Intake. Options for submitting referrals include phone, fax web and OrderTrax™, a desktop application that can be loaded on the adjuster/case manager’s computer to help expedite the order process. Ease of placing referrals/orders saves adjuster/case manager administrative time.
  2. Initial Patient Contact. Introductory call to confirm services, date and availability.
  3. Appointment Scheduling. Scheduling of appointment with provider within one day of authorization. Geo-mapping is utilized to ensure appointment is made within close proximity of the patient and to verify mileage from transportation providers.
  4. Follow Up Patient Communication. Patient is notified of appointment and reminder call is made prior to the appointment. Adjuster or case manager has access to check latest status of order online through Sequoia™. Every process step is documented and reportable.
  5. Confirmation Contact. Patient is called at time of pickup to confirm in process. 100% commitment to cover client expenses if IME (Independent Medical Exam), QME (Qualified Medical Exam) or AME (Agreed Upon Medical Exam) are missed due to Healthcare Solutions’ delay.
  6. Quality Check. Patient is called after service is completed for a final quality check.

Transportation/ language services are ideally paired with other services including diagnostic imaging and physical medicine/rehabilitation therapy allowing adjusters/case managers to make one call to schedule all services.

Contact a Healthcare Solutions representative to learn more about our Transportation and Translation Services.

 

 

Home/Vehicle/Workplace Modifications (back to top)

Healthcare Solutions coordinates home, vehicle and workplace modifications. Available services include temporary and permanent modifications such as ramps, lifts and elevators, room additions, bathrooms (grab bars, roll in showers, benches) and complete home rebuilds. Our nationwide network of contractors ensures availability and reduces time adjuster/nurse care manager invests locating and qualifying contractors.

A project manager is assigned to each project to oversee the bid process and the renovation and provide continuous oversight. Responsibilities include:

  • Conducting environmental assessment and preparing written report and/or photos
  • Ordering specialized equipment and supplies
  • Coordinating the storing of materials
  • Estimating costs and determining billing/payment terms
  • Ensuring proper licensing and permitting; reducing exposure
  • Quality control and assurance
  • Managing all aspects of the project and guaranteeing responsiveness/accountability
  • Completing project indemnification

The process includes obtaining at least two competitive, itemized bids from contractors. Verification is conducted to be certain contractors are licensed, bonded and insured, reducing exposure and liability. Project completion evaluations are submitted within 48-72 hours of contractor visit. Each job meets or exceeds ADA guidelines (space allowing) as well as elevator standards, and national, state and local building codes.

Healthcare Solutions provides only medically necessary modifications. Nurse life care planners receive report of modification for submission as part of long-term patient need.

Contact a Healthcare Solutions representative to learn more about our Modifications Service.

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