Services

Independent Medical Exams (IME)

Count on CareWorks Managed Care Services to provide an accurate and defensible Independent Medical Examination to help you deliver the best care, confirm extent or cause of injuries, and resolve disputes over billing. Our comprehensive technology simplifies the review process. We’ll organize documents, eliminate duplicates and maintain all case information in one secure location, which can be accessed by the examining physician, adjuster or legal team.

Our IME team handles a variety of claims, including:

  • Workers’ compensation
  • Department of Labor
  • Liability
  • Auto/No fault
  • Non-subscribers
  • Occupational accidents
  • Second opinion
  • Impairment rating assessments

Evidence-based Medicine

CareWorks Managed Care Services provides credentialed, independent physicians who can apply evidence-based medicine to objectively assess a case early in the process or provide retrospective review to help resolve payment issues. In addition, our peer specialty reviews can resolve of variety of specific disputes.

Early and Accurate Identification of Injuries
Early and accurate identification of injuries is a key to providing appropriate care and controlling costs and outcomes. We strive to identify an injury early in the review process and to define it as precisely as possible to prevent escalation of billing issues associated with “injury creep” during the life of the claim.

 

Stringent Standards

CareWorks follows stringent standards when choosing a physician to independently review your claim. We have access to doctors who specialize in specific injuries and understand the medically and legally accepted protocols of treatment.

What We Offer:
  • Retrospective Medical Review
  • Peer Specialty Review
  • Streamlined Access to Medical Records
  • An Eye on Fraud

CareWorks applies its IME standards to help you choose the physician who can perform a comprehensive review and analysis of medical records, including any diagnostics.

Our physicians will apply the proper evidence-based medical protocols to support their opinions regarding diagnosis and cause of injury and assess the chosen treatment’s appropriateness, necessity and relation to the injury.

When a dispute calls for unbiased, fair review, our network of credentialed medical providers will provide an independent, fact-based report.

If a client requests a peer review, either because that level of review isn’t required or because it is not possible to do the IME in person in a physician’s office, CareWorks can complete a file/peer review from existing records in the claimant’s file. The review includes a comprehensive review, by a qualified physician, of medical history, medical records, and other pertinent information.  CareWorks’ peer review staff provides a comprehensive report to help evaluate services and assist with settling disagreements.

A variety of specialty review services are available:

  • Peer review: A physician peer review addresses the accuracy of the diagnosis and causal relationship to the incident and identifies unrelated diagnoses and/or pre-existing conditions.
  • Medical bill audit: Determines the accuracy of all provider and hospital charges, and supplies a summary of all bill reductions based upon state reimbursements fee schedules or usual and customary charges.
  • Impairment rating review: Applies American Medical Association guidelines to evaluate permanent impairment on a state-by-state basis to help determine the accuracy of rating.
  • Independent group panel examination: Addresses claims which require greater access to an array of specialists when a claimant may have complex issues, requiring multiple specialists. Panel examinations are carried out with the same stringent protocols applied to independent medical examinations.
  • EMG re reads: Provides a detailed critique on: providing a detailed critique on:
    • Credentials of the practitioner performing the study
    • Technical quality of the study
    • Validity of the diagnosis rendered based on the data provided.

Our team consists of physicians who are board certified in physical medicine and rehabilitation and electro diagnostic medicine to review EMG/nerve conduction studies.

  • MRI re read: Evaluates the actual films and reports supplied, providing documentation on the accuracy of the diagnosis and previous impression which will help to determine if the findings are new or pre-existing.
  • Early compensability analysis: Determines whether the claim should be accepted on evidence-based medical and scientific grounds and is performed by a physician who reviews all available medical records.

In certain states — currently Arizona and Texas — patients may be eligible to attend a clinical evaluation with a doctor directly at CareWorks-operated clinic, creating even greater efficiency.

CareWorks’ proprietary technology allows us to organize your case’s documentation and make it available in one secure place.
We save you time and money by compiling records, removing duplicates and creating a link to our online portal, which allows for customizable sorting by criteria such as treating physician, type of procedure or date of injury. We can provide a PDF of all pertinent records with a hyperlinked index for ease of access and review. to all pertinent records.

If your review progresses into a legal phase, CareWorks already has a “clean” set of records available in a neat package and providing considerable savings.

Communication comes first

CareWorks takes pride in administering your IME efficiently and delivering excellent customer service.
We are an industry leader in keeping adjusters, physicians and interested parties informed during every phase of an IME. With CareWorks, there’s no need to worry about whether your review or appointment is scheduled or whether results have been returned. If delays occur, you will be promptly informed.

A national network

Our network of credentialed physicians is available across the U.S. Whether reading an X-ray or assessing a treatment plan, our doctors are experts in their field, specialty or occupational injury. CareWorks can provide a choice of qualified doctors, and you can make the choice for your specific review.

Our medical professionals are versed in workers’ compensation and medical regulations. They will work assiduously to flag questionable claims and ferret out potential fraud or abuse, while applying fair, objective professional standards to your claim.

A truly effective managed care solution

Our comprehensive array of managed care services deliver the right results for our clients and their injured workers.

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