Clients are impacted by uncontrollable medical cost and high litigation claims in the administration of their claims. Defense attorneys are inundated with large caseloads and find themselves losing sight of the medical issues. Claims Examiners focus on timely benefit payments and reporting rather than the medical issues of a claim. High medical costs are significant cost drivers in workers’ compensation claims as well as General Liability and Property Damage claims.

AMCM provides Utilization Review in compliance with Labor Code 4610 as well as Nurse Case Management for clients to assign nurses to handle some of the medical issues involved in their claims. 

Utilization Review (UR) is used to review the reasonableness and necessity of medical treatment in occupational injuries in the workers’ compensation system.  Employers can use UR to prevent the provision of unreasonable medical treatment, goods or services in their workers’ compensation claims.

Medical Case Management utilizes Registered Nurses to provide explanations and medical management assistance to claims examiners, clients and claimants throughout the claims administration process. 

AMCM was created to:

• Comply with Workers’ Compensation Utilization Review requirements under Labor Code Section 4610.
• Increase medical peer review in the claims administration process.
• Improve the understanding and communication between examiners, claimants and clients concerning the medical issues involved in the claims administration process.
• Increase client medical control in their risk management program.

With AMCM clients can better understand and control the medical issues in their claims administration.

The Ultimate Lien Solution (TULS) is a full-service lien resolution program that offers clients low-cost options to resolve their workers’ compensation and insurance liens and close their claims.
TULS services are accessible to any public and private employer-side entities that can benefit from specialized lien resolution services in the workers’ compensation and insurance industries.

MjM

Bill Review Services Inc.

MJM Bill Review reviews medical bills in workers’ compensation cases to ensure that medical providers comply with State mandated fee schedules.  Bills that exceed these fee schedules are objected to and reduced accordingly pursuant to legal and regulatory bill review guidelines.

MJM Bill Reviewers are bill review experts with Designations in compliance with State Insurance Code requirements, and under continuing education training obligations.  MJM Bill Reviewers are expert in receiving and processing medical bills with appropriate reductions and objections.  These expert reviews and reductions provide ICA and MJM clients with tremendous hard-dollar savings.

The Murata Consulting Group, Inc. offers specialized consultation and administration services in property damage, general liability and workers’ compensation insurance including the following services:

• Highly-complex, severe or high exposure claims administration consultations.
• Case closure projects.
• Pre-loss risk prevention training and consulting.
• Auditing Services.
• Risk Management Program development and improvement including programs such as:

• Return to Work
• Medical Provider Networks
• Health Care Organizations
• Safety Training
• Risk Profiling
• And other programs based upon needs of the client

 

Please contact us for more information on this affiliate service.