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A Scientific, Evidence- Based and Multi-Disciplinary Approach to Prevent, Minimize and Control Catastrophic Workers’ Compensation and Chronic Pain Claims

Intervention may be necessary for complex or catastrophic claims which drive 80% of all claims cost and consume critical resources within your company! These claims can be magnified by turnover in claims personnel or complex medical records. Our collaborative panel of Board Certified Physicians are all experienced in workers’ compensation medicine and are:
• Orthopedic Surgeon Former Work Comp State Medical Director Fellow, American Academy of Orthopedic Surgeons Fellow, American Academy of Disability Evaluating Physicians • Neurosurgeon American Academy of Disability Evaluating Physicians, President-Elect American Association of Neurological Surgeons, Past-President University Medical Faculty	• Anesthesiologist PhD, Pharmaceutical Economist University Medical Faculty • Neuropsychologist Fellow, National Academy of Neuropsychology Harvard Medical School Massachusetts General Hospital Post-Doctoral Fellowship Member, American Academy of Disability Evaluating Physicians
OMCA - CLAIMSCLEAR® OFFERS A SCIENTIFIC EVIDENCE-BASED PROGRAM THAT CAN PROVIDE: 1. Prediction and early identification of claimants with addictive behavior tendencies and of losses with catastrophic cost potential; 2. Protocols to modify, minimize or eliminate ineffective, inappropriate or costly chronic drug and pain management treatment; 3. The latest scientific data for cost effective and optimal outcome treatment plans; 4. Objective evaluation, assessment and remediation recommendations for complex and chronic claims. SOLVING COMPLEX CLAIMS THROUGH EVIDENCE-BASED MEDICAL SCIENCE CLAIMSCLEAR® INTERVENTION IS ESSENTIAL FOR: • Post-award cases with significant on-going medicals • Multi-issue cases • Multiple prescriptions/prescribers • Active pain treatment • Long term controlled substance treatment

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Injured Worker

OMCA staff works with the injured worker to obtain prompt, effective medical care for treatment of the work injury. The Nurse Case Manager is a resource for the worker to obtain information regarding their injury, prescribed medications and proposed treatment. The Nurse Case Manager helps the worker successfully navigate the medical system to return to their pre-injury state of health.

Employer

The OMCA system assists the employer in reporting claims promptly, obtaining information regarding the work status of injured worker and identifying work duties that could allow the employee to return to work within medical restrictions. Those employers who enroll in the OMCA managed care system are assisted in selecting the network of medical providers from which the employee may choose, thereby reducing the opportunity for malingering by those few workers who may attempt to work the system.

Provider

OMCA works closely with the medical provider to get the employee the appropriate care at the appropriate level without delay. Unless there is an issue with compensability of the claim or relatedness of the procedure most pre-certs are approved with the initial phone call. Providers within the OMCA network have access to a provider relations representative who can assist them with questions related to claims filing and reimbursement questions.