“Scientific Solutions for Complex Situations”
The ClaimsCLEAR® program targets large medical cases with significant issues, costly procedures, multiple prescription drugs and complex medical facts. The primary bjective of ClaimsCLEAR® is to lower payers present and future medical payouts.
ClaimsCLEAR® untangles complex claims by:
- Utilizing the best minds in medical science
- Utilizing the latest scientific-based medical evidence
- Bringing clear medical thinking to your most complex and difficult claims
OMCA ClaimsCLEAR® Services
Complex Case Review
Nurse reviewers provide a written review of the medical history and current treatment plan. Issues of concern are identified, recommendations are provided to assist in the medical management of the claim. Optional services include referral to a ClaimsCLEAR® physician reviewer, or intensive nurse case management.
Physician experts provide a written review of medical care and treatment recommendations based on national guidelines. The ClaimsCLEAR® physicians will make evidence based recommendations to improve the clinical outcome for the patient while reducing unnecessary cost to the payer.
Peer to Peer Consultation
The best way to have maximum positive impact on a case is through peer-to-peer consultations.OMCA has access to some of the finest physicians in the country covering a variety of disease and treatment processes. If you have an employee or dependent who is facing a substantial medical event, let OMCA’s physician panel work directly for you by ensuring that all major medical decisions are the right ones. This is particularly helpful in cases such as:
- Organ Transplants
- Closed Head Injuries
- Chronic Pain Management
- Complex Spine Surgeries
These cases are going to cost your plan hundreds of thousands of dollars. It only makes sense to have a highly qualified expert on your team. It will cost a fraction of the bill and could potentially save thousands of dollars.
OMCA provides ClaimsCLEAR® services to carriers, third party administrators and self-funded employers. These programs are also effective for excess/reinsurance carriers.
To hear more about ClaimsCLEAR® contact Rosalie Faris, RN, BSN, CCM, COHN-S at email@example.com
From our Clients & Colleagues
Mike Bibelhauser AIG
“OMCA is an elite managed care organization, committed to operating at the highest level”
- Utilization Review
- KHA Referral Form
- KY Health Admin
- UR Process
- Pharmaceutical Solutions
- Medical Cost Containment
01/10/19 | Google This in 40 Years
In writing these newsletters, I’m always looking for current, relevant, and credible materials. More often than not, I focus on the rising cost of healthcare […]
12/18/18 | Reefer Madness — From Down Under
…and I’m not talking about the Great Barrier Reef. There was a recent study published in The Lancet Public Health and Pain Medicine News […]
12/11/18 | Pill Popping Protocols
We are learning that the fight to contain opioids is multifaceted. There are many tentacles and cutting one off doesn’t mean the others have […]
12/04/18 | Shocked to Their Senses
I’m linking to an Associated Press article by Mitch Weiss and Holbrook Mohr that recently ran in The Courier-Journal. The story highlights the safety, expense […]
10/30/18 | That’s One Small Step For Kentucky…
Actually, it’s a pretty big step. The most recent session of the General Assembly gave a very big task to Department of Workers’ […]