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ClaimsCLEAR®

“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

Phase 1.
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.

Phase 2.
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
  • Burns

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 rosalie.faris@omca.biz

From our Clients & Colleagues

Yasmine Subhi Ali, MD, MSCI, FACC, FACP Nashville Preventive Cardiology

"Thank you so much for the update and for passing along the feedback!  You helped make my day.  :-)  I have to say, you all at OMCA have been extraordinarily easy to work with, too, and I look forward to continuing to work with you!"

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