Managed Care Organization
“Who’s managing your cost?”
- Certified MCO since 1994
- Experienced nurse case managers
- Strategic provider networks
- Proven cost reductions
- Nationwide telephonic case management
- URAC accredited for Workers’ Compensation Utilization Management
- Unsurpassed customer satisfaction
As the first certified Managed Care Organization (MCO) approved in Kentucky, OMCA remains a leader in providing innovative cost-containment solutions. All of our MCO products are specifically customized to meet our clients’ needs. OMCA handles all of the filing, administration and reporting, providing a turnkey, no-hassle experience for our clients and their injured workers. The customization may be geographic and/or industry specific, and is seamlessly integrated with a carrier’s or TPA’s current operations.
The OMCA MCO combines our select provider networks, UR/Peer Review programs, board certified physician advisors, pharmaceutical solutions, and nurse case managers to help control your Workers’ Compensation costs. All of our professionals are dedicated to helping the injured worker recover and return to work as soon as possible. In Kentucky, only those employers in a certified MCO can limit injured workers to a panel of select providers.
Kentucky Certified MCO Provider Network
OMCA Network is a statewide provider network approved by the Kentucky Department of Workers’ Claims with accessibility in all 120 counties. Providers are recruited for their willingness to treat Workers’ Compensation injuries, and to effectively communicate with all parties. OMCA credentials network providers to industry standards. Networks may be customized to meet the needs of specific employers and/or geographic areas.
Kentucky Certified MCO Pharmacy Network
Our specialized pharmacy MCO plans allow our clients to limit pharmaceutical access to approved pharmacy networks or PBMs. These plans control drug costs and narcotic abuse by managing and limiting:
- Expensive physician dispensing;
- High cost pharmacy networks;
- Extent and duration of narcotics.
Registered nurses with case management certification are the key to any successful MCO. A prompt, safe return to work is our case manager’s goal for every injured worker. All OMCA case managers are registered nurses with experience and training in occupational medicine. Their role is to see that all available resources are correctly used to improve outcomes. Throughout the process, there is constant communication and interaction with the adjuster, employer and treating provider. Case managers monitor the injured worker’s progress to see if adjustments to the treatment plans are necessary and to ensure all parties are held accountable and giving maximum efforts. Of all the members of the MCO, the role of the nurse case manager is the most important as they help payors control medical costs and case reserves.
Utilization Review (UR) involves screening certain proposed medical procedures and pharmaceuticals to determine if they are medically necessary and appropriate based upon established review criteria. This includes prior authorization for hospital admissions, all surgeries and diagnostic studies, and concurrent stay review, ensuring that injured workers are discharged from the hospital when the level of service they are receiving no longer requires inpatient care.
At OMCA, UR is not merely an administrative function. Our nurse case managers and physician advisors utilize the latest evidence-based criteria in evaluating each UR submission.
As a member of a select fraternity that has chosen to be URAC accredited for Workers’ Compensation Utilization Management, OMCA has made the investment to ensure that appropriate requests are promptly approved while denials are thoroughly researched and scientifically supported. Several of our physician advisors are authors of Workers’ Compensation clinical guidelines and recognized nationally as leaders in their fields of medicine. URAC accreditation lets clients know that OMCA adheres to the highest industry standards as we help payors effectively control their medical costs and case reserves.
Our Client Services department has effectively trained thousands of employers and injured workers in the correct use of the managed care system. Reporting injuries promptly, selecting in-network medical providers and communicating with case managers are the keys to a successful MCO program. Training can occur at your facility on all shifts. Educational materials include posters, letters and videos.
For more information about Workers’ Compensation services, contact OMCA at (800) 633-5960 or email@example.com.