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Managed Care Organization

“Who’s managing your cost?”

  • Certified since 1994
  • Experienced Registered Nurse Case Managers
  • Strategic Physician Networks
  • Proven Cost Reductions
  • Unsurpassed Customer Satisfaction
  • Nationwide Telephonic Case Management
  • URAC Accredited for Workers’ Compensation Utilization Management

MCO Network

With the experience and capacity to help payers of any size implement a certified managed care program, OMCA will deliver quality medical care oversight to injured workers and reduce costs for payers. Managing programs that cover employers with as few as ten employees to those with several thousand, from small manufacturing and repair to high tech and professional, from minor lacerations to joint replacements, the professionals at OMCA know what works and what doesn’t.

The OMCA MCO combines our select provider networks, UR/Peer Review Programs, Board Certified Physician Advisor Panels, Pharmaceutical Innovations and Registered Nurse Case Managers to help control your workers’ compensation costs. All of our professionals are dedicated to helping the employee recover and return to work as soon as possible. In Kentucky, only those employers in a certified managed care organization can direct claimants to a panel of select providers.

Kentucky Certified Pharmacy MCO Network

Our specialized Pharmacy MCO Plans allow our clients to limit and control pharmaceutical access to specific 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

Case Management

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 claimant. 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 get the injured worker well. Throughout the process there is constant communication and interaction with the adjuster. Case Managers routinely talk with treating physicians, therapists and other providers to make sure there is a specific plan for the injured worker. They monitor the worker’s progress to see if adjustments to the treatment plans are necessary. If there are delays in expected recoveries, the Case Manager will intervene to make sure that both the provider and the injured worker are giving maximum efforts to achieve recovery. Of all the members of the managed care organization, the role of the Registered Nurse Case Manager is the most important as we help payers control medical costs and case reserves.

Utilization Review

Effective UR to the highest industry standards is a critical MCO function. 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 payers effectively control their medical costs and case reserves.

Client Services

A vital piece of workers’ compensation certified managed care is effectively training employees in their responsibilities. Reporting injuries promptly, selecting “in network” medical providers and communicating with Case Managers are required of all injured workers. Failure to properly use the system can result in medical bills being denied.

Our Client Services department has effectively trained thousands of workers (and their supervisors) in the correct use of the managed care system. Selecting a network physician is a critical part of this process and over 96% of our initial visits are “in network” because the employee has been well trained. Training can occur at your facility on all shifts. Training material includes posters, letters and videos.

Customization

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 customers and their employees. The customization may be geographic and/or industry specific, and is seamlessly integrated with a carrier’s or TPA’s current operations.

From our Clients & Colleagues

Madonna Senger Workers' Comp Adjuster

“The best network ever was the original PPO network of OMCA.”



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