NurseLine provides access to registered nurses via a toll free telephone number whenever an injury occurs, available 24 hours a day, seven days a week. Via NurseLine, nurses assess workers’ injuries and help them receive the appropriate care.
Automated technology refers targeted claims to an ESIS Triage nurse who actively reviews and compares the file against clinical guidelines, utilizes medical expertise, and documents a medical review assessment to ensure its appropriate medical direction.
TCM is a criteria-based, early identification and assessment management service, providing registered nurses with early notice of work injury in order to facilitate appropriate medical care and return-to-work. This involves channeling the injured worker to a PPO, which includes ESIS ExPO®. If hospitalization services are warranted, the TCM nurse will conduct pre-admission/continued stay review services at no additional charge.
Medical FCM services are provided by registered nurses dedicated to ESIS, allowing for national coverage. The nurse assigned to a particular file works closely with the employer, physician, claim representative, and injured worker. The objective is to assist in reducing disability to ensure appropriate medical services are offered and implemented, as well as to facilitate return-to-work. This service ultimately reduces claim costs.
ESIS’ UR process evaluates the necessity, appropriateness of setting, efficacy, and quality of care for medical services, treatments, procedures, and supplies. A prior approval is often required before a patient can be hospitalized, receive costly tests and procedures, or be referred to a specialist. Utilization Review not only helps avoid costly or unnecessary treatments, it also helps prevent inappropriate treatments that put patients at risk. Additionally, Utilization Review is used to ensure injured workers receive care based on guidelines developed using clinical, evidence-based medicine.