NurseLine provides access to registered nurses whenever an injury occurs, available 24 hours a day, seven days a week. Through NurseLine, clinicians assess workers’ injuries and help them receive the appropriate self-care recommendations or referral for treatment to your preferred provider.
Automated technology refers targeted claims to an ESIS Clinical Resource Nurse who actively reviews and compares the file against clinical guidelines, utilizes medical expertise, and documents a medical review assessment to ensure appropriate medical direction to support the ESIS claim adjuster.
Telephonic Case Management program which utilizes advanced analytics and review of each potential case to determine if TCM would be of clinical assistance. Our process assesses key aspects of the claim and injured worker medicals continuously within the first 180 days of the claim to determine if the clinical support of a TCM would benefit the file. This means we have completed the research and due diligence to assign TCM only on those cases where we believe it will have an impact.
Our FCM services are provided by registered nurses dedicated to ESIS, allowing for national coverage. The nurse will work closely with the employer, physician, claim representative, and injured worker to ensure appropriate medical resources are utilized and help facilitate return to work. Our FCM program is highly customized to support complex cases, extensive treatment, questionable diagnosis, etc., ultimately reducing 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. ESIS UR program is highly integrated with our claim process and ensures compliance with all state-mandated UR programs and timeframes.