ENCOMPASS Disability Review/Absence Management
and Workers' Compensation Review
ENCOMPASS' integrated Disability Review/Absence Management and Workers' Compensation Review processes offer proven cost containment strategies promoting quality of care. We start by working with each client to determine the most efficient way to initiate our early intervention after an illness or accident. Early intervention is critical to ensure prompt and appropriate treatment.
By applying proprietary screening criteria to each case, our nurses evaluate medical necessity and treatment setting. If criteria are not met, cases are referred to one of our 180 provider consultants across the country for a determination of medical necessity. As appropriate, ENCOMPASS review services can include coordination with lost time, modified duty and return-to-work initiatives.
Customizing Solutions
These services can include a customized list for review of:
- Inpatient services
- Outpatient services
- Ambulatory services
- Procedures
- Medical supplies and equipment
In addition to review services, ENCOMPASS offers clients the ability to support:
- Coordination with lost time, modified duty and return-to-work initiatives
- Redirection to network providers
- Interface with your claims administrator and other plan vendors
- Coordination with our other Care Coordination and Medical Management programs
- Absence management
As with all ENCOMPASS services, these programs' case information is completely integrated in our proprietary software system, QualiTrac, which supports documentation and reporting for all programs. QualiTrac is a member-centric system making information available to ENCOMPASS medical professionals to address health status and medical needs across all Care Coordination and Medical Management programs.
Improving Outcomes
For more than 20 years, our commitment to supporting the right care at the right time in the right setting has created successful partnerships with members, clients and health care providers. Because we work to improve the quality of medical care received as well as eliminate unnecessary treatment, health care costs generally decrease due to improved outcomes.
To help ensure our services conform to best practices in the industry, our Worker' Compensation Review program has been continuously accredited since 1997 by URAC, a respected accreditation organization. ENCOMPASS is also licensed or certified as required to provide Medical Management services in all 50 states.
Demonstrating Results
ENCOMPASS' services deliver results with a strong return on investment. Through the report packages for these services, we demonstrate value through decreased utilization, documented savings, and provider activity.