Premium Services

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StrataCare has enhanced StrataWare to include several new Premium Services, that offer advanced bill review solution configurations. The first Premium Configuration is the addition of Medical Disability Guides. Future releases will include other modules.

 

Medical Disability Guides

StrataCare’s Medical Disability Guides (MDG) are an effective resource for utilization standards, which can be used to optimize results in workers’ compensation cases. MDG is an automated feature that provides color-coded recommendations by applying business logic that evaluates treatment duration and the appropriateness of billed diagnosis codes versus service codes on the bill. The MDG color code recommendations help identify bills and services that could be demonstrating a propensity toward excessive treatment or inappropriate utilization.

mdg test v2

Within StrataWare®, MDG color recommendations and guide links are available in the bill review processing module, bill lookup module and AdjusterPortal interface. This seamless integration and visibility with direct linking to evidence-based guides facilitates monitoring of treatment and appropriateness of services rendered. This can ultimately translate to better management of claims and enhanced cost-containment outcomes. Additionally, MDG can reduce provider friction by citing an independent evidence-based reference for medical decisions.

The MDG feature can increase efficiencies by providing a centralized support resource for adjusters and nurse case managers to view specific medical evidence regarding proposed or scheduled medical treatments. StrataCare’s MDG offering includes the Work Loss Data Institute’s® (WLDI), Official Disability Guidelines™ (ODG) and the American College of Occupational and Environmental Medicine (ACOEM®) Practice Guidelines. The state-specific ACOEM guides are also offered.

Read more about ODG or ACOEM.

Administration:

  • Client accounts are configured by state
  • One or both guidelines can be applied to each state
  • Thresholds include total billed charges and allowance minimums, apply to provider type, and effective/term dates
  • AdjusterPortal Business Rules and the PathWays Rules Engine can utilize MDG color coding for routing and automated handling

Bill Review Integration

  • Color flags are visible from within the Bill Review module and the AdjusterPortal
  • MDG source information, associated reference links, UR Max and UR Units are prominently displayed in the Bill Review module and AdjusterPortal
  • Bill Review Logs contain MDG color flag derivation information on a per-service line basis

 

Legal Disclaimer: StrataCare does not practice evidence based medicine, perform utilization review, or make decisions regarding treatment plans. Official Disability Guidelines™ is a third party resource published by the WLDI® and is licensed through StrataCare. The ODG Library is intended for use as a resource tool and is ideally utilized as one component of a comprehensive plan of care. MDGuidelines® published by ACOEM is a third party resource of medical practice guidelines. Medical treatment and care decisions remain the responsibility of the licensed practitioner and the care management team, and which may include the adjustor and case management staff. For more information on ODG, please visit Work Loss Data Institute’s website at www.worklossdata.com. ODG and WLDI are registered trademarks of Work Loss Data Institute. MDGuidelines® is licensed from American College of Occupational and Environmental Medicine®. For more information on AECOM, please visit AECOM’s website at www.acoem.org.