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WorkersChoice

At Hometown Health, we provide insurers and employers with a unique workers’ compensation claims administration alternative. We leverage our relationship with Renown Occupational Health and offer more than a decade of highly successful program management experience.

WorkersChoice is available to our TPA clients and uses experienced claims examiners, medical professionals and state-of-the-art information management technology to integrate proven claims administration, managed care and return-to-work best practices. As a result, we help companies protect vital financial and human resources by ensuring that injured workers receive appropriate benefits in a fair and timely manner.

Claims Management
We recruit and develop the region’s most talented claims professionals and provide them with industry-leading best practices, technology and career development opportunities. Our examiners work closely with employers, medical care experts and other ancillary service providers to help injured workers navigate the system, expedite medical recovery and minimize lost time due to an occupational injury or illness. This innovative philosophy dramatically improves workplace productivity and reduces overall workers’ compensation program costs.

Care Coordination
WorkersChoice claims examiners and Hometown Health nurse case managers use the American College of Occupational and Environmental Medicine (ACOEM) guidelines to verify medical necessity and assure the most cost effective place of service for all treatment related to an occupational injury or illness.
Examiners also work closely with our nurse case managers to proactively coordinate care for complex medical conditions. The nurse’s expertise and knowledge of providers and community resources ensure that injured workers receive the best possible care to optimize medical recovery, return to work and permanent disability objectives.

Provider Panel
WorkersChoice partners with Renown Occupational Health to facilitate convenient and expedited access to urgent care, occupational medicine, physical rehabilitation, diagnostic testing and hospital services.

Renown Occupational Health operates northern Nevada clinics with excellent primary care providers, extended evening and weekend hours, integrated alcohol and drug testing services, compliance with client-specific return to work and reporting requirements and preferred access to Renown Regional Medical Center and Renown South Meadows Medical Center.

WorkersChoice also contracts with the community’s leading medical, surgical and ancillary care specialists to manage complex injury and illness claims in the most cost-effective manner.

Pharmacy Network
WorkersChoice selected Express Scripts as its exclusive provider for workers’ compensation Pharmacy Benefit Management (PBM) services. Express Scripts is one of the industry’s largest workers’ compensation PBMs, holds direct contracts with most Nevada pharmacies and understands the goals of an effective medical cost containment program, including:

  • Robust utilization management programs designed to increase patient safety and clinical effectiveness

  • Home delivery allowing injured workers the convenient option of receiving prescriptions at home, in addition to providing significant cost savings

  • Express Scripts, Renown Occupational Health and WorkersChoice have developed an effective “First-Fill” process that enables injured workers to conveniently obtain medically necessary prescriptions while providing clients with substantial savings.

Visit the Express Scripts website for more information about their innovative solutions for the workers’ compensation industry.

Medical Bill Review
Medical care consumes 50 percent of allocated loss expenditures. Our experienced medical examiners leverage fully integrated medical review software to reprice all bills in accordance with pre-authorized treatment parameters, state medical fee schedules and rules, and preferred provider network contracts to generate maximum medical cost savings.

Our streamlined medical bill review process automatically:

  • Verifies medical reserve adequacy

  • Generates an integrated check and Explanation of Review for the medical provider

  • Cost allocates all medical payments to the claim.

  • WorkersChoice also makes all medical provider treatment and charge data available for utilization, cost and outcome reporting.

Data Management
WorkersChoice has partnered with Aon eSolutions and implemented iVOS. This systems streamlines operating costs and ensures that clients have real-time access to the information necessary for managing the most sophisticated workers’ compensation insurance programs.
Our web-based claims management system enables clients to submit claims, monitor activities and generate management reports via the Internet. At the same time, a complete set of claims administration, medical cost management, document imaging, electronic communications and comprehensive report writing tools generate the operational savings needed for WorkersChoice to succeed in the ever-competitive insurance services industry.

Contact Us
Our innovative approach to integrating claims, care and medical cost management services helps companies protect vital financial and human resources by ensuring that injured workers receive appropriate benefits in a fair and timely manner.

Partner with WorkersChoice, a workers’ compensation claims administration alternative with more than a decade of highly successful program management experience. Call 775-982-3100 to speak with an Account Executive today.

Industry Links
American College of Occupational and Environmental Medicine (ACOEM)
Economic Development Authority of Western Nevada (EDAWN)
Nevada Association of Employers
Nevada Division of Industrial Relations (DIR)
Nevada Division of Insurance (DOI)
Nevada Legislature
Nevada State Claims Association
Nevada State Government
Northern Nevada Human Resource Association (NNHRA)
Risk & Insurance Management Society (RIMS)
Self-Insurance Institute of America (SIIA)