Medical & Bill Audits


Review of a file and/or bill to render a nursing opinion on such issues as appropriateness of treatment to claimant’s diagnosis or accident and subsequent related costs.


Independent Medical Evaluation-only


Paragon Case Management will coordinate and schedule an IME with appropriate physician.   We will send a letter to the physician confirming the IME and listing requested information to be addressed by the physician.  A letter will also be sent to the client to confirm the IME.  The physician’s office will also be contacted for confirmation.  With client approval, we will attend the IME appointment to get the needed medical information from the client and physician.  A report will then be generated providing the requested information and the file will be closed unless the carrier requests further activity. 


Our services expand throughout the Southeastern United States.

Vocational Placement Services


Vocational case manager will meet one to two times per week with the injured employee to provide appropriate viable job leads and will assist in scheduling appointments and interviews.  Follow up with all leads will insure client participation and compliance.


Medicare Set Asides


A MSA report identifies the amount of settlement dollars to be “set aside” for injury-related medical expenses typically covered by Medicare in order to avoid the shifting of burden from the primary payer to Medicare.  


Transferable Skills Analysis


Conducted to determine injured employee’s current skills for employment while considering education, work history, physical abilities and interests.  


On-Site Hospital Utilization Review


Conducted to determine current medical status of patient and possible alternate care settings or services.  Report on the appropriateness of ongoing hospitalization. 


Medical Community Relationships


Through our experience in this field, we have developed close working relationships with many of the state’s top physicians and treatment facilities.  We have negotiated rate reductions for many treatment facilities.  We have established numerous vendor contacts for medical equipment and services.  


Labor Market Survey


Conducted to determine viability of employment in a particular geographic area.  A vocational case manager will contact prospective employers whose work environments match the client’s vocational abilities and physical restrictions to determine job availability and salary levels.  A report with recommendations will be provided and the file will be closed unless the carrier requests further activity. 


Peer Review


Paragon Case Management will arrange to have a specialized physician review medical records and diagnostic studies to determine appropriateness of care or proposed plan of treatment.  A full report will follow the evaluation.


Medical Legal File Reviews


A report that details chronologically the medical treatment of the claimant. The nurse offers recommendations to the adjuster/claims examiner with regard to future treatment protocols and cost effective procedures currently available. This report includes a Medical Cost Projection upon request.


Services


Certified Life Care Plan


A comprehensive plan forecasting the future financial costs of the medical needs for a catastrophically injured person or a person with a devastating illness, throughout the life expectancy of that individual.


Custom Services/Task Assignments


In addition to the standard services described here, Paragon Case Management will make every effort to accommodate individual needs through customized programs and services.  We work with the carrier to define, design, and implement these custom services.  We will also provide a Value Statement periodically to show your true cost containment savings, if necessary.


Telephonic Case Management


Includes file assignment to a specified Registered Nurse for complete medical case management services via telephone.  This type of case management is a very cost-effective tool for claims that are not complex enough to require extensive onsite medical management.


Vocational Assessment


Includes aptitude testing, interest inventory and vocational exploration with recommendations for further job development and/or placement.  


Medical Field Case Management


Includes full medical management (injured employee, physician, employer contact) or flexible arrangements for specific requests.