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MEDICAL CASE MANAGEMENT COMPONENT DATA SHEET
Medical Case Management
Track medical events, coordinate services among providers and compare recommended
treatment plans with accepted protocols for workers’ compensation, liability or automobile
claims involving injuries — reducing medical expenses and returning individuals to work as
soon as possible.
OneShield Market Solutions Medical Case Management module is designed to help ensure quality and necessary medical care
is delivered in the most cost-effective manner — speeding an individual’s return to work and reducing medical expenses while
addressing your claimant’s specific needs and promoting positive outcomes.
With this hosted solution, you can be up and running quickly with features and functionality configured to the unique needs of
your business and your claimants.
When we ask our clients why they continue to choose OneShield, they say it is the “OneShield Experience” – the positive
impact of working with our people, our products, and a decade’s worth of proven and successful implementations. They choose
OneShield because… we get it.
Module Highlights
The primary focus of the Medical Case Management module is to coordinate services among providers to return an injured person
back to functional capability as soon as possible by tracking the medical event itself, episodes of care, and multiple other data
points, including:
nPhysician Orders
nICD9 Code(s)
nCPT Code(s)
nHospital admission information
nAnticipated length of stay
nFrequency and duration of treatment(s)
nCase-specific journal entries, including file notes, recorded statements, documents, diaries and emails
MEDICAL CASE MANAGEMENT COMPONENT DATA SHEET
The Medical Case Management module uses ICD codes to identify clinically appropriate treatments, based on medical reports
and doctor discussions. Treatment plans are then compared against ODG, a leader in the medical protocol industry. The claim and
medical-related data is passed to ODG’s website bringing the user directly to the appropriate reference area within the guideline.
In addition to basic claim data, the Medical Case Management module maintains a database on all caregivers, including
demographics, locations, languages spoken, clinical expertise and specialties — allowing your team to refer injured parties to
providers near their place of work or home.
Along with the claim record is a sub-module to track Return-To-Work segments designed to monitor an injured employee’s return
as soon as medically feasible.
Typical Case Management Workflow
1.
Identification
and Selection:
Identify claimants who would
benefit from case management
services. This may include
obtaining consent for case
management services, if
appropriate.
4.
Implementation
and
Coordination of
Care:
2.
Assessment
and Problem/
Opportunity
Identification:
Begins after completion of
case selection and intake into
case management and occurs
intermittently, as needed.
5.
Evaluate the client’s status and
Evaluation of
goals, and associated outcomes.
Plan and Followup:
3.
Development
of Case
Management
Plan:
Establishes goals of the
intervention and prioritizes
the client’s needs, as well as
determines the type of services
and resources available to
address the established goals or
desired outcomes.
6.
Termination
of Case
Management:
Puts the case management plan
into action.
Brings closure to the care and/or
episode of illness. This process
focuses on discontinuing case
management when the client
transitions to the highest level
of function, the best possible
outcome has been attained, or
the needs/desires of the client
change.
System Requirements
For the cloud-based solution, the technology requirements are simple — any Web-enabled workstation can access the system. A
secure URL and login credentials presents users with easy access, based on a security profile defining their rights and privileges to
the system. OneShield can also accommodate clients who need a local instance of this solution — providing options for Oracle or
Microsoft SQL Server.
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Leadership. Service. Technology. That’s our policy.
OneShield, Inc. delivers core business software solutions to the global P&C and General
Insurance industry. Our portfolio of standalone applications, and subscription- and cloud-based
software products includes enterprise-class policy management, billing, claims, rating, product
configuration, and business intelligence and analytic solutions that leverage a tool-based open
architecture and single data model platform to streamline your business.
OneShield Insurance Software automates and simplifies the complexities of core systems with
targeted solutions, seamless upgrades, collaborative implementations, and lower total cost of
ownership.
OneShield, Inc. has a combined 44 products in production across all commercial, personal and
specialty lines of business.
To learn more about how we can help your insurance
business succeed, visit www.oneshield.com.
OneShield Global
Corporate Office
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Marlborough, MA
01752-3028
United States
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+1 774 348 1000
[email protected]
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Australia
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+91 124 485 6100
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Canada
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United Kingdom
+1 774 348 1000
[email protected]
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Leadership. Service. Technology. That’s our policy.