Medical treatment and healthcare services are unique in workers’ compensation. Instead of sending injured workers to their regular primary care providers, under workers’ comp regulations, Colorado-based businesses must designate or appoint several medical clinics to treat injured or ill workers if a claim arises. You might not realize that provider relationships are essential to positive employee experiences throughout medical treatment, for smoother claims processing and better health outcomes.
You may have already designated provider clinics when you initially purchased a policy with Pinnacol. If you didn’t, providers may have been assigned to you based on your location. You can always check in on your designated providers in the Policyholder Portal.
How do you choose a provider based on your business’ unique needs? We asked local occupational medicine doctor and expert X.J. Ethan Moses, MD, MPH, chief medical officer at Peak Form Medical Clinic (Boulder and Brighton), for advice on how to choose the best provider for you and how to foster a mutually beneficial relationship.
Level I and Level II DOWC certification
Workers’ compensation-specific medical treatment, billing and documentation requirements are unique and can be complex, so choosing providers who understand the process can make everything run much more smoothly. Pinnacol requires all providers who participate in our SelectNet provider network to achieve and maintain Level I or Level II accreditation through the Colorado Division of Workers’ Compensation (or DOWC), which means they are adept at the workers’ compensation treatment protocols and processes in Colorado.
Location, location, location
Choosing accessible providers is important because it makes treatment easier for workers who may have to travel to multiple appointments. You may also want to consider where most of your employees live respective to your work site(s) and factor that in. Designating providers in the most accessible locations for your employees can add less cost to claims for mileage reimbursements and lost time away from work.
“You don’t want to stress an injured or ill worker’s schedule so that they’re driving half an hour to medical appointments. This cuts into their personal and work time,” said Moses.
You can also ask providers if they offer extended hours to accommodate workers with varied schedules.
The importance of responsiveness
Moses points out, “If clinics are not responsive to you while you are looking at designating them, they likely won’t be responsive to you once they are treating your employees. It’s vital to look for a clinic that keeps the lines of communication open.”
According to Moses, “responsive” clinics should be able to quickly find the right person to answer questions and describe to you how they will keep you updated through the life of a claim. Dr. Moses and his team keep both Pinnacol and the employer updated throughout the treatment process and after each visit. They always call employers after an initial visit to ensure the employers understand the diagnosis and treatment plan. Moses stresses there are lots of approaches to communicating with employers among provider clinics, and his is just one of many that support good communication.
Moses relates the story of an injured worker who showed up in his clinic with an uncommon chemical exposure. “Because I had familiarized myself with that employer and the unique conditions of that worksite, I was able to more quickly assess and respond to this very specific exposure.” He was also able to work with the employer to recommend alternate chemicals that would pose less health risks to workers.
Dr. Moses and his team make a point to reach out to employers who have designated his clinic if he isn’t familiar with the work conditions, and occasionally he’ll engage in site visits or walk-throughs of employer worksites.
Simply proactively contacting provider clinics can initiate these types of relationships and make for a smoother working relationship if claims happen. Pinnacol created an interview guide you can use when searching for provider designees.
“If clinics are part of SelectNet, Pinnacol has done the background checking for you,” said Dr. Moses. “You don’t have to worry about whether they are in good standing or appropriately certified.”
You can peruse Pinnacol’s SelectNet provider directory online anytime and filter for location, Level II Certification and provider type.
Here is an array of Pinnacol resources that will help you find your perfect match: