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?
Level I and Level II DOWC Accreditation
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 primary care providers who participate in our SelectNet provider network to achieve and maintain Level I accreditation through the DOWC or complete Pinnacol’s Workers’ Compensation Basics for Providers online course, which means they are adept at the workers’ compensation treatment protocols and processes in Colorado. In addition, all physicians who are board certified in occupational medicine are required to achieve and maintain Level II accreditation through the DOWC.
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 can also ask providers if they offer extended hours to accommodate workers with varied schedules.
The importance of responsiveness
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. Providers should 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.
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.
SelectNet providers are contractually held to higher participation standards and must go through an extensive credentialing process to ensure they have no medical license restrictions. Pinnacol monitors SelectNet providers for their expertise and demonstrated commitment to quality care of injured workers.
On average, claims managed by SelectNet providers resolve three weeks faster than those managed by out-of-network providers. Network providers work hand in hand with Pinnacol’s return-to-work consultants to provide compassionate care and have injured workers back to work as soon as medically reasonable. Average claims costs for cases managed by SelectNet providers are $2,672 less than those of out-of-network providers and, on average, injured workers have eight fewer days of temporary total disability.
You can search Pinnacol’s SelectNet provider directory online anytime and filter for location, Level II accreditation and provider type.
Here is an array of Pinnacol resources that will help you find your perfect match:
Pinnacol Assurance assumes no responsibility for management or control of customer safety activities. Please ensure your business meets the requirements of all federal, state, and local laws, regulations, or ordinances related to workplace safety.