Blue Cross of California
State Fund has partnered with Blue Cross of California (BCC) to assist in the management of the medical care of injured employees. In 1994 BCC, a subsidiary of WellPoint Health Networks Inc., began development of a program to integrate group health and workers' compensation. What has evolved from this continued effort is the Workers' Compensation Managed Care Services (WCMCS) business unit of Blue Cross Life and Health (BCLH).
WCMCS has taken the strengths and experience of their group health managed care programs and molded them into a sound workers' compensation program.
BCC provides State Fund with the following services:
- Provider Network Access
- Acute Hospitals
- Ambulatory Surgery Centers
- Home Health Care Services
- Home Infusion Therapy Services
- Skilled Nursing Facilities
- In-Patient Utilization Management
- Discharge Coordination
How It Works
The State Fund claims examiner and BCC work together to ensure that whenever possible, the provision of medical care and treatment for an accepted industrial injury is actively channeled to a facility in the BCC network. The BCC network of hospitals and providers is the largest in California.
BCC also provides utilization management review for each network inpatient stay. This review includes the determination of the appropriate length of stay and the level of care.
The constant communication between the BCC representatives and State Fund claims examiners is what truly makes this program shine. For example, a BCC representative apprises the claims examiner of the status of the inpatient stay, provides recommendation for post-acute care and/or services prior to discharge, and confirms when the injured employee has been discharged from the hospital.
Savings
Access to the BCC provider network helps State Fund control medical claims costs. Additional savings are realized from BCC's review of appropriate length of stay and level of care for hospital admissions. Through these controls State Fund can assist employers with the reduction of their workers' compensation claims costs.
Convenience
The extensive BCC network of facilities offers many locations throughout the state. If one of your employees experiences a work-related injury and you have reported it to State Fund, the claims examiner and the 24-Hour Claims Reporting Center will make every effort to channel the injured employee to a BCC network facility.
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