Patriot Care Management, Inc.

Patriot Care Management is a managed care services company that provides nurse case management and bill review services with headquarters in Fort Lauderdale, Florida.

Services

  • Medical Bill Review
  • Nurse Case Management
  • Utilization Review

Medical Bill Review

Patriot utilizes a Medical Bill Review program within the workers' compensation market. The Medical Bill Review program generates both savings and efficiencies for clients. Savings result from reductions on medical bills through the application of the appropriate fee schedule / UCR and utilization review audits.

Patriot eliminates billing abuse by ensuring that each bill goes through the appropriate review process by offering:

A PPO Network Application

Patriot has available a PPO network which includes multiple networks, instead of a singular network. This delivers maximum savings and penetration for each client based on their jurisdictional requirements. In addition, we continually perform subsequent analysis to ensure that each client's expectations and needs are exceeded.

  • PPO network discounts are applied via an overnight pend and transmit process, which allows the designated network to apply the most current contracted discounts, consequently increasing accuracy and reducing provider disputes.
  • Our Bill Review program retrospectively reviews pharmacy claims to ensure that network reductions, contracted rates, Fee Schedule/UCR were applied properly. In addition, the program provides out of network reviews and negotiations.
  • We recognize that rising medical costs are a large factor contributing to the escalating cost of medical claims. Patriot utilizes a pharmacy benefit management program to better assist clients.

Nurse Case Management

Patriot's Registered Nurse case managers have the expertise and experience to ensure that a Carrier is able to provide telephonic case management services to clients, small and large and with specific needs.

Patriot offers telephonic case management services in all states and our focus is in the workers' compensation industry. Telephonic services are offered in a pro-active model of early Triage and assignment post-accident date facilitating early and cost effective medical treatment as well as timely return to work for the injured worker.

Patriot's Registered Nurse case managers offer many services including:

  • National network of case managers who serve as the advocate for the injured employee.
  • Assistance with a physician selection from a network of providers who specialize in workers compensation and the treatment of work injuries.
  • Maintaining focus on full recovery as well as a safe and timely return to work.
  • Injured employees are empowered to take responsibility for their own recovery, while working to remove barriers to a safe return to work.
  • Ensure that efficient service is provided to all parties involved.
  • Provide a goal oriented approach for communication between the injured employee, health care provider, employer and insurance carrier.
  • Assist the injured employee with appointment scheduling, treatment authorization, and provide clarification of activity levels.
  • Relationships with ancillary service networks provide the injured worker and their medical providers immediate access to diagnostic radiology, physical therapy, durable medical equipment and prescription drug services.

Utilization Review

Patriot's experienced registered nurses review medical treatment requests using medically accepted clinical review criteria to validate medical necessity and appropriateness of a treatment plan.

Utilization Review provides the claims professional with a prospective, concurrent or retrospective review of the medical necessity for services requested. A registered nurse completes a first level review based on national evidence-based guidelines, and if indicated, will coordinate reviews with a physician advisor when such guidelines are exceeded or unmet.