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Medical Management

Our goal is to help provide the appropriate assistance for the worker on leave for a work-related absence or time away from work without incurring unnecessary costs. To do so, we employ a holistic approach to deliver the best care and resources possible for speedy recovery. By integrating evidence-based criteria, clinical expertise and advanced technology into the claims process, we can implement medical management cost saving services that generate better outcomes.

We offer:

  • A strong network of both field and telephonic experts providing both medical and vocational services
  • A multi-level, multi-layered BOLD PPO Network that includes cost drivers such as pharmacy, physical therapy, home health, and DMEs
  • A Chronic Pain Management component for at-risk injured employees
  • Compassionate, professional medical management team with extensive experience and credentials
  • Access to the most current information about treatment, healthcare and rehabilitative techniques
  • A resource database of thousands of evidence-based studies and best practices
  • System integration with claim adjusters
  • Onsite physician advisors and online medical resources
  • Flexible program offerings
  • AAHCC/URAC accreditation for quality


Michael J. Hoberman
Chief Client Officer
Phone: 973-439-6761
Michael_Hoberman@choosebroadspire.com

Our Capabilities

Medical Bill Review

Broadspire’s Medical Bill Review (MBR) can help reduce unwarranted charges associated with workers compensation, general and auto liability. Our Medical Bill Review team combines expertise, advanced technology, a customized rules engine and proprietary reimbursement methodologies to reduce costs far beyond basic state-mandated reductions. Broadspire’s customers have experienced significant savings that continue to increase annually. Customers who used medical bill review in 2013 averaged a 62.3% savings from the identification of inaccurate and unwarranted charges.

BOLD PPO Network:

Broadspire’s revolutionary BOLD PPO network has created a new strategy for superior penetration rates and savings. Instead of relying on one broad network, Broadspire has formed a carefully selected multi-dimensional, multi-tiered network to ensure we have access to the best medical professionals. By overlapping networks and adding specialty networks, BOLD provides the right coverage and the right providers to help boost productivity by returning employees to work quickly.

Comprehensive Pain Management:

Our expert clinical staff of board-certified physicians and nurses reviews these cases, evaluates the biopsychosocial influences of the problem and creates a treatment plan for each individual. By applying our depth of clinical expertise, developing value-added programs with measurable outcomes and working with high quality medical partners, we customize the right solution for each employee suffering from chronic pain.

Case Management:

Broadspire’s case management team plays a vital role in our comprehensive medical management strategy. By creating a proactive action plan, our field, telephonic and vocational case managers can help claimants to recover as quickly as possible. By utilizing their clinical expertise, a vast database of evidence-based medical studies and the knowledge of dozens of on-staff physicians, they work with providers to avoid obstacles and find the resources needed to return to work. 

  • Vocational Case Management: Our masters-level, nationally certified vocational counselors work closely with employers and employees to carefully assess the skills needed to help injured workers back to work. They then engage the appropriate products and services to return them to work at their former occupations or one that fits their current skills and capabilities.
  • Utilization Management: With Broadspire’s objective evaluations of the medical necessity and appropriateness of proposed treatment plans, it’s easier to manage and contain medical and disability costs. Broadspire’s utilization management (UM) program uses professionally recognized standards for evaluating treatment plans, supported by Broadspire’s in-house medical department, which includes more than 240 contracted physicians in 40 specialty areas.

Physician Review Services (PRS):

PRS is a valuable resource for securing clinical expertise in claim management and medical case management. Our diverse panel of specialized, experienced physician reviewers provides well-reasoned and carefully documented determinations that evaluate the medical necessity of medical services, support timely return to work and assess the extent of functional impairment.

Pharmacy Management:

Combined with an effective medical bill review service and preferred provider network, Broadspire leverages a nationwide network of more than 54,000 pharmacies to obtain medication—both retail and mail order—at a significant savings beyond fee schedules and usual and customary charges. Further, our utilization management team determines whether prescribed drugs are related to the compensable injury and screens drugs for excessive or unusual dosages, premature fill requests, adverse drug-to-drug reactions and duplicate medication classes.