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An injury at the workplace can be devastating to both the injured employee and the business itself. Yassa Agency's proactive, service-oriented workers' compensation program ensures quality claims management and timely medical care for injured employees at a reasonable cost to employers.
Once notified of a work related injury, our claims examiners contact the injured worker immediately to discuss medical status and to provide information about benefits. In cases where lost time occurs, temporary disability payment begins upon verification of a disability. This prompt, attentive service minimizes the understandable anxiety and uncertainty that an injured worker often experiences. We also contact the employer and the treating medical provider to obtain more complete information about the injury, medical condition and the treatment plan of the injured worker.
Medical Cost Containment Programs: Yassa Agency's claims department has a variety of medical management programs in place to help contain medical costs, improve quality and timeliness of medical care. Our programs include:
- Texas Health Care Provider Network
- California Medical Provider Network (MPN)
- Medical Bill Review
- Preferred Provider Organizations (PPO's)
- Telephonic Case Management
- Specialized Services Network
- Occupational Health and Industrial Clinic Network
Early Return to Work
Yassa Agency is a strong supporter of Early Return to Work (ERTW) programs. These programs help workers remain in or rejoin the workforce in a temporary, modified duty capacity while they are recovering, are an effective way to manage the total cost of a Worker Compensation program including medical and vocational rehabilitation costs for employers while helping to restore an employee's sense of value and self-worth.
Benefits of an ERTW Program:
Allows an injured employee to remain a productive member of the employer's workforce.
Demonstrates the employer's interest and concern for injured employees.
Reduces length of disability and the medical costs associated with the injury.
Maintains open and on-going communications between the employer, the employee and the treating provider.
Minimizes malingering.
Demonstrates the employer's interest and concern for injured employees.
Reduces length of disability and the medical costs associated with the injury.
Maintains open and on-going communications between the employer, the employee and the treating provider.
Minimizes malingering.
For Early Return to Work program documentation and checklists visit the Risk Services Early Return to Work site.
Claims Process
The return to work process begins soon after notification of an injury. Yassa Agency claims staff and nurse case managers work with all parties to help the disabled employee remain in or return to the workplace as quickly as possible. Members of this Claims Team work together to:
Assess medical treatment plans, job requirements, transitional work and medical barriers (ERTW)
Communicate with all parties including employer, medical provider and injured employee to discuss opportunities for transitional work (ERTW)
Establish plans to facilitate medical recovery and transitional work (ERTW)
Communicate with all parties including employer, medical provider and injured employee to discuss opportunities for transitional work (ERTW)
Establish plans to facilitate medical recovery and transitional work (ERTW)
The focus and goal of the Yassa Agency ERTW program is to get injured employees back to work and back to pre-injury status in a timely and efficient manner. This is accomplished by working closely with the employer and the treating provider to focus on the abilities of the injured worker and identify return to work opportunities.
Medical Bill Review
Through a completely automated process, all physician and treatment bills submitted for payment are reviewed to applicable state fee schedules, duplicate billing and other potential billing errors and finally preferred provider discounts are applied when applicable. Yassa Agency has an added review service for those high dollar provider and hospital bills which receive little or no reduction in the early part of the bill review process. This program enhancement is also completely automated and affords, you the customer, with greater potential to reduce your medical costs.
Preferred Provider Organizations (PPO's)
A PPO is a network of hospitals and other health care providers that offer quality services at much reduced rates. A network would normally include most major hospitals in a given area, as well as surgery centers and home health care agencies. These "preferred providers" have contracted with the PPO to offer services to workers' compensation claimants at rates that are usually much lower than normal charges.
Yassa Agency's claims department also has access to Talispoint, our online preferred provider tool. Talispoint allows quick access to a listing of Yassa Agency's workers' compensation preferred provider network. If you need assistance locating a medical clinic or provider please use the following link to locate a provider and, if you wish, create your own customized provider directory.
Locate a provider
Telephonic Case Management
Yassa Agency has onsite registered nurses who specialize in the early evaluation of claims. The role of the nurse includes:
Yassa Agency has onsite registered nurses who specialize in the early evaluation of claims. The role of the nurse includes:
Maintain active communication with employer, Yassa Agency Claims examiner, medical provider, and the injured employee
Assess medical treatment plans, functional abilities and medical and ERTW barriers
Establish a specific plan to facilitate medical recovery and ERTW
Assist in channeling injured employees to the preferred provider network
Assess medical treatment plans, functional abilities and medical and ERTW barriers
Establish a specific plan to facilitate medical recovery and ERTW
Assist in channeling injured employees to the preferred provider network
Specialized Services Networks
Preferred vendor relationships have been established for negotiated discounts, below fee schedule, for durable medical equipment, diagnostic services, transportation, home health services and physical therapy services.
Pharmacy Benefit Management Program
Yassa Agency has an established relationship with a national Pharmacy Benefit Management Company. This program proactively manages the pharmacy aspect all claims. We are able to get the best available pricing for prescriptions, manage drug utilization, avoid drug interactions, and encourage use of generics versus brand names. Yassa Agency encourages use of this pharmacy network for all work related pharmaceutical services.
Occupational Health and Industrial Clinic Network
Yassa Agency has established a relationship with a national network of occupational health clinics, to make immediate and quality occupational healthcare services available to our customers. The resulting efficiencies are likely to produce lower overall costs to you:
Injured workers are given prompt, quality medical treatment which reduces the time away from the workplace.
Improved communication between you, the physician, Yassa Agency, and the injured worker.
Improved communication between you, the physician, Yassa Agency, and the injured worker.
The clinics work closely with the Claim Handlers and Nurse Case Managers to assure appropriate and timely care to control your costs.
A strong emphasis on early and sustained "early return to work" for injured employees. Modified duty and full duty work capacity will be evaluated at each medical appointment and communicated to you and Yassa Agency.
A strong emphasis on early and sustained "early return to work" for injured employees. Modified duty and full duty work capacity will be evaluated at each medical appointment and communicated to you and Yassa Agency.
In the end, our ability to deliver fair and appropriate benefits to injured workers depends on our ability to work as partners with employers and employees. In order to serve you best, we ask that you report claims promptly, contact us immediately if you ever question the validity of a claim, cooperate with our investigation of a claim, and seek opportunities for early return to work through modified duties. Prompt reporting of all claims is critical if our claim representatives are to achieve this mission.
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