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The KARE claims management program emphasizes intensive claims investigation, as well as your input into the claims process. As claims are an inevitable part of the workers' compensation process, the true benchmark for quality in a workers' compensation program is how well your claims are managed by your insurance company. You can always depend on KARE for the following value added claims services:
Prompt and accurate payment of claims
Thorough medical bill audit service to ensure accuracy
Appropriate, injury-specific medical treatment and rehabilitation
Fraud detection screening and investigation of potentially fraudulent claims
Monthly, quarterly, or annual experience reports to identify claims issues
and assist in correction at an early stage
Specifically assigned claims adjuster and customer service representative
to each account
Local staff with local claims knowledge handling local claims (Other
states claims are also supervised locally for consistency/continuity.)
It is a proven fact that managed care helps to control claims costs while returning injured employees to work as soon as practical. KARE utilizes the services of Bluegrass Health Network (BHN), which is an admitted occupational oriented managed care organization in all counties in Kentucky and utilizes the services of First Health in other states. As a non-provider controlled organization, BHN provides the following services to assist you and your employees:
Utilization Review of the use of services to ensure an appropriate match
to the injury
Medical Bill Audit to adjust provider submitted bills to the Kentucky fee schedule
Case Management to coordinate care for the injured employee and to facilitate
return to work
Electronic Data Interchange (EDI) transmission of the First Report and
Subsequent Report of Injury to the state, as required by statute
Preferred Provider Network of occupationally oriented providers throughout
KARE also utilizes the following services of BRI Case Management in situations of severe or long term injuries:
Medical Case Management
Vocational Evaluation and Assessment
Catastrophic Case Management
Hospital Case Review
Job Analysis and Modification
Sometimes, fraudulent claims are filed. KARE works in a coordinated effort with the Kentucky Department of Workers Claims to detect and investigate any suspected claims involving workers' compensation fraud. For more information on reporting a suspected fraudulent claim or to obtain workplace posters to deter possible fraudulent claims, please call 800-554-8601.
When an injury occurs, follow the steps below:
1. For emergencies and all serious injuries (fatality, amputation, head/neck/back/spinal cord injury, or multiple employees injured in the same accident), send the injured worker(s) to the nearest emergency facility. Then, within 24-hours, phone or fax the First Report of Injury to Bluegrass Health Network (BHN). The sooner you report the injury, the sooner we can go to work for you and your injured employee(s).
Tel 502-245-8012 or 800-928-13422. For non-emergencies and medical only claims*, the injured worker should seek treatment from a BHN gatekeeper listed in the BHN provider directory, presenting his/her BHN identification card to the BHN medical provider who gives treatment. The employer should submit a First Report of Injury to BHN by mail or fax as soon as possible.
Bluegrass Health Network3. BHN's nurses will work with the medical providers and claims adjuster to coordinate medical care of your injured workers and facilitate return to work. For lost time injuries, your adjuster will contact you (employer) and your injured worker.
*A medical only claim is a simple cut, sprain, bruise, or other work-related injury for which the claimant will not miss a day of work.
As a KARE policyholder, you have access to the BHN Provider Network. For your convenience, this database is available online. To find a workers' compensation provider, simply click here and fill out the brief form.
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