Managed Care Network |
Anti-Fraud Services |
How to Report a Claim |
Find a Provider 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 the state 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 Expert Testimony Catastrophic Case Management Hospital Case Review Job Analysis and Modification ADA Consulting 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. About KARE | Agent Locator | Regulatory News | Newsletter Archive Policyholders | Agents | Why Choose KARE? | Contact Us | Home Copyright © 2001-2002 Kentucky Association of Responsible Employers. All rights reserved. Questions or comments about this site? We welcome your feedback. Experiencing technical difficulties? Contact our webmaster. Site created & maintained by iCOM |
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