CSG's Workers' Compensation programs offer employers an integrated, proactive approach to managing work-related injuries and controlling costs. CSG serves as a managed care and PPO partner, guiding each case to optimal MMI and RTW outcomes. From the time of injury through the end of the treatment path, the CSG case manager ensures the injured worker receives timely and medically necessary treatment 24/7 and 365 days per year. CSG's Medical Management programs result in savings throughout each facet of delivery.

Medical Ability

CSG's proprietary program of nurse assessment, care coordination and cost projections delivers efficient, cost effective recovery. Nurses coordinate all care through our CHN PPO network, which offers highly-credentialed providers specifically skilled in diagnosing and treating workplace injuries. The network includes providers in all medical subspecialties, home care, support services and inpatient and outpatient facilities. We can also develop customized provider panels targeting specific geographic locations according to client objectives.

Technical Agility

With CSG's proprietary medlogix® software, claims professionals can access the ongoing medical management of a workers' compensation file in real time, tracking step-by-step case progress for services such as nurse medical case management, case status, provider billing and IME status. Nurses and claims managers communicate online in real time, receiving automatic alerts when there is a change in work status, compensability or other relevant item. Each user receives a login and password to access the software, and case-specific alerts appear when logging in so both the adjuster and case manager are aware of each other's activities on the file.

Report A Claim

Three ways to report an injury:

Please remember to have the following information when reporting:

  • Name of employer
  • Name, address and social security number for the injured worker
  • Employee's current wages
  • Current contact numbers (home phone/cell)
  • Injured workers' job title and department
  • Date, time and description of injury

No Medical Treatment Requested

Available Services

Our First Report of Injury (FROI) services make it easy for employers to report on-the-job injuries and begin the workers' compensation claims process. CSG provides 24/7 claim intake via web referral, fax or phone. Additionally, we complete all state-required accident forms and submit them to the appropriate parties in hard copy or EDI format. From the moment we receive the injury report, our proficient, knowledgeable case managers ensure claimants receive the highest quality, most appropriate care. Our seamless, technology-driven service model provides efficiency, reporting, data and analytics from the onset of injury and throughout the claims process.
CHN offers a specialized PPO product specifically tailored to workers' compensation. This customized Exclusive Provider Organization (EPO) is comprised of panel providers in geographic locations, who specialize in the diagnosis and treatment of work-related injuries. Some of the specialties offered include primary care, occupational medicine, orthopedics, physical therapists, surgeons, urgent care facilities, hospitals and trauma centers. All providers undergo CHN's rigorous credentialing process with re-credentialing every two years in accordance with industry standards. Provider panels are jointly created by CHN's network development team in conjunction with CHN's clinical staff. These select providers deliver the most effective care and results for work-related injuries.

The direct oversight of a medical professional provides valuable guidance for complex or catastrophic cases, or those that are not progressing as expected. Nationally certified registered nurses (CCM and/or CRRN) with three to five years of catastrophic case management experience assess and coordinate treatment by working with medical care providers, employers, attorneys, injured persons and their families to ensure quality health services are delivered in a cost-effective manner. The result is decreased hardship to individuals and their families/significant others as a result of their injuries and reduced financial exposure for insurers and self-insurers.

Case management is directed toward:

  • Early identification and assessment
  • Discharge planning
  • Planning for complications
  • Identifying appropriate physician, facilities and outpatient referrals
  • Avoiding unnecessary hospital admissions
  • Negotiating appropriate rates and levels of care

Requested for serious injuries and catastrophic claims, Lifetime Cost Projections (LCP) provide a comprehensive evaluation of current and future treatment needs and expected medical costs associated with the treatment plan. Case management professionals perform an extensive review of the claim file and medical history and deliver a comprehensive report, along with supporting documentation.

Services include:

  • Case assessment (Cost projections and care plan projections)
  • Medical records review
  • Case synopsis
  • Contact with injured party, necessary care givers and product suppliers
  • Evaluation of future treatment needs
  • Evaluation of future cost, life expectancy
  • Detailed report with electronic submission
  • Rated Age Life Expectancy Projection

CSG provides a highly advanced bill review system powered by medlogix® -- our proprietary, web-based platform for managing claims information. This seamless, integrated platform provides real-time claims data 24/7 and meets all local, regional and national jurisdiction requirements. Utilizing this powerful system, CSG bill reviewers evaluate the diagnosis relationship, medically necessary treatment and properly coded billing patterns against the corresponding covered loss. medlogix® automatically scans for duplicates and matches treatment codes to actual documented treatment. The bill reviewers utilize this technology to identify improper coding or billed services that may require further scrutiny. Where appropriate, they reprice provider, facility and ancillary service bills. They also apply preferred provider adjustments or, if preferred provider discounts do not apply, refer bills for out-of-network negotiations. The result is the utmost in efficiency and savings for our customers.

medlogix® software employs the following automated analyst edits for all applicable state medical fee schedules and rules, including the following:

  • Current and past state-specific medical fee schedules by regions
  • Applicable PPO fee schedules by region
  • Applicable U&C calculation schedules, where appropriate
  • Multiple procedure reduction formula calculations
  • Modifier calculations
  • Trauma facility flags
  • Policy limit flags
  • Deductible and co-payment calculations
  • Interest calculation
  • Crosswalks (correction of invalid code to a valid code, V-codes, ICD-9, NDC and CPT)
  • NCCI edits
  • Duplicate bill and line checking indicators
A Certified Nurse will perform desktop or onsite hospital and provider auditing and review records to ensure all services billed are causally related and properly documented. CSG requests all pertinent information necessary for the review (provider bills, medical authorizations and medical records). Results are documented and recommendations made for payment.

Our robust, multi-specialty network of IME providers delivers objective assessments to determine the medical necessity of treatment while demonstrating fairness and respect for the injured person. Our highly-credentialed network includes over 35,000 IME providers representing all relevant medical specialties. We also offer IME service in all 50 states through our coast-to-coast network of affiliate partners.

Services include:

  • Expert medical evaluations
  • Medical expert testimony
  • Registered nurse review and consultation
  • Record and chart reviews
  • Concise medical reports supported by contact/coordination
  • Immediate notification when an appointment is missed
A division of CSG, CHN PPO is a leading preferred provider organization serving the northeastern United States with over 140,000 health care provider locations. A proprietary network with all providers directly contracted, CHN's cornerstone is top-quality health care providers. Through these direct network contracts and a national network of PPO affiliates, CHN delivers a coast-to-coast competitive edge to the clients we serve. By partnering with select regional PPOs that meet our rigorous standards for credentialing, accessibility and cost savings, CHN offers seamless national PPO access to our clients.

CSG's dedicated telephonic case managers ensure medically appropriate care by assessing medical needs and evaluating treatment options. Treatment management is initiated with triage at the time of injury and continues through all treatment paths. Outcomes are measured by comparing nationally accepted guidelines. Nurse case managers provide constant communication with the adjuster, treating provider, employer and injured worker. CSG physician advisors and nurse case managers gather data, share information and provide ongoing assessments. Their clinical assessment is compared to that of the treating provider and variances are discussed. A proactive course of treatment is mutually agreed upon and an appropriate return-to-work program is implemented through a cooperative team effort.

Case management is directed toward:

  • Early identification and assessment
  • Discharge planning
  • Planning for complications
  • Identifying appropriate physician, facilities and outpatient referrals
  • Avoiding unnecessary hospital admissions
  • Negotiating appropriate rates and levels of care

Through our pharmacy benefit management partners, CSG offers a complete solution for prospective, concurrent and retrospective prescription management that helps our clients manage prescription drug costs, ensures adherence to approved guidelines and provides claimants with convenient access to medications. Our integrated approach to clinical management identifies key opportunities to reduce the total pharmacy costs. Combining health care expertise with advanced technology, we help injured people return to health and make the adjuster's job easier.

CSG's pharmacy benefit management program offers:

  • Transactional services, such as network administration, provider communications, first fill programs, card administration, POS processing, mail order, out-of-network management, call center support, payment and billing.
  • Clinical services, such as formulary management, clinical red flags, utilization review services, drug trends analysis and quality measurement.
  • Strategic services, such as customized strategy and product development, integration with bill review and outcomes measurement.
For cases that require a physician review to determine medical necessity, CSG provides access to highly-credentialed medical directors to provide professional guidance regarding the appropriate treatment of worksite injuries. CSG maintains a full staff of multi-specialty medical directors in all appropriate specialties, which includes numerous medical directors on-site at CSG's customer service center. CSG's technology-enabled medical director review services deliver complete and defensible recommendations. Our robust medlogix® technology distills multi-page medical record documents into one digital file that is easy to access, read and utilize. The result is a more efficient process, increased accuracy, more complete and defensible information, and a more positive interaction with the treating provider.

A CSG coding professional reviews the CPT-4 and ICD-9/ICD-10 coding of outpatient services by physician, diagnostic, therapeutic, and durable medical equipment companies to assess and resolve inappropriate billing practices. CSG's code review services are performed by a team of highly skilled registered nurses with years of coding experience. Codes requiring review can be customized based on client needs and are triggered during the bill review adjudication process to ensure provider billings are not unbundled, fragmented, up-coded, unrelated or otherwise improperly coded according to national or regional billing practices. When a provider bills with modifiers, the coding professional reviews the documentation to confirm the use of the modifier is supported, adjusting the provider bill and removing the modifier, where necessary.

Services include:

  • Full review of HCFA 1500 or UB92 and associated medical records
  • Detailed revision of medlogix® EOR
  • Provider contact (if necessary)
  • Response to provider if rebuttal to assessment decision occurs

Bill negotiations reduce the costs of medical bills from providers and facilities not participating with a provider network for total cost management. The negotiation team proceeds with a review of UCR, Medicare, claims utilization history and in-network payment rates to aggressively negotiate with non-network hospitals, physicians, and ancillary health care providers to reduce costs.

CSG's Bill Negotiation program includes:

  • Direct negotiations by experienced, highly-skilled negotiators with expertise and knowledge of rate levels
  • Signed Letters of Agreement from providers
  • Prospective and retrospective negotiations
  • Customized referral criteria

When a face-to-face evaluation is not required or possible, our network of fully credentialed and board certified physicians can provide a retrospective review of treatment to quickly and competently determine whether care provided was medically necessary and causally related. Our panel of physicians are required to have their own functioning practice and must be willing to testify in the event of a dispute.

The end product will include:

  • Quality assurance review by a nurse to ensure all questions have been answered and clinical documentation has been used
  • Conclusive determinations on the issues of medical necessity and causality
  • Turnaround time of 5-7 business days
  • Full compliance of all state regulations