PMA California MPN Implementation Materials

Medical inflation impacts claims costs for employers. PMA invests in numerous programs to manage costs, provide quality health care to injured workers and produce satisfaction among injured employees. We understand the link between escalating medical costs, higher insurance rates and overall business costs-and how innovative medical savings strategies can reduce the financial impact on your business. Early intervention and return to work as soon as it is medically safe is our focus.

Superior Disability Management - PMA's Disability Management Coordinators and Case Managers are registered nurses, most with Certified Case Manager designations. Disability and medical case management begins within 24 hours after injury notification. Our three levels of disability management include telephonic case management, on-site management for complex workers' compensation injuries, and for catastrophic case management, we partner with a nationally recognized specialist.

Preferred Provider Network (PPN) - PMA provides injured workers with access to a network of carefully credentialed providers who offer quality medical care at preferred rates. PMA's PPN includes a broad network of hospitals and medical providers, so injured workers have many providers from which to choose. We also offer our clients the option of nominating new providers to our network.

Medical Bill Review - Our multi-step program is designed to realize savings by identifying inappropriate medical charges. PMA's Customer Service Center and medical bill repricing software review all medical bills. Bills with more complex coding combinations and clinical reports are reviewed by our Medical Cost Containment Team of coding and nursing professionals.

Out of Network Negotiation Program - Our Out of Network Negotiation Program targets costly medical bills from providers that are outside of our Preferred Provider Network, often generating additional savings below submitted charges, traditional state fee schedule rates, or usual and customary charges on these bill types. Enhanced savings are achieved on medical bills received for ambulatory surgical services, outpatient hospital services, inpatient hospital services, durable medical equipment, emergency room treatment and ambulance services.

Pharmacy Benefits Management Program - Our program helps to address rising prescription drug costs by providing discounts on drugs at nearly 50,000 pharmacies nationwide. Injured workers can access an array of pharmacies and incur no out-of-pocket costs.

Return-to-Work Program - A comprehensive, easy-to-execute program is available for PMA clients, incorporating the best practices from PMA's expertise in returning thousands of workers to productive employment. From the first report of injury, our disability management program has a return-to-work focus and transitioning the employee safely back to work once it is medically safe. You can count on PMA professionals to act as your expert resource, guiding you through the RTW process.