Injury Response

Adopt a formal program for both point-of-injury response and post-injury follow-up and contact. This includes displaying a positive and concerned response to an injury and maintaining regular contact with the employee until he or she is back on the job.

Channeling to Medical Providers

Promote and publicize your medical provider panel before workplace injuries occur. Ensure your supervisors and managers are familiar with the designated medical providers and train them to recommend the occupational medical provider for initial care in non-emergency situations.

Return to Work

OneBeacon® manages workers compensation claims to promote your employee’s recovery and quickest possible return to work. OneBeacon also works directly with employers to return employees to transitional work whenever possible. Getting injured employees back to work is our primary focus.

Medical Cost Containment - OneBeacon Insurance Group

Management of the medical expense portion of a claim is critical. Medical claim costs can escalate quickly, so OneBeacon works with key partners to deploy a full array of cost containment programs. These programs begin immediately after an injury occurs and will continue as long as treatment is medically necessary. Our cost containment programs include:

Preferred provider organizations:

Genex Provider Pathways is utilized for CO, CT, GA, MA, MN, NJ, NY, PA, and VA

  • Accessing the Genex Provider Pathways Channeling Site:
    • Go to: www.genexservices.com.
    • Click Find a Provider/Genex Provider Pathway (top right)
    •  Login with Username: One and Password: Beacon 
  • Features:
    • Search for Network Providers by address, name and region
    • Create Work Site Posters

If you have any problems accessing Genex Provider Pathway, contact GenexProviderPathway@genexservices.com

 


California MPN

  • To search for providers, please visit: www.coventrywcs.com.
  • Select “Client Login & Tools” in the top right center of the homepage.
    • Enter Client ID: BEA and submit
  • Select channeling tools 
    • Allows you to search for a Network Provider by address, name and region
    • Allows you to create Work Site Posters
  • The requirements for CA employers can be found in the publication: Atlantic Specialty Insurance Company-Select MPN or Rhode Island Employers with California locations.
  • The MPN provides MPN Medical Access Assistants within the United States who are available Monday – Saturday, 7:00 a.m. to 8:00 p.m. Pacific Time to provide employee assistance with access to medical care under the MPN.
California MAA Contact California MPN Contact
Phone: 888.937.1663
Fax: 866.819.8201
Email: CAMPNMAA@onebeacon.com
Jonny Buell
Sr. Claim Representative
Phone: 877.440.6274
Fax: 866.984.5094
jbuell@onebeacon.com

Coventry’s First Health is utilized for all other States which are handled by Gallagher Bassett:

KY, LA & TX have specific requirements regarding the use of a PPO to direct care. If you print a posting notice from the Coventry website for any State it will be in compliance with the States jurisdictional rules.

Pharmacy First Fill Program 

  • First Fill Program – A prescription drug card program designed to ensure that the injured worker receives their initial medication as soon as possible after sustaining an injury, even before the claim is accepted as compensable.  This program provides access to our national network of over 60,000 pharmacies with NO out-of-pocket costs for the injured worker.  There is an $85 cost limit and a 10 day supply limit and the temporary card expires 30 days after the injury.
  • Once a claim is accepted as compensable, generally within 7-14 days, a personalized prescription card will be mailed directly to eligible claimants allowing full refills of covered prescriptions. 
  • Our PBM’s will absorb the cost of the first fill prescription if the claim is later denied or the medications are unrelated to the injury.  OneBeacon covers the costs of the first fill prescriptions for injury related medications that are medically necessary on claims that are ultimately accepted as compensable.
    • For CA, CO, CT, GA, MA, MN, NJ, NY, PA & VA, our Pharmacy Benefit Manager is TMESYS.  To locate participating pharmacies, please visit www.tmesys.com
    • For all other States, the Pharmacy Benefit Manager is FirstScript.  To locate participating pharmacies, please visit www.firstscript.com

Telephonic Nurse Case Management

Our telephonic nurse case management program is designed to ensure the injured worker’s medical treatment is proceeding appropriately  for his or her injuries, resulting in enhanced medical care, cost-effective medical treatment, and the earliest possible return to work. Our collaborating professional nurses work closely with insureds, injured workers, their physicians and our workers compensation claims professionals to establish and implement return-to-work programs for employees who have suffered serious injuries.

Catastrophic Injury Management

OneBeacon partners with a vendor specializing in the management of catastrophic injuries to ensure the most challenging injuries receive coordinated medical treatment and quality, cost-effective medical care.

Hospital Bill Review

Through our hospital bill review program, we review hospital bills for accuracy, necessity of services, questionable charges and duplicate billing.

Provider Bill Review

To help manage the ever-increasing cost of medical care, we employ several cost control methods, including the use of a sophisticated medical bill review program. We partner with a leading bill review vendor that allows us to leverage a state-of-the-art bill review system to help prevent duplicate payments, avoid payments for unrelated charges and reduce medical payments to appropriate amounts.

Utilization Review

OneBeacon utilizes a program providing expert review and consultation with doctors and nurses regarding the appropriateness, timeliness, and cost-effectiveness of proposed medical treatment for in-patient and out-patient services.