Medical

The Medical page, available for selection from the Details menu, allows you to view medical information on the ICD, Treatment, Case Management and Provider tabs for the selected workers' compensation or disability claim. For general liability claims, only the ICD tab is displayed. This page allows you to track managed care vendor information, treatment plan entries and managed care referrals. If the client is utilizing electronic automation for managed care, this information will be populated by the managed care vendor.

Note: For general liability (GL) claims, only the ICD tab is displayed.

Note: Please refer to the Claim Header Information help file for documentation regarding fields appearing in the header information of the Medical page.

ICD Tab

The ICD (International Classification of Diseases) section lists ICD code numbers, along with descriptions that exist for the claim. The table below describes the information found on the ICD tab of the Medical page:

ICD Tab

Field	Description
Provider Search Tool	Click this link to access the viaOne Provider Search website and look up medical provider information. Note: This link is only available to clients using Sedgwick bill review services.
Effective Date	The date the ICD code went into effect. Click the dropdown to select another effective date, if desired.
Primary ICD	The primary ICD code, indicating the primary disability diagnosis. This field is updated by the managed care vendor, such as Sedgwick Managed Care; if the client has not selected Care30 or Early Assessment, this field will be blank.
Groups	The group the ICD code belongs to
Description	The description of the primary ICD code
Body Side	Indicates if the injury supporting the ICD code affected the claimant’s Anterior, Bilateral, Left, Posterior, or Right side.
Body Parts	The body part description associated with the ICD code.
Status	Decision of the acceptance of the ICD code. This is not related to the claim but to the individual ICD code. Options include Accepted, Denied, and Pending Investigation.
Date of Onset	Date of the first appearance of the signs or symptoms of ICD code.
Date Resolved	Resolution date for specific ICD code.
Objective Findings	Supporting medical evidence of verifiable indications to support the ICD code.
Subjective Findings	Claimant’s symptoms to support the ICD code.
Mid Range Days	The number of mid-range days.
Mid Range Date	The mid-range date for the recommended RTW (Return to Work) date range.
At Risk Days	The number of at-risk days.
At Risk Date	The at-risk date for the recommended RTW (Return to Work) date range. This is the date when the claim needs to be reviewed because the claimant has been off-work for an extended period of time. While the at-risk date is not outside the recommended date range for the specific injury/illness, it is close enough to the end of the date range to cause concern.
Calendar Days Away from Work Decile	The recommended return to work days range with the minimum duration date displaying at 10% and the maximum duration date displaying at 90%; percentages are based on the length of time it took people with a similar injury/illness to return to work (for instance, if there are 14 days in the 50% rate, half of those with a similar injury/illness returned to work within 14 days)
RTW Best Practice	Indicates the best practice selected by the claims examiner for returning the claimant to work (based on the claimant's occupation and injury/illness; A description of the best practice is provided.
RTW Duration	The duration for the best practice. This RTW duration is measured from the time the practice is begun to the Mid Range Date of the practice (measured in the number of days from today). For example, if the duration of a best practice is 0 - 7. the best practice would begin today and reach the Mid Range Date seven days from today.
Additional ICD Codes
ICD Code	Click to select an additional ICD code (ICD 2-20) and view its details below. ICD 2 is entered by the JURIS claims  examiner. The remaining ICD codes are updated by the bill review vendor and may change with each bill received.
ICD	ICD code and version number.
Groups	Group the selected ICD code applies to.
Body Side	Indicates if the injury supporting the ICD code affected the claimant’s Anterior, Bilateral, Left, Posterior, or Right side.
Body Parts	The body part description associated with the ICD code.
Status	Decision of the acceptance of the ICD code. This is not related to the claim but to the individual ICD code. Options include Accepted, Denied, and Pending Investigation.
Date of Onset	Date of the first appearance of the signs or symptoms of ICD code.
Date Resolved	Resolution date for specific ICD code.
Objective Findings	Supporting medical evidence of verifiable indications to support the ICD code.
Subjective Findings	Claimant’s symptoms to support the ICD code.

Treatment Tab

The Treatment Plan section allows you to review information regarding treatment plans, such as beginning and ending dates for the treatment plan, the CPT code and description.

The table below describes the information found on the Treatment tab of the Management page:

Treatment Tab

Field	Description
Initial Treatment	Indicates what type of medical treatment the employee initially received. These are the IAIABC (International Association of Industrial Accident Boards and Commissions) initial treatment codes; Options include the following: 1 - No Medical Treatment 2 - Minor On-Side remedies by Employer 3 - Minor Clinic/Hospital Remedies and Diagnostic Testing 4 - Emergency Evaluation, Diagnostic Testing and Medical Procedures 5 - Hospitalization Greater than 24 Hours 6 - Future Major Medical/Lost Time Anticipated, i.e. Hernia Case
Doctor's First Report	Indicates Y (Yes) if the doctor's first report was received, or N (No) if not
Starting Date	The beginning date for the treatment plan
Ending Date	The ending date for the treatment plan
Code	The CPT (Current Procedural Terminology) code
Description	The CPT code descriptions
Units Required	The required number of units for the CPT code
Units Approved	The approved number of units for the CPT code
First Date of Treatment	Start date of treatment
Last Appointment Date	Date of most recent appointment
Next Appointment	Date of next scheduled appointment
Hospitalized From	Start date of hospitalization
Inpatient/Outpatient Surgery	Defines type of hospitalization
Estimated Due Date	Due date of claimant, if time loss is for pregnancy
Show [#] Records Per Page (Update)	To expand the list of treatment plans, enter the number of records you wish to display in the Show [#] Records Per Page field and click the Update link

Case Management Tab

Note: Due to Montana state law restricting insured employers’ access to claim information, this tab is not available to client users viewing an insured workers’ compensation claim under Montana’s jurisdiction.

The table below describes the information found on the Case Management tab of the Management page:

Case Management Tab

Field	Description
Trigger Description	The description of the trigger
Date Referred	The date the trigger was referred
Triggered By	The circumstances that created the trigger, if applicable
Starting Date	The date the referral started
Referred By	The person or entity making the referral
Type	The type of managed care program used for the referral; options include the following: 30 - Telephonic Case Management EA - Early Assessment UR - Utilization Review
Status	The status of the referral; options include the following: Accept - New referrals will have a status of Accept Reject - Referrals with a status of Reject will always come from Sedgwick Managed Care
Rejected By	The login of the user who rejected the referral
Date Closed	The date the referral was closed

Provider Tab

The Provider tab allows you to view managed care referral information. The table below describes the information found on the Provider tab of the Management page:

Provider Tab

Field	Description
Type	The type of provider/facility
Provider/Facility	The name of the provider/facility
Address	The address of the provider/facility
City	The city in which the provider/facility is located
State	The state in which the provider/facility is located
Zip	The zip code in which the provider/facility is located
Show [#] Records Per Page (Update)	To expand the list of providers, enter the number of records you wish to display in the Show [#] Records Per Page field and click the Update link
Requested	The number of days requested for the claimant's hospitalization
Approved	The number of days approved for the claimant's hospitalization
Admitted	The date the claimant was admitted to the hospital
Released	The date the claimant was released from the hospital
Days Saved	The calculation of the approved length of stay less the actual length of stay (hospital release date - the hospital admitted date)
Hospitalized	Indicates Y (Yes) if claimant was hospitalized or N (No) if not
Date	The date the claimant was hospitalized, if applicable
Surgery	Indicates Y (Yes) if claimant underwent surgery or N (No) if not
Date	The date the claimant underwent surgery, if applicable
In/Out-Patient	Indicates In (In-Patient) or Out (Out-Patient)

Tip: You can sort data in ascending or descending order by clicking on the desired column heading.