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Workers’ Compensation: Who is CorVel?

If you have workers’ compensation coverage through GuideOne Insurance, you have likely heard or seen the CorVel® name. As a policyholder, you may question whether CorVel and GuideOne are the same. The two companies are different; however, GuideOne utilizes the services of CorVel in many aspects of the workers’ compensation claim handling process to help manage the risk once an on-the-job injury has occurred.

  • Panel Posters – If you are in a state that allows an employer to direct the medical care of an injured employee, it is likely that you have received a poster of suggested medical providers. These providers are from the CorVel Network and are knowledgeable about workers’ compensation guidelines and standards of care. When an employee seeks treatment within the CorVel Network, additional savings are obtained when the bill is processed.
  • Bill Review and Payment – All medical bills related to a workers’ compensation claim are reviewed and processed for payment by CorVel on behalf of GuideOne. CorVel is able to review the bill for fees related to the injury, and reduces those fees, when appropriate, according to state guidelines and contracted pricing. Professional review services of doctors and nurses are applied when questions arise regarding appropriateness or relatedness of treatment. CorVel also issues payments to the provider on behalf of GuideOne.
  • TCM program – On any workers’ compensation claim, when the injured worker has been placed off work, a Telephonic Nurse Case Manager (TCM) is assigned. The TCM, claims adjuster, and employer work together to obtain the best medical care for the injured worker. The focus of this program is to have the employee return to work as soon as medically possible, as well as return the injured worker’s health to its original state prior to the injury.
  • CoreRX – CoreRX is a pharmacy program. When medications are filled through a participating pharmacy, greater than 32 percent savings is obtained. Each injured worker is mailed a pharmacy card to use for medications related to their injury. This card can be utilized at most of the big name pharmacies (CVS, Walgreens, Wal-Mart, OSCO, Rite Aid, etc.) along with many locally based pharmacies nationwide.
  • Utilization Review/Pre-certification – Often, providers request services and/or ongoing treatments that may or may not be appropriate for the scope and severity of the injury. GuideOne sends requests for treatment to CorVel according to state regulations and internal protocols. The request for treatment and current medical records are reviewed by the appropriate medical professional for approval or denial of treatment. Treatment is rendered based on the professional review of medical personnel in the area of specialty deemed appropriate.

Although GuideOne and CorVel are separate entities, GuideOne GuideOne utilizes the services of CorVel in many aspects of claims handling. It is GuideOne’s goal to manage claims in a manner that provides quality care and services to the injured employee, yet manage the costs that impact policyholder’s premiums.

If you would like more information, please contact Christine Opfer, Workers’ Compensation Medical Operations Manager, 515-267-5166.

© 2024 GuideOne Insurance. GuideOne® is the registered trademark of the GuideOne Insurance Company. All rights reserved. This material is for informational purposes only. It is not intended to give specific legal or risk management advice, nor are any suggested checklists or action plans intended to include or address all possible risk management exposures or solutions. You are encouraged to retain your own expert consultants and legal advisors in order to develop a risk management plan specific to your own activities.