Corvel's Business Segments

CorVel is a national provider of workers’ compensation solutions for employers, third party administrators, insurance companies, and government agencies seeking to control costs and promote positive outcomes. The Company applies technology, intelligence, and a human touch to the challenges of risk management so that their clients can intervene early and often while being connected to the critical intelligence they need to proactively manage risk. CorVel specializes in applying advanced communication and information technology to improve healthcare management for workers’ compensation, group health, auto and liability claims management. With a technology platform at its core, the Company’s connected solution is delivered by a national team of associates who are committed to helping clients deliver programs that meet their organization’s performance goals.

The Company’s services include claims management, bill review, preferred provider networks, utilization management, case management, pharmacy services, directed care and Medicare services. CorVel offers its services as a bundled solution (i.e. claims management), as a standalone service, or as add-on services to existing customers. Customers of the Company that do not purchase a bundled solution generally use another provider, use an in-house solution, or choose not to utilize such a service to manage their workers’ compensation costs. When customers purchase several products from CorVel, the pricing of the products sold is generally the same as if the product were sold on an individual basis. Bundled products are generally delivered in the same accounting period.

CorVel Corporation provides a comprehensive range of solutions designed to manage and reduce healthcare costs for employers, insurers, and self-insured entities. Their services are broadly segmented into several categories aimed at optimizing both medical care and claims management efficiency. Below is a detailed description of CorVels segments, products, and services.

1. Network Solutions

CorVel’s Network Solutions encompass various services aimed at providing medical savings on both in-network and out-of-network medical bills. Key offerings in this segment include:

- PPO Management: Management of Preferred Provider Organization (PPO) networks to facilitate reduced healthcare costs through pre-negotiated rates with providers.
- Specialty Networks: Access to tailored networks for specific medical specialties, ensuring quality care.
- Medical Bill Repricing: Strategies to negotiate bill reductions before payment.
- True Line Item Review: An in-depth analysis of each billed line item to validate charges.
- Expert Fee Negotiations: Access to professional negotiators who aim for better pricing on claims.
- Professional Nurse Review: Clinical evaluation by registered nurses to ensure appropriateness and compliance in billing.
- Automated Adjudication: Streamlined processes for claim approval and payment.
- Electronic Reimbursement: Facilitation of electronic payments to streamline transactions.

These features collectively enhance processing efficiencies while maximizing cost-savings opportunities for payors.

Bill Review Services

CorVels proprietary bill review process is designed to meet the requirements of state-mandated fee schedules, focusing on faster turnaround times and higher savings. Utilizing an advanced artificial intelligence engine with over sixty million individual rules, the services include:

- Coding Review and Re-bundling: Evaluation of coding for accuracy and consolidation of services for cost optimization.
- Reasonable and Customary Review: Ensuring billed services align with typical community charges.
- Fee Schedule Analysis: Assessment of payments in relation to state-mandated fee structures.
- Out-of-Network Bill Review: Special handling for claims outside of network agreements.
- Pharmacy Review: Examination of pharmacy bills for accuracy and compliance.
- PPO Management and Repricing: Continued management of negotiated rates and reductions on bills.

CERiS™ Enhanced Bill Review Program

This program provides claim payors with the capability to adjust line item charges to reasonable levels while identifying billing errors through a thorough professional review process, including:

- Universal Chargemaster: This proprietary tool defines each charge code, enabling precise error identification and billing corrections.

Professional Review Services

CorVels professional review services audit facility bill accuracy, ensuring compliance with established industry standards through experienced nurse auditors with clinical backgrounds in all medical disciplines.

Provider Reimbursement

This feature automates provider reimbursement processes, enabling clients to track expenses and manage billing more effectively. It incorporates check-writing capabilities or direct integrations for provider payments.

Pharmacy Services

CorVels pharmacy program includes:

- Formulary Management: Managing drug lists for optimal patient care.
- Discounted Prescriptions: Financial savings off retail prices for prescriptions related to workers compensation.
- Utilization Management: Monitoring drug interactions and ensuring compliance with therapy protocols.
- Client Access: Streamlined processing and management for pharmacies at the point of sale, including options for mail order and 90-day retail prescriptions.

Directed Care Services

The national directed care network facilitates access to specialty services, including:

- Medical Imaging and Diagnostics: Collaborations with imaging and therapy service providers to ensure timely care.
- Coordinated Care: A focus on managing the patient experience from scheduling through reimbursement.

8. Medicare Solutions

CorVel offers administrative services to assist clients in managing Medicare requirements, particularly focusing on:

- Medicare Set Asides: Planning for future medical costs related to work injury claims.
- Agent Reporting Services: Assisting with compliance and reporting for insurers and employers as required by CMS.

9. Clearinghouse Services

CorVels clearinghouse services automate the conversion of electronic claims into formats suitable for payment, ensuring compliance and streamlining workflows.

10. Patient Management

An integrated claims administration approach advocating medical management to achieve cost reductions and promote quicker recovery. Services include:

- Personalized Treatment Programs: Automated solutions tailored to individual needs.

11. Claims Management

CorVel has been active in claims management since 2007, with features that include:

- Comprehensive Reporting: Including insights into claim status and history.
- Automated First Notice of Loss: Streamlined processes for reporting claims.
- Expert Claims Handling: Focused on all aspects from intake through resolution.

12. Case Management

This service encompasses all areas of disability management, including early intervention, telephonic support, and ongoing treatment reviews.

13. 24/7 Nurse Triage

Injured workers can receive immediate consultation from registered nurses to assess their conditions and direct them to appropriate care.

14. Utilization Management

Monitoring proposed medical care for cost-effectiveness and necessity, resulting in reduced expenses through efficient treatment planning and oversight.

15. Vocational Rehabilitation

Focused on creating pathways back to employment for injured workers, this service includes job-seeking skills training and career counseling.

16. Life Care Planning

This service projects long-term needs and associated costs for catastrophic injuries, aiding families and insurers in strategic planning for care.

1 Disability Management

A comprehensive program that promotes an early return to work, incorporating evaluations and reporting across various aspects of disability management.

18. Liability and Auto Claims Management

CorVel also serves the liability sector with services that combine claims management and analytics to reduce costs and mitigate risks associated with injuries and accidents.

Through these extensive offerings, CorVel Corporation provides robust solutions that address the diverse needs of clients in managing healthcare costs, claims processes, and patient care efficiently.