One Call Care Management Outlines Best Practices for Workers’ Comp Dental Claims

Dental injuries that occur on the job are challenging, complicated, and costly for workers’ compensation programs, according to Laura Gorman, RN and vice president of Clinical Sales at One Call Dental + Doctor.

Gorman presented a session on “Managing Dental Claims” at the Northeast Occupational Health & Safety Conference in Wilkes-Barre, Pa., earlier this month. The course aimed to educate industry professionals to better enable them to cope with dental injuries when they arise.

“Given the infrequency with which dental injuries occur, workers’ compensation and occupational health professionals are often unfamiliar and inexperienced in handling these cases, and don’t know how to get injured workers the care they need to return to work promptly,” said Gorman. “My course provides a basic understanding of dental terminology, procedures and specialists, so occupational health professionals have the knowledge they need to manage these injuries, facilitate appropriate treatment, and contain claims costs.”

An employee may slip and fall, chipping his tooth, or may be hit by a moving object, resulting in several knocked out teeth. When these types of worksite accidents happen, One Call assists by connecting injured workers to qualified, credentialed dentists nationwide. Its dental team provides clinical oversight and administrative support to move dental claims along the continuum of care, while avoiding unnecessary procedures and treatment delays.

“A major challenge is traditional dental insurance encourages a dentist to treat a patient’s whole mouth to achieve optimal oral health, but in workers’ compensation, without proper clinical oversight and guidance, this approach may lead to overtreatment, as dentists address issues unrelated to the injury, such as periodontal disease or gingivitis, which would not otherwise be covered by workers’ compensation,” explained Gorman.

One Call ensures its dental providers perform a prospective oral evaluation to determine what conditions are related to the workplace injury and what procedures should be covered in order to restore full functionality to the claimant’s mouth. One Call works with dentists to present a treatment plan to claims adjusters or nurse case managers for review and approval. The company also assists dentists in completing the documentation, administrative requirements and billing procedures necessary in workers’ compensation.

To find out more about One Call’s dental claims services and clinical expertise, or to schedule a dental CEU for your claims team, contact Laura Gorman (Laura_Gorman@onecallcm.com). One Call clinicians will also be attending the National Workers’ Compensation & Disability Conference (Las Vegas, Nov. 19-21, 2014), addressing various workers’ compensation issues at its clinical booth #1456.

Source: One Call Care Management