Oregon Managed Care 101

Majoris is a trusted partner in the Workers’ Compensation arena.

Our Executive team is comprised of experienced workers’ compensation experts with years of knowledge of the Workers’ Compensation Industry.

Why use an MCO?

Medical management of workers’ compensation claims supports high-quality care and controlled costs. However, in Oregon insurers, self-insured employers and TPAs are not allowed to engage in those activities. The only entities allowed to make determinations of medical necessity and appropriateness, or direct workers to a specific panel of providers are state certified Managed Care Organizations (MCOs).

Having an MCO in place equips adjusters with comprehensive medical case management, enhancing their resources for effectively managing workers’ compensation claims.

How does Majoris manage care?

Majoris utilizes a proactive case management approach, board-certified physician reviewers for all medical decisions, and a curated network of medical providers. Specific services include:

  • Proactive tracking of treatment and return-to-work plans and daily activities to ensure they are based on objective medical findings and within evidence-based guidelines.
  • Physician based medical oversight including:
    • Utilization review
    • Assistance with treatment plans
    • Peer education and conflict resolution
  • Identifying the appropriate level of care, assisting with finding providers, and scheduling appointments.
  • Streamlined dispute processes for medical issues.
How does Majoris collaborate with Insurers to support injured workers in receiving the right care at the right time?

At Majoris, we collaborate closely with adjusters by tailoring our communication to the needs of each individual claim. Our extensive expertise in the workers’ compensation arena allows us to provide adjusters with the most relevant information for effective claim resolution. Majoris also takes on the responsibility of obtaining and sharing timely medical records with adjusters.

What if I have questions about the status of a precertification request or want assistance with a claim?

Please contact the claim representative assigned to the claim. You can use our Claim Rep Lookup tool for more information.

How does it help me to have an MCO network?

Majoris maintains a workers’ compensation network of providers and facilities to treat injured workers.  Contracted providers are expected to:

  • Provide timely, complete chart notes
  • Give updated functional capacities following each appointment, with the worker being evaluated every 30 days so long as restrictions are being prescribed
  • Refer in network unless an exception is pre-approved
  • Respond timely to correspondence
  • Utilize the formal Dispute Process if they disagree with an MCO decision

Majoris offers a unique medical review process that ensures high-quality care from enrollment to resolution. We proactively monitor key events, maintain regular communication with claims adjusters and managers, and leverage our physician reviewers to handle complex cases. Our approach includes:

  • Proactive File Review Medical Management
  • Medical Treatment Reviews by Board-Certified Physicians
  • Evidence-Based, Peer-Reviewed Guidelines
  • Physician-to-Physician Treatment Collaboration

Additionally, we address common concerns within the workers’ compensation system with innovative programs like our prospective opioid management and sprain/strain programs. This ensures treatment plans and physical restrictions are informed by objective findings, are focused on the work injury, and incorporate a progressive return to work and life activities. The result is higher quality care and significant long-term savings.

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Better networks create better results.

Majoris is selective in the providers we partner with, seeking those who understand the unique demands of treating workers’ compensation patients and who meet high credentialing standards. Our provider relations staff keeps in close contact with our providers to support strong relationships, providing training on workers’ compensation best practices and outreach on individual cases experiencing administrative stall-outs.

When there are questions about treatment, providers can expect to speak with a board-certified physician with a background in treating injured workers. Our outreach is centered on collaboration, with the goal of finding the right treatment plan for each patient’s unique needs.

Credentialing

Credentialing goes beyond confirmation of licensure and malpractice history – we look at past treatment records to ensure there is evidence of sound medical reasoning, reliance on objective medical findings and integration of daily activities and work into the overall rehabilitation plan.

Best Practice Standards

To support their responsibilities as a provider of care to injured workers, Majoris developed a series of guidelines, protocols and techniques to facilitate efficient delivery of care within the workers’ compensation framework. This includes support of other stakeholders’ responsibilities.

Our provider manual offers a road map of best practice, streamlining the flow of required information to reduce effort and administrative burden for all. Our treatment guidelines are derived from evidence-based medicine and specific to the workers’ compensation patient population when the data is available.

All network providers have committed to following these best practices, and our provider relations team provides hands-on support when needed to ensure information is received and timelines are met.

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We utilize sophisticated IT solutions, featuring customized programs and advanced data interfaces. The result is seamless collaboration with all stakeholders and high data integrity. Our cutting-edge technology streamlines operations, enhances communication, and drives effective collaboration.

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