State Fund has partnered with Anthem Blue Cross to assist in the management of the medical care of injured employees. In 1994 Blue Cross, a subsidiary of WellPoint Health Networks Inc., began development of a program to integrate group health and workers' compensation. What has evolved from this continued effort is the Anthem Workers' Compensation (AWC) business unit of Anthem Blue Cross Life and Health (Anthem).
AWC has taken the strengths and experience of their group health managed care programs and molded them into a sound workers' compensation program.
Blue Cross provides State Fund with the following services:
The State Fund claims examiner and Blue Cross work together to ensure that whenever possible, the provision of medical care and treatment for an accepted industrial injury is actively channeled to a facility in the Blue Cross network. The Blue Cross network of hospitals and providers is the largest in California.
Blue Cross also provides utilization management review for each network inpatient stay. This review includes the determination of the appropriate length of stay and the level of care.
The constant communication between the Blue Cross representatives and State Fund claims examiners is what truly makes this program shine. For example, a Blue Cross representative apprises the claims examiner of the status of the inpatient stay, provides recommendation for post-acute care and/or services prior to discharge, and confirms when the injured employee has been discharged from the hospital.
Access to the Blue Cross provider network helps State Fund control medical claims costs. Additional savings are realized from Blue Cross's review of appropriate length of stay and level of care for hospital admissions. Through these controls State Fund can assist employers with the reduction of their workers' compensation claims costs.
The extensive Blue Cross network of facilities offers many locations throughout the state. If one of your employees experiences a work-related injury and you have reported it to State Fund, the claims examiner and the Claims Reporting Center will make every effort to channel the injured employee to a Blue Cross network facility.