Q. What is a CWMP?

A. A Certified Workplace Medical Plan is a detailed and comprehensive
managed care system that enables an employer to effectively and
efficiently coordinate medical care for an employee who is injured on
the job.

Q. How does a CWMP work?

A. When an employee becomes injured, he/she will give immediate
notice of the injury to the employer unless the injury requires
emergency care. For emergencies, notice should be given as soon as
practical after care is initiated for the employee at the nearest
appropriate facility.

The employer or employer’s insurance company/TPA/adjuster will provide notice of the injury to CompCHOICE to initiate medical oversight and management for employees when the level of care meets or exceeds levels of medical complexity or “triggers”. CWMP case management triggers are approved by the Oklahoma State Department of Health.
Throughout the course of an employee’s treatment, the Case Manager does the following:

  • Communicates with the employee and treating physician and other providers;
  • Informs the employer and risk bearer regarding expected length of treatment and estimated return to work; and
  • Informs the risk bearer regarding the diagnosis, treatment options, prognosis, and the expected cost of the treatment to allow more accurate case reserves to be established.

Q. How is CompCHOICE compensated for services?

A. CompCHOICE is compensated by the Payor (insurance company
or self-insured) by the following means:

  • Network Access Fee (based on providing access to network providers and tied to actual discounts achieved)
  • Bill Review (charged for processing provider bills and applying associated discounts)
  • Hourly Nurse Case Management (billed in six-minute increments)