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Medical Case Management

Hess, Karfomenos & Associates Inc, is an independently owned and operated Medical/Legal Case Management and Consulting company, located physically in Northern Indiana. Established in 2001, our company has risen to a position of national recognition in the fields of Medical Case Management, Life Care Planning and Legal Nurse Consulting.

We recognize and intimately understand the claims demands of a wide variety of insurance products at various levels of the insurance spectrum. Containing case specific medical costs, limiting indemnity exposures, in depth medical analysis and cost projections of files for reserve setting, precise and timely communication, negotiation, accessing appropriate and quality medical providers, preparation for arbitration and settlement, these are but a few of the strategic functions that our professional staff are prepared to provide to you, your staff and your customers. Result? Your claims staff is allowed to focus on the intricacies of administrating their caseloads, with the confidence that they are indeed partnered with the finest certified, medical professionals in the industry. Your customers actualize high impact, aggressive interventions, thorough medical research and creativity, that brings dynamic results and value added service, coupled with finely accurate reporting, cost reduction and cost containment.

Our expertise in managing LTD and STD files was refined years ago when our core group was dedicated to Unum Provident. With our professionals located in Northern and Central Indiana as well as North Eastern Pennsylvania and Central TN, we are strategically positioned to service The Midwest, North East and South Central United States with on-site case management services. Licensure in 10 States provides a geographic extension of our continuum of services.

When it comes to Worker’s Compensation, we provide a continuum of services that are guaranteed to assist the employer / carrier in aggressively reducing financial exposures as well as assuring top quality medical care for the injured employee which ultimately shortens disability duration timelines.  Our expert professional certified medical case managers learned strategic and aggressive case management skills – while handling the internal marquee accounts of Liberty Mutual - and now bring these “top shelf “skill sets and outcomes driven services… to YOU!

The staff of Hess, Karfomenos & Associates , has extensive experience in the carrier based and independent administration of outcomes driven medical case management and utilization review/management encompassing the areas of Long Term Disability/Short Term Disability, Workers Compensation, Group Health, Catastrophic Injury, PIP, Auto, and Liability. Our team fluidly interfaces with Third Party Administrators, Stop-Loss Carriers and Re-Insurers, analyzing and/or medically managing large exposure cases, as one of our focused specialty services. In addition, we have provided Medical Legal File Reviews for numerous carriers, as their claims and legal teams have prepared for arbitration and/or trial.

Catastrophic Injuries and Catastrophic Illnesses are inherently very complex and contain a myriad of issues, barriers and concerns that  require the highest level of expertise and experience to manage. Hess, Karfomenos & Associates has a dedicated Catastrophic team of professional and nationally certified Nurse Case Managers. With strong clinical backgrounds in trauma, and complex critical care pathologies, this team  has a proven track record of having managed the medical needs of  employee/insured’s with; Multiple Trauma, Burns, Spinal Cord Injuries, Traumatic Brain Injuries, Complex Cardiology,  Organ Transplantation, to name a few.

Our professionals have extensive medical case management experience in 18 state jurisdictions (Workers’ Compensation and Group Health). They are professionally licensed in 10 states. They hold the credentials of CCM (national – Certified Case Manager) as well as CNLCP (national – Certified Nurse Life Care Planner), ORC (Qualified Rehabilitation Coordinator – State of KY) and CM (Case Manager – State of TN). Hess, Karfomenos & Associates   is also certified as a provider of rehabilitation case management services for Workers’ Compensation in the State of Ohio, by the Ohio Board of Workers’ Compensation and listed under the Health Partnership Program. Our service guarantee to our customers includes the fact that ALL our staff members are certified in one or more specialties.

We have established a network of professionals not only locally, but also nationally, to assist you by means of  providing or arranging Medical or Chiropractic Peer Review, Independent Medical Examinations, Pprocurement of Expert Witnesses, and specific case appropriate medical interventions through referral to or provider suggestion. We also assist in referral to procurement of  DME venders and supplies, prescription services, prosthetics, orthotics, vehicle and home modifications, Therapists and Vocational Rehab Specialists. When you are looking for medical case management as an adjunct for your high profile or high exposure cases, you need not look any further than Hess, Karfomenos & Associates.

Ultimately, Hess, Karfomenos & Associates  stands ready to serve the needs of you, your staff and your customers, within the areas of your expertise. We are prepared to provide you with our extensive clinical, medical case management and medical-legal experience. Our creativity can bring value added services as well as positive cost reduction impact to your product lines.

We welcome the opportunity to explore the ways we can assist you and...

“Allow our expertise to enhance your success”

Members: American Association of Nurse Life Care Planners, American Association of Legal Nurse Consultants, Indianapolis Chapter-American Association of Legal Nurse Consultants, CMSA (Case Management Society of America), NFIB (National Federation of Independent Business), IWCI (Indiana Worker’s Compensation Institute), OIPRS (Occupational Injury Prevention Rehabilitation Society), IARP (International Association of Rehabilitation Professionals), Academy of Certified Case Managers, American Nurse Association, Indiana State Nurses Association, Emergency Nurse Association,  NAMSAP (National Alliance of Medicare Set Aside Professionals), Associate – American Bar Association and the  Greater Elkhart Chamber of Commerce.
Professional Nurse Licensures:   Indiana, Michigan, Tennessee, Texas, Pennsylvania, Illinois, Florida, Ohio, Kentucky and Kansas
National Certifications held by staff include: Certified Case Manager (CCM) and Certified Nurse Life Care Planners (CNLCP),  Certified Rehabilitation Nurse (CRRN)
Certified Vendors by BWC – State of Ohio – Case Management Services and Life Care Planning
State Certifications/Case Management: TN and KY
             
Registered Vendor:   “Opportunity Indiana”