CORVEL CORP

CORVEL CORP

Previous company name
FORTIS CORP
Name change date
2/1/1960
Company Overview
CorVel Corporation is a national, independent provider of leading-edge healthcare management services and solutions for workers’ compensation, auto & liability, group health and disability insurance markets. In 1988, Gordon Clemons joined with Jim Michael and Jeff Michael, investors from Minnesota, to found CorVel Corporation (originally named “FORTIS”). Three small vocational rehabilitation firms were consolidated to form the initial foundation of the new company, valued at approximately $2 million. The company’s corporate headquarters is located in Irvine, California.
The company’s clients include employers, insurance companies, TPA’s (third party administrators) and government entities. In addition to its national network of preferred healthcare providers, CorVel offers case management, medical bill review and disability management programs. The company’s team of associates provides a wide range of services designed to allow customization of individual clients needs with a constant focus on making a difference in healthcare outcomes.
CorCare is CorVel’s line of national healthcare service networks, including over 450,000 preferred providers. The company’s provider development staff builds networks of preferred physicians, hospitals and ancillary facilities in the communities where they live and work. They capitalize on local knowledge and relationships to build networks based on the demographics, utilization patterns and geography of its customers. Providers are selected based on demanding criteria including quality, range of services, price and location. Each one is thoroughly evaluated and credentialed, and then re-credentialed biannually. Through this extensive evaluation process, CorVel’s CorCare networks are able to provide significant provider discounts while maintaining quality care for patients.
CorVel provides assistance to people recovering from illness or injury. Its nurse case managers work directly with patients all over the US, helping over 30,000 people each month.
The company built a superior network of quality case managers, hospitals, physicians and ancillary providers to assist patients through their episode of care. Its network of care is supported by CorVel’s national resources, yet represented by local CorVel associates who work with employers in local communities. CorVel utilizes innovative healthcare management solutions to accelerate quality care for patients. The company aims is to provide proactive assistance to patients, helping with their episode of care and return to work.
CorVel offers TPA a complete line of healthcare management services and solutions for the workers’ compensation, group health and disability insurance markets. From case management to detailed medical bill review, CorVel specializes in applying advanced communication and information technology to improve healthcare management.
CorVel’s services can be provided onsite and it also offers electronic data interfacing (EDI) capabilities that are designed to automatically update and exchange information with the customer’s claims administration system.
Business Summary
CorVel Corporation (CorVel) is a provider of risk management solutions to employers, third party administrators, insurance companies and government agencies. It focuses in applying advanced communication and information technology to improve healthcare management for workers’ compensation, group health, auto and liability claims management. The Company’s services include claims management, bill review, preferred provider networks, utilization management, claims management, case management, pharmacy services, directed care and Medicare services. CorVel offers its services as a bundled solution (claims management), as a standalone service, or as add-on services to existing customers. The Company offer services in two categories: network solutions and patient management.
Description and history
CorVel Corporation (CorVel), incorporated in 1987, is a provider of risk management solutions to employers, third party administrators, insurance companies and government agencies. It focuses in applying advanced communication and information technology to improve healthcare management for workers’ compensation, group health, auto and liability claims management. The Company’s services include claims management, bill review, preferred provider networks, utilization management, claims management, case management, pharmacy services, directed care and Medicare services. CorVel offers its services as a bundled solution (claims management), as a standalone service, or as add-on services to existing customers. The Company offer services in two categories: network solutions and patient management.

Network Solutions

CorVel offers a complete medical savings solution for all in-network and out-of-network medical bills, including PPO management, medical bill repricing, true line item review, professional nurse review and automated adjudication. The Company’s bill review and claims management technology automates the review process for the customers. CorVel’s artificial intelligence engine includes over 10 million individual rules. The bill review services include coding review and rebundling, reasonable and customary review, fee schedule analysis, out-of-network bill review, pharmacy review, PPO management and repricing.

PPOs are groups of hospitals, physicians and other healthcare providers that offer services at pre-negotiated rates to employee groups. The Company’s PPO network is comprised of over 750,000 providers. In total, the Company has more than 120 national, regional and local personnel supporting the CorVel network. The number includes a national PPO manager in addition to locally based PPO developers who are responsible for local recruitment, contract negotiations, credentialing and re-credentialing of providers, and working with customers to develop customer specific provider networks.

CorVel’s enhanced bill review program allows claim payors to adjust individual line item charges on all bills to reasonable and customary levels while removing all error and billing discrepancies with professional review. The bill review program scrutinizes each hospital line description and charge as a separate and distinct claim for reimbursement. CorVel’s Universal Chargemaster defines each code and description, enabling their registered nurses to identify errors, duplicate charges, re-bundle exploded charges, correct quantity discrepancies and remove unused supplies.

CorVel’s services offer a complete audit and validation of facility bill accuracy. This solution also includes review of in-network facility bills. The Company’s nurse auditors have clinical backgrounds in all areas of medicine, medical billing and coding to ensure an accurate, consistent and thorough review. If a bill is identified for professional review, the bill image and its associated medical reports are routed within the system to an experienced medical nurse for review and auditing.

Through the bill review system, CorVel has the capability to provide check writing or provider reimbursement services for its customers. The provider payment check can be added to the bill analysis to produce one combined document.

CorVel provides patients with a full-feature pharmacy program, which offers discounted prescriptions, drug interaction monitoring and eligibility confirmation. The Company’s pharmacy services program includes preferred access to a national pharmacy network, streamlined procession for pharmacies at point of sale, mail order and 90-day retail options and peer-to-peer medication review services.

CorVel has contracted with medical imaging, physical therapy and ancillary service networks to offer access, appointments and rates. The Company manages the entire coordination of care from appointment scheduling through reimbursement, working to achieve timely recovery and increased savings. The Company has directed care networks for diagnostic imaging, physical and occupational therapy, independent medical evaluations, durable medical equipment and transportation and translation.

The Company offers solutions to help manage the requirements mandated by the Centers for Medicare and Medicaid Services (CMS). Services include Medicare Set Asides and a new service, Agent Reporting Services, to help employers comply with new CMS reporting legislation. As an assigned agent, CorVel could provide services for Responsible Reporting Entities (RRE), such as insurers and employers. CorVel is able to electronically submit files to the CMS in compliance with timelines and reporting requirements.

CorVel’s medical review software and claims management technology interfaces with multiple clearinghouses. The Company’s clearinghouse services provides for medical review (including HCN networks), conversion of electronic forms to appropriate payment formats, seamless submittal of bills for payments and rules engines used to help ensure jurisdictional compliance.

Patient Management

CorVel’s offers claims administration and patient management. The Company administers claims as a third party administrator and provides patient management services to their managed care customers.

CorVel serves customers in the self-insured or commercially insured markets. Claims are reported, through an electronic first notice of loss (FNOL) to the claims management portal, www.caremc.com. FNOLs are immediately processed by CorVel’s rules engine, which provides alerts and recommendations throughout the life of a claim. This technology instantly assigns an expert claims professional, while simultaneously determining if a claim requires any immediate attention for triage.

The Company serves the clients in the self-insured or commercially insured market through alternative loss funding methods, and provides them with a complete range of services, including claims administration, case management, and medical bill review. In addition to the field investigation and evaluation of claims, the Company also may provide initial loss reporting services for claims, loss mitigation services such as medical bill review and vocational rehabilitation, administration of trust funds established to pay claims and risk management information services.

CorVel’s case management and utilization review services address all aspects of disability management and recovery, including utilization review (pre-certification, concurrent review and discharge planning), early intervention, telephonic, field and catastrophic case management, as well as vocational rehabilitation.

The 24/7 Nurse Triage services is a feature of the case management services of the Company. Employees could call at the time of injury or incident and speak with a nurse who specializes in occupational injuries. An assessment is made to recommend self-care, or referral for further medical care if needed. CorVel is able to provide quick and accurate care intervention, often preventing a minor injury from becoming an expensive claim. The 24/7 nurse triage services provides channeling to preferred network of providers, allows employer access to online case information, incident gathering, and healthcare advocacy for injured workers.

Utilization Management programs review proposed ambulatory care to determine appropriateness, frequency, duration and setting. These programs utilize experienced registered nurses, medical treatment protocols and systems technology to avoid unnecessary treatments and associated costs. Processes in Utilization Management include: injury review, diagnosis and treatment planning; contacting and negotiating provider treatment requirements; certifying appropriateness of treatment parameters, and responding to provider requests for additional treatment. Utilization management services include prospective review, retrospective review, concurrent review, second opinion, peer review and independent medical evaluation.

CorVel’s Vocational Rehabilitation program is designed for injured workers needing assistance returning to work or retaining employment. This suite of services helps employees that are unable to perform previous work functions and faces the possibility joining the open labor market to seek re-employment. These services are available unbundled, on an integrated basis as dictated by the requirement of each case and client preference, or by individual statutory requirements. Vocational rehabilitation services include ergonomic assessments, rehabilitation plans, transferable skills analysis, labor market services, resume development, job analysis and development, job placement, and expert testimony.

Life Care Planning is used to project long-term future needs, services and related costs associated with catastrophic injury. CorVel’s Life Care Plans summarize medical data and compile it into a report for future care requirements, aiding improved outcomes and timely resolution of claims. The features of the Company’s Life Care Planning services include documentation, projecting future care requirements, customized reporting, costs specific to local area, and certified documentation.

CorVel’s disability management programs offer a continuum of services for short and long-term disability coverages that advocate an employee’s early return to work. Disability management services include absence reporting, disability evaluations, national preferred provider organizations, independent medical examinations, utilization review, medical case management, return to work coordination and integrated reporting.

CorVel also offers liability claims management services that can be sold as a stand-alone product or part of patient management. The Company’s services include auto liability, general liability, product liability, personal injury, professional liability and property damage, accidents and weather related damage. The service includes claims management, adjusting services, litigation management, claims subrogation, and investigations. The Company’s auto claims services include national preferred provider organization, medical bill review, first and third party bill review, first notice of loss, demand packet reviews and reporting and analytics.

Gordon Clemons joined with Jim Michael and Jeff Michael, investors from Minnesota, to found CorVel Corporation (originally named “FORTIS”)

Business Line
A national, independent provider of leading-edge healthcare management services and solutions for workers’ compensation, auto & liability, group health and disability insurance markets
Subsidiary
CAREIQ INC
Advisor
HASKELL & WHITE LLP
IPO date
5/1991
US SIC Code
8099
Company Address
Suite 600
2010, Main Street
City province or state postal code
92614, IRVINE, CA
Phone: +1 949 851 1473
Fax: +1 949 851 1469
Country address: UNITED STATES OF AMERICA
Website url: www.corvel.com