Medical and Injury Management

Overview

The Medical and Injury Management process in Diamond gives users the ability to track medical treatment, billing, wage and injury information for any line of business.

Workflow

Step 1: System Settings

• Claims / Medical Folder: "Enabled." Set this to "True." This makes the Medical Tab visible in the Claims System.

Step 2: Administration / User Setup

For each user needing access to Medical Information, the following authorities should be granted in the Claims Detail group:

• Add / Edit / Delete Medical Facility: Allows users to access Medical Facility function (Diamond Administration) and maintain medical facilities.
• Add / Edit / Delete Medical Provider: Allows users to access Medical Provider Maintenance (Diamond Administration) and maintain medical providers.
• View Medical Bill Detail Tab: Access to view the Medical Bill Tab.
• View Medical Treatment Tab: Access to view the Medical Treatment Tab.
• Add Medical Bill Detail: Allows entry (Add / Edit) of new medical bill records on the Medical Bill tab.
• Edit Imported Medical Bill Records: Allows users to edit records imported from a 3rd Party Vendor.
• Add / Edit / Delete Medical Treatment Records: Allows users to add, edit and delete (Inactivate) medical treatment records on the Medical Treatment tab.

Step 3: Diamond Administration / Claims / Medical Facility Maintenance

Here, users can add, edit and delete various medical facilities such as hospitals, rehab facilities, etc.

Add a Medical Facility

• Click Add from the toolbar.
• Click the Medical Facility link to add name, address, and phone information.
• Once entered, click Save to return the screen with information populated.
• Active: Leave the check mark in this field to indicate this facility is an option for selection on the Medical tab.

Step 4: Diamond Administration / Claims / Medical Provider Maintenance

Here, users can add, edit and delete various medical providers such as doctors, nurse practitioners, etc.

Add a Medical Provider

• Click Add from the toolbar.
• Click the Medical Provider link to add name, address, and phone information.
• Once entered, click Save to return the screen with information populated.
• Active: Leave the check mark in this field to indicate this provider is an option for selection on the Medical tab.
• Click Save to add the provider to the List View.

To assign a provider to a facility:

• Highlight the provider and click Edit.
• Select the facility to which the provider is affiliated.
• Click Associate.
• Click Save.

Step 5: Claim System / Loss Notice

Once a Loss Notice is submitted, users can begin entering medical information on a claimant.

Step 6: Claims / Medical Treatment Tab

Highlight the claimant the medical information will be entered for and click Edit. From the Medical tab, click the Medical Treatment tab / Add.

On this tab, users can select and enter information about the provider, facility and provider type, patients number, treatment start / end dates as well as narrative about the diagnosis and treatment plan. Save your information once entered.

Step 7: Claims / Medical Bill Tab

Here, all billing detail is maintained. Users can enter all preliminary information, save it then add any remaining information at a later date.

Step 8: Wage Tab

All wage information is maintained on this tab as well as occupation. employment status, employer. Similar to the Medical Bill tab, users can also enter preliminary information, save it and add any remaining information at a later time.

Step 9: Injury Tab

Specific information to an injury is entered here, such as injury summary, description, injury type category, body part category, nature of injury, cause of injury as well as diagnostic codes.