 OCFMC offers the availability of a nurse via telephone for nursing advice and direction to plan participants twenty four hours a day, seven days a week. It has been demonstrated by the nurse triage line that emergency visits can be decreased, compliance with treatment plans can be increased and patients appreciate the availability of a live person to discuss confidentially their personal health concerns.
The program at OCFMC is unique since the nursing staff that support the twenty four hour line are also the same nurses that work with the claims adjustors and utilization management program. These nurses are familiar with the patient’s health plan and history and utilize the Milliman and Robertson Criteria.
The twenty four hour program is supported by standardized software that provides decision tree logic to assist the nursing staff in their interaction with the patient. Data is tracked regarding the calls and available for reporting. The reporting provides valuable information when making future decisions on plan design. |
