Risk Management Services : state of Georgia employee brochure for Workers' Compensation Managed Care Organization

Dispute Resolution
AmeriSys Managed Care will respond to any dissatisfaction regarding a network provider of managed care services under your employer's plan. If you have a complaint, please contact AmeriSys Managed Care at 678-781-2848 or 800-900-1582. The Dispute Resolution Coordinator will discuss your complaint with the appropriate party and respond to you within 24 hours, or the next working day.
A written complaint regarding claims practices or provision of services concerning the Managed Care Plan or its network providers may be sent in writing to:
AmeriSys Dispute Resolution Coordinator 9 Dunwoody Park Suite 106
Atlanta, Georgia 30338
If the dispute cannot be resolved within 30 days by the managed care dispute resolution procedure, any party may request intervention by the State Board of Workers' Compensation.
Upon request of the injured party, DOAS Risk Management Services may become involved at any time during the dispute process.
Please Note: If your dispute involves the payment of benefits or aspect of your claims not directly related to the provision of medical care, contact DOAS Risk Management Services at 404-656-6245 or 877-656RISK (7475) and select Option #3 for assistance.

State of Georgia Workers' Compensation Program
AmeriSys...................... Your Managed Care Company MyMatrix ................................... Pharmacy Network Coventry Health Care ..................... Provider Network DOAS .......................................... Claims Administrator
200 Piedmont Avenue, SE 1220 West Tower Atlanta, GA 30334
Phone: 404-656-6245 Email: risk.management@doas.ga.gov
www.doas.ga.gov

State of Georgia Employee Brochure
for
Workers' Compensation Managed Care Organization

Dear Employee:
Welcome! You are now part of the State of Georgia Workers' Compensation Program, which is administered by the Department of Administrative Services (DOAS). The state has a Managed Care Organization plan with AmeriSys which provides care for job-related injuries. Medical services will be provided through the Coventry Health Care Network of physicians, customized for the state of Georgia. DOAS Risk Management Services and AmeriSys want you to receive quality medical care and help you return to work as soon as you are medically able.
If you are injured on the job, you must report the injury to your supervisor immediately. Your supervisor should report your injury to DOAS by calling 877-656-RISK (7475), and then call AmeriSys at 678-781-2848 or 800-900-1582 to speak with a case manager who will assist you in selecting a physician, scheduling an appointment, and obtaining follow-up care.
This guide will serve to answer any questions you may have regarding the services available to you in the event you have a work-related injury or illness.
Most importantly, you will be provided with information regarding how to find an authorized treating physician, who will direct your medical care. Please read the guide carefully and if you should have any additional questions, please ask your supervisor or other designated employer representative.

Emergency Care
If, because of a work-related injury or illness, you require immediate medical attention, please proceed to the nearest emergency medical care facility or call 911 for assistance.
Following your emergency admission, service or procedure, you or your designated representative must notify AmeriSys Managed Care of your injury by calling 678-781-2848 or 800-900-1582.
If you require additional care, contact AmeriSys Managed Care at 678-781-2848 or 800-900-1582 to speak with a case manager who will assist you in selecting an authorized treating physician. Your authorized treating physician will then evaluate your treatment plan and make further recommendations.
Injured Worker Responsibilities
If you experience a workers' compensation injury, you should notify your supervisor immediately (no later than 24 hours).
Thenext step isto call AmeriSysManaged Care at 678- 781-2848 or 800-900-1582 and speak with a case manager who can assist you in obtaining medical care, findinga physician or getting you the appropriatefollowup care. You will be asked to choose an authorized treating physician who will supervise your medical treatment to ensure you are receiving high quality, appropriate care.
You may change your authorized treating physician, within the DOAS Physician Network, one time during your treatment simply by calling your assigned adjuster as well as AmeriSys Managed Care. Any further change of physician will require the concurrence of Risk Management and the nursecase manager.
Referral to Specialist
Your authorized treating physician is responsible for determining the medical necessity for referrals to specialists if needed. Your authorized treating physician is required to contact AmeriSys Managed Care for referral approval within the network. Authorization for non-participating physicians will be considered only in special circumstances when required for specialized care not available within network.

Treatment by Non-Participating Providers
You are required to receive all medical care through a participating network provider. The only exception will be under special circumstances as approved by the Nurse Case Manager and Risk Management jointlyand in compliancewith State Board of Workers' Compensation Rule 208.
Case Management
The AmeriSys Case Manager will be in contact with you from the time of your injury ensuring that you are receiving the best medical care to enable you to return to work as quickly as possible. The nature and severity of your injury will determine the extent of the case management services provided. Your medical case manager is a licensed, registered health care professional whose responsibilities include helping you make informed decisions regarding your care. Your case manager will also work with your employer in developing a return to work plan that is approved by your authorized treating physician.
Amerisys Responsibilities
AmeriSys will make sure that all medical services are provided by licensed, qualified providers. If you have any complaints about your care, AmeriSys will provide you with the information needed to file for dispute resolution. AmeriSys will also help you withquestions regarding yourmedicalcare.
DOAS Risk Management Responsibilities
DOAS Risk Management is responsible for paying all authorized medical treatment and/or other benefits that may become due. If you need to speak with someone in Risk Management, call 404-656-6245 or 877-656-RISK (7475) and select Option #3.