In 1997, the Virginia Department of Planning and Budget conducted a study of the State’s Workers’ Compensation Program. In total, thirty-seven recommendations were made to reduce cost and strengthen the workers’ compensation program’s fiscal position, improve services to the injured worker, assist agency representatives with the reporting and management of claims, and return injured workers to gainful employment. The Program was outsourced in a competitive bid process and awarded to Managed Care Innovations, now known as MC Innovations (MCI), effective July 1, 1998.
The Commonwealth of Virginia provides management oversight of the State’s Workers’ Compensation Program through The Department of Human Resource Management (DHRM), Workers’ Compensation Services (WCS). The Program is also supported by The Office of The Governor through Executive Order 109 (2010) which addresses Workplace Safety and Employee Health. The Program is currently operating in its fourth contract with MC Innovations, which was effective July 1, 2013.
In coordination with Workers’ Compensation Services, MCI, a Virginia Certified Small Business, serves as the General Contractor of the Program. The MCI model provides single contract administration, fiduciary accountability, and management of all services associated with the timely and accurate payment of claims with the goal of controlling total program costs. Under the banner of Total Program Management, MCI provides a Team of specialty service providers to meet the unique needs of the Commonwealth and the State Agencies. For the Commonwealth of Virginia Program, this approach assures contract compliance, a quality assurance process to make certain all performance standards are met, transparency in all transactions, and a vision for a continuous improvement process.
Services provided include:
• Claim Management Services
• Bill Review and Payment
• Telephonic Nurse Case Management
• Preferred Provider Organization (PPO) Network
• Independent Medical Exam Services
• Medical Vocational Services
• Loss Control Services
• Pharmacy Network
• Durable Medical Equipment
• Job Club
• Field Investigations
• Diagnostic Services
• Payroll and Classification Audits
In addition to oversight of the claims functions, Workers’ Compensation Services provides assistance for all State Agencies with the development of Return To Work program initiatives, loss control support and training, distance learning through the Virginia Learning Center, Safety Day, and coordination of Return To Work information with the Virginia Retirement System for VSDP.