Certified PPO

Certified PPO is the only mechanism available to most New York State employers for directing injured workers into a medical network to manage their care. It offers a proven, successful strategy for obtaining better outcomes and controlling workers’ compensation costs.

MagnaCare’s Certified PPO program focuses on building a strong relationship between the employer, injured worker, and providers to achieve better overall outcomes.

Tailored Provider Panels

Customized employer-specific network panels include providers in the locations and types of specialties you need. Trusted providers are educated on your individual requirements and agree to:

  • New patient appointments within 48 hours
  • Reduced opioid prescriptions
  • Treatment pursuant to NYS medical treatment guidelines (MTGs)
  • Cooperation with employer-specific return to work rules
  • Referrals to only in-network specialists
  • Meetings with employers

Direction of Care

Care Coordinators assigned to your account schedule appointments with your pre-selected providers for the life of the claim. Injured workers appreciate the immediate appointments and quick referrals to state-of-the-art treatment and therapy, eliminating doctor-shopping.

Quality Assurance

We review quarterly reports to ensure both employee and provider compliance, as well as program performance.

Program Administration

MagnaCare prepares all the required Certified PPO contracts, reports, and documentation, and submits them on your behalf to the Workers’ Compensation Board (WCB) and the Department of Health (DOH) for approval.

Utilization Review

Working closely with trusted providers will reduce the need for utilization review.

Opioid Oversight Program

Through early intervention, prior authorization, personalized case management, and collaboration with your pharmacy benefits manager (PBM) and other providers, our Opioid Oversight Program reduces your medical and pharmacy costs and the risk of opioid addiction among your members.

The majority of injured workers remain with your preferred providers for the life of the claim

Case Study: NYS Union employer

37%

of injured workers used 100% in-network providers

61%

of injured workers used greater than 50% in-network providers

2%

of employees used out-of-network providers

MagnaCare Certified PPO network highlights:

  • Better patient outcomes and rapid return to work
  • Reduced unit costs through provider and hospital contracted rates
  • Faster access to care and higher employee satisfaction through MagnaCare Care Coordinators
  • Decreased indemnity payments
  • Decreased overall claim costs
  • Reduced lawyer involvement