Administrative Services Only (ASO)
An arrangement where an employer self-funds its health plan but hires a third-party administrator to manage claims processing, billing, and compliance.
Case Management
A coordinated approach involving nurses or claims specialists to monitor an injured worker’s progress, treatment, and return-to-work readiness.
Claims Management
The process of coordinating, evaluating, and resolving employee injury claims to ensure timely treatment, compliance, and cost control.
Compliance Monitoring
The ongoing process of ensuring that all claims, reporting, and administrative actions meet federal, state, and industry regulations, such as ERISA and OSHA guidelines.
Employer of Record (EOR)
An entity responsible for employment-related compliance, payroll, and administrative functions for workers—often relevant when managing workforce transitions after an injury.
First Report of Injury (FROI)
The initial document filed when an employee reports a workplace injury. It begins the claims process and provides essential details for evaluation.
Independent Medical Evaluation (IME)
A third-party medical assessment used to confirm injury extent, treatment progress, or ability to return to work.
Network Optimization
The strategic selection and management of medical providers to improve care quality and reduce claims costs through negotiated rates and efficient treatment pathways.
OSHA Recordability
A determination of whether a workplace injury or illness must be recorded per OSHA’s reporting requirements.
Prior Authorization
A requirement that certain medical procedures, medications, or therapies receive approval before being performed to ensure cost-effectiveness and medical appropriateness.
Return-to-Work Program (RTW)
A structured plan designed to help injured employees safely return to the workplace through modified duties or transitional assignments.
Self-Funded Health Plan
A benefits model in which an employer assumes the financial risk for providing healthcare services to employees instead of paying fixed premiums to an insurance carrier.
Stop-Loss Insurance
A financial protection policy that reimburses employers when claims exceed pre-defined thresholds, safeguarding against catastrophic costs.
Utilization Review (UR)
A clinical evaluation process that verifies the medical necessity and appropriateness of proposed treatments, procedures, or ongoing care.
Still have questions?
We’re here to help you with any inquiries.
