Policies and Procedures
Employers are required by the Georgia Workers’ Compensation Law to provide prompt medical and disability benefits for injuries sustained on the job by workers resulting in partial or total incapacity or death.
Reporting
Do not report the incident if no medical attention is required, as your department will be charged (read memo under Quick Links).
The supervisor or authorized departmental representative should immediately report work-related injuries by calling 1-877-656-RISK (7475). Then, the employee should call AmeriSys at 678-781-2848 to speak with a case manager who will assist in selecting a physician, scheduling an appointment and obtaining follow-up care.
For Departments
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Transportation & Process
In case of an emergency the injured person should never attempt to transport themselves, or have their friends or non-medical co-workers transport them.
Call Campus Police 404.894.2500 or (9) outside line and 911. If their injury truly is life-threatening, there could be complications such as convulsions, cardiac arrest. An ambulance and/or appropriate medical personnel should always be called to transport the injured person if it is truly a life-or-limb threatening emergency event.
For other minor non-emergency/non-life-or-limb threatening injuries, it may be possible to transport the person via another means to an approved medical facility.
After the injured employee is admitted the supervisor or authorized departmental representative must notify AmeriSys Manage Care at 678-781-2848. Finally, the supervisor or designated person must contact DOAS at 1.877.656.RISK (7475) to obtain a WC number and to ensure that the claim is properly set up for payment.
For follow-up care the employee should call AmeriSys at 678-781-2848 to speak with a case manager who will assist with selecting a physician and scheduling appointments.
Note: An employee will not be reimbursed for medical bills if the accident occurred on their way back from lunch on campus.
Employee Resources
- Case Management
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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.
- Dispute Resolution
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AmeriSys Managed Care will respond to any dissatisfaction regarding a network provider or managed care service 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.
The Dispute Resolution Coordinator will 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
Integrated Care Management
5 Dunwoody Park Suite 118
Atlanta, GA 30338If the dispute cannot be resolved within 30 days of a written notice, by the Managed Care Dispute Resolution Procedure, any party may request intervention by the State Board of Worker’s Compensation.
DOAS Risk Management may become involved at anytime during the dispute process upon the request of the injured party.
Please Note: If your dispute involves the payment of benefits or aspects of your claims not directly related to the provision of medical care, contact Risk Management for assistance by calling 404.656.6245 or 877.656.RISK (7475) and selection Option 3.
- Emergency Care
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If, as a result of a work-related injury or illness, you require immediate medical attention, you should 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 and speak to 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.
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Pharmacy Benefits
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Matrix Healthcare Services (1.877.804.4900)
Injured Georgia Tech employees should identify themselves at the pharmacy by stating that the Processor is:
Premier Pharmacy Plan – Group ID 2105
- Referral to Specialists
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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
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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 jointly and in compliance with the State Board of Worker’s Compensation Rule 208.
If you experienced a workers’ compensation injury or illness prior to the effective date of this managed care plan, you may continue treatment already in effect. An AmeriSys Nurse Case Manager will be assigned for continued coordination of care when needed, in accordance with the State Board of Worker’s Compensation Rule 208.
Injured Workers' Responsibilities
If you experience a workers’ compensation injury, you should notify your supervisor immediately (no later than 24 hours).
The next step is to call AmeriSys Managed Care at 678.781.2848 or 800.900.1582 to speak with a case manager who can assist you in obtaining medical care, finding a physician or getting you the appropriate follow-up 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 AmeriSys Managed Care. Any further change of physician will require the concurrence of Risk Management and the Nurse Case Manager.