About CAREWORKS
CAREWORKS is a healthcare software platform from Netsmart that provides solutions for digitizing enterprise processes. It combines the CareFabric Platform, CareThreads Blog, and Client Login so organizations can improve their efficiency in managing healthcare services. The platform also features a Value-Based Care playbook specifically designed for post-acute care providers. This comprehensive offering allows healthcare professionals to access vital information and resources to support their operational needs. Additionally, the inclusion of the CareThreads Podcast and CCBHC advocacy initiatives helps stakeholders stay informed on relevant topics and trends. Key capabilities: CareFabric Platform CareThreads Blog Client Login Value-Based Care playbook CCBHC advocacy Best for: healthcare organizations that need to implement value-based care and improve digital capabilities.
CareWorks Managed Care is a cloud-based, web-accessible managed care information system designed to streamline workers’ compensation and auto liability claims while controlling medical costs and ensuring high-quality care. The platform connects employers, insurance carriers, third-party administrators, and medical providers, providing a centralized environment for claims management, medical bill review, and provider network coordination. Its user interface, accessed via the CareWorks Provider Portal or Client Login, is data-centric and role-based, allowing claims adjusters, case managers, and employer representatives to quickly view claim statuses, bill approvals, and provider locations, though new users may encounter a learning curve due to the integrated module complexity. Key features include 24/7 nurse triage, which helps assess injury severity and prevent unnecessary emergency visits, an advanced medical bill review engine that identifies coding errors and fee schedule discrepancies, a proprietary PPO network that ensures access to pre-screened providers, and behavioral health integration to address psychological aspects of recovery.
Pros & Cons
- +PPO discounts combined with RN-led bill audits deliver strong cost containment and significant savings for employers
- +Nurse triage ensures medical-led care decisions, prioritizing clinical accuracy over purely administrative processes
- +Benchmarking tools provide detailed insights that allow organizations to compare claims performance against industry standards
- −Limited provider networks frustrate employees if preferred local doctors are not included in the plan
- −The provider search interface occasionally lags behind real-time updates on physician availability and locations
Features
Key features
- Proprietary PPO Network
- Provides a curated network of over 900,000 providers specifically optimized for occupational injury and workers' compensation care.
- Nurse Triage (24/7)
- Delivers immediate medical assessment following an injury to ensure employees receive the right level of care and start treatment faster.
- Surgery Nurse Solution
- Offers specialized support for employees facing surgery to improve physical and mental preparation and expedite the return-to-work timeline.
- Transitional Work Placement
- Identifies temporary, modified-duty work opportunities for injured employees when their original employer cannot accommodate their restrictions.
- Predictive Analytics & Benchmarking
- Leverages a massive data set to identify cost drivers, pinpoint trends, and provide industry benchmarking for claims performance.
- RN Complex Bill Review
- Utilizes registered nurses to perform line-item audits on high-dollar or complex medical bills to identify inaccuracies and prevent overpayment.
Additional features
- Nurse Triage
- Ensures injured employees get immediate care recommendations via 24/7 telephonic access to clinical professionals.
- Case Management
- Includes telephonic and field-based nursing support to coordinate appropriate medical treatment and shorten claim durations.
- Surgery Nurse
- Supports injured workers through the entire surgical process, from pre-operative planning to post-operative recovery coordination.
- Behavioral Health
- Provides specialty clinical skillsets to address psychological factors, such as trauma or fear, that may hinder physical recovery.
- Utilization Review
- Evaluates medical necessity and appropriateness of requested treatments to ensure compliance with clinical guidelines.
- Pharmacy Management
- Oversees prescription drug usage and costs to ensure appropriate medication therapy and maximize savings.
- Vocational and Return to Work Services
- Helps employees return to productive work through rehabilitation, job analysis, and safe-return planning.
- Transitional Work Placement
- Facilitates temporary work assignments at non-profit or community organizations for employees with temporary restrictions.
- Ancillary Care Network
- Manages a network of over 40,000 providers for services like diagnostic imaging, durable medical equipment (DME), and transportation.
- Proprietary PPO Network
- Offers nationwide access to credentialed providers with negotiated rates to drive significant savings on medical expenses.
- Bill Negotiations
- Employs expert negotiators to secure deeper discounts on large medical bills and out-of-network charges.
- Medical Bill Review (Workers' Comp)
- Applies a robust rules engine and state fee schedules to identify billing errors and re-price charges accurately.
- Medical Bill Review (Auto Liability)
- Provides accurate re-pricing and bill review specifically for auto first-party and personal injury protection (PIP) claims.
- Demand Management
- Utilizes nurse consultants to analyze medical treatment in liability claims to help reduce settlement costs.
- Custom Provider Panels
- Develops specific lists of preferred providers for employers to simplify the search process for injured workers.
- Electronic Payment Issuance
- Streamlines the financial side of claims by providing digital payment options for provider reimbursements.
Pricing
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About CAREWORKS
CAREWORKS is a healthcare software platform from Netsmart that provides solutions for digitizing enterprise processes. It combines the CareFabric Platform, CareThreads Blog, and Client Login so organizations can improve their efficiency in managing healthcare services. The platform also features a Value-Based Care playbook specifically designed for post-acute care providers. This comprehensive offering allows healthcare professionals to access vital information and resources to support their operational needs. Additionally, the inclusion of the CareThreads Podcast and CCBHC advocacy initiatives helps stakeholders stay informed on relevant topics and trends. Key capabilities: CareFabric Platform CareThreads Blog Client Login Value-Based Care playbook CCBHC advocacy Best for: healthcare organizations that need to implement value-based care and improve digital capabilities.
CAREWORKS Details
CAREWORKS's In-App Market Place
Does CAREWORKS have an in-app market place?
Yes
How many Mini-Apps in the marketplace?
1
Mini Apps
No
Pricing Options
Accepted Payment Currencies
USD ($), EUR (€)
Pros & Cons
- PPO discounts combined with RN-led bill audits deliver strong cost containment and significant savings for employers
- Nurse triage ensures medical-led care decisions, prioritizing clinical accuracy over purely administrative processes
- Benchmarking tools provide detailed insights that allow organizations to compare claims performance against industry standards
- Limited provider networks frustrate employees if preferred local doctors are not included in the plan
- The provider search interface occasionally lags behind real-time updates on physician availability and locations
CAREWORKS's Support Options
Email Address
support@netsmarttech.comContact
1-800-678-6756Documentation
https://www.ntst.com/DocumentationCommunity Forums
https://nq.oncloudos.com/forum/CAREWORKS's Alternatives
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