Through the development and application of professional health management techniques and services, Hoover is committed to assisting our clients with their health and disability issues while reducing the cost of doing business.

Since our incorporation in 1979, Hoover has grown from its Pennsylvania base to become one of the largest privately held workers’ compensation management firms in the Mid-Atlantic. Hoover has 35 years of experience in workers’ compensation management, including:

  • Medical case management of workers’ compensation and auto liability claims
  • Telephonic care management (TCM)
  • Absence case management (short term disability)
  • Vocational Case Management
  • Catastrophic loss management
  • Life Care Planning
  • Early intervention back injury program
  • Medical record reviews
  • Reserve setting cost projection analysis
  • Medicare Set-Asides
  • Medicare conditional payment investigation and negotiation services
  • Medical pre-certification
  • Independent Medical Examinations
  • Peer Reviews
  • Act 6 Peer Reviews (Approved PRO)
  • Utilization Reviews
  • Jurisdictional Utilization Review compliance
  • Medical claim reviews
  • Direct reporting for workers’ compensation, auto liability, commercial and homeowners’ claims (24/7/365)
  • Multi-jurisdictional EDI first report of injury reporting compliance
  • Medical invoice repricing to fee schedule and usual & customary guidelines
  • Medical bill negotiation program
  • Hospital bill review services
  • PPO network affiliation and access
  • Specialty network affiliation
  • Pharmacy benefit management through KeyScripts, LLC

 

Corporate Designations
URAC-Accredited Case Management – URAC, an independent, nonprofit organization, is well-known as a leader in promoting health care quality through its accreditation, education and measurement programs.

Peer Review Organization – Certified by the Insurance Department of the Commonwealth of Pennsylvania

Decision Point Review-Precertification Organization – Approved by the New Jersey Department of Banking & Insurance

Utilization Review Provider – Approved by the Michigan Department of Labor and economic Growth Health Care Services Division to perform Utilization Review

Utilization Review Agent Certification – State of Tennessee Department of Commerce and Insurance; Tennessee Department of Labor and Workforce Development Registration Number: U00000048

Managed Care Organization (MCO) – Approved by the New Jersey Department of Banking & Insurance and the Department of Health & Senior Services

We offer access to specialty network services, including:

  • Pharmacy benefit managements
  • Physical medicine and diagnostic testing
  • Chiropractic care
  • Translation services
Corporate Philosophy

During our nearly 35 years of service, we have maintained our fundamental philosophy of serving the business needs of workers’ compensation and auto insurance carriers, self-insured employers and third party administrators. Our professional staff is experienced in the provision of medical cost containment, disability and absence management services within the scope of all relevant jurisdictional requirements. We have built our business by developing close, interdependent working relationships with our customers. Hoover achieved URAC Case Management certification in 2000, and has maintained that accreditation since that time. Hoover continues to demonstrate its commitment to providing quality services while continually enhancing and improving our business processes through benchmarking against nationally recognized standards.

Our customers may select services from our broad menu offering, as best meets their needs. Some insurance carriers and self-insured employers have selected Hoover to provide our full range of services company-wide to their claims. In such cases, Hoover is involved from claim origination, providing services that include:

  • Direct report of injury/ incident intake interviews for workers’ compensation, auto liability, commercial and homeowners’ claims
  • Assigning claim numbers to injury/incident intakes
  • Medical cost projections to assist in setting workers’ compensation claim reserves
  • Performing telephonic, medical and catastrophic case management
  • Performing medical invoice repricing for both workers’ compensation and auto claims, bill negotiation, bill audits, and utilization review
  • Providing medical pre-certification services per jurisdictional statute
  • Providing pharmacy benefits management through KeyScripts, LLC
  • Providing vocational case management services
  • Producing Life Care Plans and Medicare Set-Asides
  • Performing Medicare conditional payment investigation and negotiation services
  • Providing short-term disability and absence management services to customer employees