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Answers to Frequently Asked Questions about TCM
Have questions about telephonic case management (TCM)? From how it works to who benefits, we’ve got clear answers to help you understand TCM.
What is Telephonic Case Management?
Telephonic Case Management (TCM) is a clinically focused, collaborative process that combines assessment, planning, facilitation, care coordination, evaluation, and advocacy to meet the medical and recovery needs of injured employees.
Case managers work by phone with the injured employee, medical providers, employers, and claims professionals to coordinate care, remove barriers, and support a safe and timely return to work.
How does TCM work in the claims process?
TCM is most effective when engaged early, ideally within the first 60 to 90 days post-injury. By acting quickly, telephonic case managers can:
- Address medical or non-medical barriers before they escalate
- Coordinate care across multiple providers
- Keep all stakeholders informed of progress and timeframes
- Facilitate a realistic return-to-work (RTW) plan
What types of cases benefit most from TCM?
TCM is valuable for a wide range of scenarios, but referral is especially important when:
- The injured employee is out of work with no RTW date
- Complex or surgical medical treatment is involved
- Multiple providers are coordinating care
- Pharmacy concerns exist (opioids, multiple medications)
- Recovery is slower than guidelines predict
- There is non-compliance with treatment
- Comorbid conditions such as diabetes or obesity may complicate recovery
How does Enlyte’s TCM differ from other programs?
Enlyte’s TCM model goes beyond traditional adjuster-driven programs by:
- Using predictive risk modeling to target cases most likely to benefit from early intervention
- Addressing both medical and psychosocial barriers to recovery
- Integrating resources such as pharmacy management, utilization review, and field case management when needed
- Offering flexible program design tailored to your organization’s workflows and goals
What are the benefits of TCM for different stakeholders?
For Injured Employees
- Timely, coordinated access to care
- Education on treatment, recovery expectations, and self-care
- A trusted advocate throughout the process
For Claims Professionals
- Real-time updates on medical status and RTW plans
- Support in making informed decisions
- Lower medical and indemnity costs
For Medical Providers
- Streamlined communication between all parties
- Assistance with treatment planning and adherence
For Employers
- Faster return-to-work and reduced lost time days
- Communication of job demands and transitional duty opportunities
How does TCM work with Field Case Management (FCM)?
TCM and FCM often work together. For example:
- A TCM may request an FCM to perform a job analysis if the treating provider needs detailed physical demand information.
- f significant psychosocial barriers are identified, a TCM may transition the case fully to an FCM for face-to-face intervention.
How is TCM success measured?
While TCM is not transactional like bill review, outcomes are measured in:
- Medical cost savings through negotiating lower fees and avoiding unnecessary treatment
- Indemnity savings by reducing disability duration compared to national guidelines
- RTW rates with high return-to-work percentages and reduced average lost time days
- Employee satisfaction with positive feedback from injured employees on their care and support
Why outsource TCM instead of keeping it in-house?
Many organizations outsource TCM for:
- Overflow support during peak volumes
- Coverage in jurisdictions where they lack licensed staff
- Specialized expertise for certain types of claims
- This provides flexibility and scalability without the cost of hiring, training, and licensing additional staff.
Is the program accredited and compliant?
Yes. Enlyte’s TCM program is URAC-accredited and follows evidence-based guidelines to ensure consistent, high-quality care.
How can I get started?
We will review your current program, identify opportunities for improvement, and design a TCM solution that aligns with your goals.