CorVel Corporation (CorVel) provides an independent nationwide medical cost containment and manages care services designed to address the escalating medical costs of workers' compensation benefits, automobile insurance claims, and group health insurance benefits.
The company's services are provided to insurance companies, TPAs, governmental entities, and self-administered employers to assist them in managing the medical costs and monitoring the quality of care associated with healthcare claims....
CorVel Corporation (CorVel) provides an independent nationwide medical cost containment and manages care services designed to address the escalating medical costs of workers' compensation benefits, automobile insurance claims, and group health insurance benefits.
The company's services are provided to insurance companies, TPAs, governmental entities, and self-administered employers to assist them in managing the medical costs and monitoring the quality of care associated with healthcare claims.
CorVel applies certain technology, including artificial intelligence, machine learning, and natural language processing, to enhance the management of episodes of care and the related healthcare costs. The company partners with employers, third-party administrators ('TPAs'), insurance companies, and government agencies to assist its customers in managing the increasing medical costs of workers' compensation, group health, and auto insurance, and in monitoring the quality of care provided to claimants. The company's diverse suite of solutions combines its integrated technologies with a human touch. CorVel's customized services, delivered locally, are backed by a national team to support its clients, as well as their customers and patients.
The company's services include claims management, bill review, preferred provider networks, utilization management, case management, pharmacy services, directed care, and Medicare services. CorVel delivers its solutions three ways - as a fully integrated claims-management program, as discrete standalone services, or as targeted add-ons that enhance an existing client workflow. Integrated, end-to-end bundled programs are designed primarily for buyers, such as self-insured employers who want a single, turnkey partner. Conversely, individual modules and à-la-carte add-ons tend to fit larger scale relationships, where insurance carriers or TPAs plug specific CorVel capabilities into a broader service stack.
CorVel provides services to employers and payors in the risk management and insurance services arenas, including workers' compensation, general liability, auto liability, and hospital bill auditing and payment integrity.
Business-Services
The company's network solutions and patient management services reduce claim costs by advocating medical management at the onset of an injury. These solutions offer personalized treatment programs that use precise protocols to advocate timely, quality care for injured workers.
Network Solutions Services
CorVel offers a complete medical savings solution for all in-network and out-of-network medical bills. The company's services include professional nurse review, true line item review, expert fee negotiations, specialty networks, preferred provider organization ('PPO') management, medical bill repricing, automated adjudication, and electronic reimbursement. Each feature focuses on increasing process efficiencies and maximizing savings opportunities for the company's customers.
Bill Review
Many states have adopted fee schedules, which regulate the maximum allowable fees payable under workers' compensation for procedures performed by a variety of health treatment providers. CorVel's proprietary bill review and claims management technology provides customers with cost savings by decreasing the turnaround time for bill review results through automated, customized algorithms. CorVel's artificial intelligence engine includes over 100 million individual rules, which offers a comprehensive, paperless solution that surpasses the capabilities of traditional, manual bill review processes.
The company's online portal, CareMC, offers a paperless and cost-effective solution for payors to review and approve bills and access savings reports online. Further, CorVel's solutions are fully customizable and can be tailored to meet unique payor requirements.
Bill review services include: Coding review and re-bundling, Reasonable and customary review, Fee schedule analysis, Out-of-network bill review, Pharmacy review, PPO management, and Repricing.
PPO Management
PPOs are groups of hospitals, physicians, and other healthcare providers that offer services at pre-negotiated rates to employee groups. CorVel offers a proprietary national PPO network and added leased network agreements to offer its customers extensive coverage and optimal network performance. As of March 31, 2025, the company's PPO network consisted of over 1.2 million providers nationwide, which are searchable based on quality, types of services, and location by the public through the company's mobile application.
CorVel has a long-term strategy of network development, providing comprehensive networks to the company's customers and customization of networks to meet the specific needs of its customers.
The company has a team of national, regional, and local personnel supporting CorVel's PPO network. This team of developers is responsible for local recruitment, contract negotiations, credentialing, and re-credentialing of providers, and working with customers to develop customer-specific provider networks. Each bill review operation has provider relations support staff to address provider grievances and other billing issues.
The company selects its providers based on their quality, range of services, price, and location. The company evaluates and credentials each provider before inviting them to join its network, and reevaluates them every three years. Through this extensive evaluation process, it is able to provide significant hospital, physician, and ancillary medical savings, while maintaining high-quality care. Provider network services include a national network for all medical coverages, board-certified physicians, provider credentialing, patient channeling, online PPO look-up, printable directories, and driving directions, as well as medical care organizations ('MCOs').
CERIS
CERIS, CorVel's enhanced review program, performs a clinical review and comparative analysis of itemized billing statements against national and customer payment standards. CERIS is a national provider of cost management solutions to employers, TPAs, insurance companies, and government agencies. The company's comprehensive forensic solution reviews charge utilization, appropriateness of charges, and billing behavior, to verify proper payment of claims. CERIS offers clarity to those who pay facility claims and are unsure if the billing is correct. CERIS produces incremental savings both prior to and after payment, lowers provider friction, increases efficiencies with client and facility relationships, and easily scales to a payor's enterprise needs.
Professional Review
CorVel's professional review service audits and validates facility bill accuracy. This solution also includes review of in-network facility bills. If a bill is identified for professional review, the bill image and its associated medical reports are routed within the system to an experienced medical nurse for review and auditing. The company's experienced nurse auditors have clinical backgrounds in all areas of medicine, medical billing, and coding to ensure an accurate, consistent, and thorough review.
Provider Reimbursement
CorVel's bill review service automatically issues provider reimbursements, and allows its customers to track dollars spent and bills reviewed, and set reserves through charts available online.
Symbeo
The company complements its comprehensive solutions by offering its Symbeo technologies, which include scanning, optical character recognition, and document management services. It has added scanning operations to most of the company's larger offices around the country, designating them 'Capture Centers,' and sells scanning and document management services through all offices. The company's scanning service includes a web interface, which provides immediate access to documents and data. Secure document review, approval, transaction workflow, and archival storage are available at subscription-based pricing.
Additionally, Symbeo automates the accounts payable process, configuring coding and approvals to customer-specific workflows.
Pharmacy Services
CorVel provides patients with a full-feature pharmacy program that offers formulary management, discounted prescriptions, drug interaction monitoring, utilization management, and eligibility confirmation. The company's network of nationally recognized pharmacies offers claimants savings on the retail price of prescriptions associated with a workers' compensation claim. The company's pharmacy services program includes preferred access to a national pharmacy network, streamlined processing for pharmacies at point of sale, first fill and next fill programs, out-of-network management, medication review services, and clinical modeling.
Directed Care Services
CorVel offers a national directed care network that provides access to specialty medical services, which may be required to support an injured worker's medical treatment plan. CorVel has contracted with medical imaging, physical therapy, diagnostics, and ancillary service networks to offer convenient access, timely appointments, and preferred rates for these services. The company manages the entire coordination of care from appointment scheduling through reimbursement, working to achieve timely recovery and increased savings. The company has directed care networks for CTs and MRIs, diagnostic imaging, physical and occupational therapy, independent medical evaluations, durable medical equipment, and transportation and translation.
Medicare Solutions
CorVel offers solutions to help manage the requirements mandated by the Centers for Medicare and Medicaid Services ('CMS'). Services include Medicare set-asides and agent reporting services to help employers comply with new CMS reporting legislation. As an assigned agent, CorVel can provide services for responsible reporting entities ('RREs'), such as insurers and employers. As an experienced information-processing provider, CorVel is able to electronically submit files to the CMS in compliance with timelines and reporting requirements.
Clearinghouse Services
CorVel's proprietary medical review software and claims management technology interfaces with multiple clearinghouses to provide for medical review, conversion of electronic forms to appropriate payment formats, seamless submission of bills for payments, and a rules engine used to help ensure jurisdictional compliance.
Patient Management Services
CorVel offers a unique approach to patient management through the TPA services it offers. Patient management services include claims management and all services sold to claims management customers, case management, a 24/7 virtual care platform with nurse triage, utilization management, vocational rehabilitation, and disability, liability claims, and auto claims management. This integrated service model controls claims costs by advocating medical management at the onset of a claimant's injury to decrease administrative costs and to shorten the duration of the claimant's disability. This automated solution offers a personalized treatment program for each injured worker, using precise treatment protocols to meet the changing needs of patients on an ongoing basis. The company offers these services on a stand-alone basis or as an integrated component of its medical cost containment services.
Claims Management
CorVel serves customers in the self-insured and commercially-insured markets. Incidents and injuries are reported through a variety of intake methods, including the company's 24/7 nurse triage call center, website, mobile applications, toll-free call centers, and traditional methods of paper and fax reporting. Reported incidents and injuries are immediately processed by CorVel's proprietary rules engine, which provides alerts and recommendations throughout the life of a claim. This technology instantly assigns the claimant an expert claims professional while simultaneously determining if a claim requires immediate attention for triage.
The company serves customers through alternative loss-funding methods and provides them with a complete range of services, including claims administration, case management, and medical bill review. In addition to the field investigation and evaluation of claims, the company may also provide initial loss reporting services for claims, loss mitigation services, vocational rehabilitation, administration of trust funds established to pay claims, and risk management information services.
Case Management
CorVel's case management services address all aspects of disability management and recovery, including utilization review (pre-certification, concurrent review, and discharge planning), early intervention, telephonic, field, and catastrophic case management, as well as vocational rehabilitation.
The medical management components of CorVel's program focus on medical intervention, management, and appropriateness. In these cases, the company's case managers confer with the attending physician, other providers, the patient, and the patient's family to identify the appropriate rehabilitative treatment and most cost-effective healthcare alternatives. The program is designed to offer the injured party prompt access to appropriate medical providers who will provide quality, cost-effective medical care. Case managers may coordinate the services or care required and arrange for special pricing of the services.
A telephonic case manager ('TCM') focuses on assisting the claimant's early return to work, medical improvement, and determining the appropriate duration of disability. Further, the telephonic case manager facilitates treatment, negotiates with medical providers on behalf of the injured worker, and directs the worker's care until certain case closure criteria are met. Utilization review of provider treatment remains ongoing until discharge from treatment.
A field case manager ('FCM') is assigned to claims requiring an onsite referral. Cases are referred to the most appropriate FCM based on geographic location and injury type. Specialized case management services include catastrophic management, life care planning, and vocational rehabilitation services.
Virtual Care Platform
Injured workers can contact the company's 24/7 nurse triage hotline to speak with a registered nurse who specializes in occupational injuries. An assessment is immediately made to recommend self-care, or refer the worker to seek further medical care from its network of preferred providers. CorVel is able to provide quick and accurate care intervention, often preventing a minor injury from becoming an expensive claim. The company's virtual platform allows employer access to online case information, comprehensive incident gathering, and healthcare advocacy for injured workers. Additionally, after being screened by a triage nurse, the service offers Telehealth, which connects injured workers with doctors for virtual appointments via their computers and smart mobile devices. Telehealth, which is approved in nearly all states, is integrated into CorVel's healthcare model as an option for qualified injuries, primarily musculoskeletal injuries. Telehealth preserves the integrity of the patient-physician relationship with confidential, HIPAA-compliant transactions, while also channeling injured workers to network providers for physical therapy or prescriptions when needed.
Utilization Management
CorVel's utilization management programs review proposed care to determine appropriateness, frequency, duration, and setting. These programs utilize experienced registered nurses, proprietary medical treatment protocols, and systems technology to avoid unnecessary treatments and associated costs. Utilization management processes include injury review, diagnosis and treatment planning, contacting and negotiating provider treatment requirements, certifying appropriateness of treatment parameters, and responding to provider requests for additional treatment. Utilization management services include prospective review, retrospective review, concurrent review, professional nurse review, second opinion, peer review, precertification, and independent medical evaluation.
Vocational Rehabilitation
CorVel's vocational rehabilitation program is designed for injured workers that need assistance to return to work or retain employment. This comprehensive suite of services helps employees who are unable to perform their work functions and who face the possibility of joining the open labor market to seek re-employment. These services are available unbundled on an integrated basis as dictated by the requirement of each case and customer preference, or by individual statutory requirements. Vocational rehabilitation services include ergonomic assessments, rehabilitation plans, transferable skills analysis, labor market services, marketability, résumé development, job analysis and development, job placement, career counseling, and expert testimony.
Disability Management
CorVel's disability management programs offer a continuum of services for short and long-term disability coverages that advocate an employee's early return to work. Disability management services include absence reporting, disability evaluations, national preferred provider organizations, independent medical examinations, utilization review, medical case management, return-to-work coordination, and integrated reporting.
Liability Claims Management
CorVel also offers liability claims management services that can be sold on a stand-alone basis or as part of patient management. Liability claims management services include claims management, adjusting services, litigation management, claims subrogation, and investigations regarding auto liability, general liability, product liability, personal injury, professional liability, property damage, accidents, and weather-related damage.
Auto Claims Management
Injury claims are one of the largest components of auto indemnity costs. Effective management of these claims and their associated costs, combined with an optimal healthcare management program, offers a unique method of cost savings for CorVel's customers. The company's auto claims services include national preferred provider organizations, medical bill review, first or third party bill review, first notice of loss, demand packet reviews, and reporting and analytics.
Systems And Technology
Infrastructure and Data Center
The company utilizes a tier III-rated data center as its primary processing site, along with leveraging a leading enterprise-grade cloud computing platform. Within the data center, redundancy is provided at many levels in power, cooling, and computing resources, with the goal of ensuring maximum uptime and system availability for the company's production systems. The company has embraced server virtualization and consolidation techniques to push the fault tolerance of systems even further. These technologies bring increased availability, speed-to-production, and scalability.
Redundancy Center
The company's national data center is located near Portland, Oregon. The redundancy center, which is located in Lone Mountain, Nevada, is the company's backup processing site in the event that the Portland data center suffers catastrophic loss. Currently, the company's data is continually replicated to Lone Mountain in near-real time, so that in the event the Portland data center is offline, the redundancy center can be activated with current information quickly. The Lone Mountain data center also hosts duplicates of the company's websites.
Adoption of Imaging Technologies and Paperless Workflow
Utilizing scanning and automated data capture processes allows the company to process incoming paper and electronic claims documents, including medical bills, with less manual handling, which has improved the company's workflow processes and resulted in cost savings to it and the company's customers. Through the company's online portal, CareMC, customers can review bills as soon as they are processed and approve a bill for payment, streamlining their workflows and expediting the payment process.
CareMC
The company's CareMC platform (www.caremc.com) offers customers direct and immediate access to its primary service lines. CareMC facilitates electronic communication and reporting between providers, payors, employers, and patients. The website gives customers the ability to report an incident/injury, request service, schedule an appointment, review bills, manage claims, access their treatment calendar, contest medical bills, and access automated provider reimbursement.
In addition, through CareMC, customers can manage files throughout the life of the claim, receive and relay case notes from case managers, and integrate information from multiple claims management sources into one database.
CareMC streamlines healthcare transaction processing. Using artificial intelligence technology, the website provides situation alerts and event triggers, to facilitate prompt and effective decisions. CareMC users can quickly see where event outliers are occurring within the claims management process. If costs exceed pre-determined thresholds or activities fall outside expected timelines, the customer is quickly notified. The latest feature within CareMC, the Edge, modernizes claims processing and adapts to the way people work. This module facilitates quicker decision-making by prioritizing information that is easily actionable. Seamlessly integrated within CareMC, the Edge browses codified data and prioritizes claims, alerting adjusters to those claims needing attention and actions that need to be taken. The Edge displays live claims information on one screen to help guide users toward their next action.
Claims Processing
The company continues to develop its claims system capabilities, which reflects its preference for owning and maintaining its own software assets. Ongoing integration projects are underway to present more of this claims-centric information available through the CareMC online portal. The company's goal is to continue to modernize user interfaces, give more rapid feedback, and put real-time information in the hands of its customers.
Customers And Marketing
CorVel serves a diverse group of customers, which include insurers, TPAs, self-administered employers, government agencies, municipalities, state funds, and numerous other stakeholders in the healthcare industry. CorVel provides workers' compensation services to virtually any size employer and in any state or region of the United States. Two customers accounted for 10% or more of accounts receivable as of March 31, 2025. The company's national branch office network enables it to market and offer its services at both a local and national account level, though it placed increasing emphasis on national account marketing. The sales and marketing activities are conducted primarily by account executives located in key geographic areas.
History
CorVel Corporation was founded in 1987. The company was incorporated in Delaware in 1987.
