As adjusters and examiners are reviewing claims statistics and planning for 2018, take a look at some of these challenges and associated suggestions that are designed to help you get ahead on controlling costs for the coming year.
With every claim comes unique challenges and situations that are complex. Claimants who sustain catastrophic, orthopedic or soft tissue injuries because of a workplace incident or an automobile accident may require anything from surgeries to home health care services. These types of claims represent additional challenges because many providers choose to unbundle the Healthcare Common Procedure Coding System (HCPCS) codes. The best practice on all claims is to reduce unbundling and the use of not otherwise classified (NOC) codes to increase transparency and reduce the chance of your company paying too much.
Discounted rates are vital to the success of an insurance company as well. The average wholesale price (AWP) of prescriptions is continuously rising as you have likely observed within claims you administer that require the use of claimant prescription medications. While you may not have the ability to control those prices, you do have the option of negotiating discounted rates for your company.
Those same providers that agree to give your company discounted rates could also offer access to prescription medicines at no out-of-pocket cost to your claimants. This suggestion has a more indirect impact on saving claims costs. When claimants are offered the opportunity to fill their injury-related prescriptions without the need to pay up front and submit reimbursement requests to their insurance company, their satisfaction with the claim and with the company increases significantly. Over time this translates into increased claimant loyalty and additional premium dollars for your company.
These are things to consider as you look toward the remainder of 2018. The most efficient and practical way to implement these ideas and solve the challenges outlined above is to form a partnership with a third-party administrator (TPA) of both workers’ compensation and automobile no-fault claims. Northwood is one such TPA with more than 20 years of experience in saving money for insurance companies.
At Northwood, we strive to bring proven processes and procedures to our clients and their claimants. From an expansive provider network offering discounted rates and the elimination of out of pocket payments for claimants to pre-authorization processes and the practice of transparency in HCPCS use, Northwood brings innovative solutions to your company.
For a more customized look into how Northwood can help you get a jump start on cost savings for 2018, please contact Rosanne Brugnoni at 586-755-3830 ext. 3771 to schedule a call.Leave a reply →