This course will educate claims professionals on why it is important to protect Medicare’s interests and requirements for complying with the law. Included in the course is MSA preparation, submission & challenges faced when handling MSAs.
Home health can be a critical part of recovery, but it should not run on autopilot. The issue for adjusters is knowing when the ordered services no longer match the injured employee’s current needs, recovery progress or claim goals. A closer look can prevent unnecessary service hours, prolonged dependency, and care that is either too much or too little for the situation.
Migraine headaches can be disabling, difficult to document and costly to treat. In workers’ compensation, they also create claim complexity when causation, medication choice or treatment progress is not clearly supported.
This analysis provides a comprehensive examination of prescription utilization across both in-network and out-of-network channels including retail pharmacies, mail-order services, and paper-based medical bill submissions. This dual-lens approach captures the full prescription landscape that extends beyond traditional pharmacy benefit management reporting, revealing critical cost and utilization patterns across all jurisdictions. While in-network channels demonstrate the real-time effectiveness of integrated clinical controls and cost management strategies, out-of-network data, often representing acute treatment episodes captured through medical bill review, exposes significant cost management opportunities and pricing anomalies. Together, these perspectives illuminate where pharmacy dollars are spent, how prescriptions are managed, and where targeted interventions can drive the greatest impact on both clinical outcomes and costs.
A return-to-work plan can be medically sound and still fall short. The employee may be released to return, restrictions may be documented and accommodations may be approved. But a return sustainable? The goal is to help employees return in a way that is sustainable.
Learn why bodily injury claims are overpaid and how consistent demand evaluation improves negotiation outcomes and reduces claim leakage
Catastrophic case management supports amputation recovery by coordinating prosthetic planning, rehabilitation and practical resources for injured employees.