Specialty Solutions Spotlight: When Home Health Referrals Need a Closer Look
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.
Ask The Pharmacist: Why Migraine Medications in Work Comp Deserve a Closer Review
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.
In-Network and Out-of-Network Trends
4 MIN READ
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.
Life After Amputation: Coordinating Advanced Recovery Options
Catastrophic case management supports amputation recovery by coordinating prosthetic planning, rehabilitation and practical resources for injured employees.
Getting Behavioral Health Out of the Claims Blind Spot
Behavioral health is one of the biggest drivers of workers' compensation claim complexity. Listen as Enlyte experts Jim Harris and Tammy Bradly discuss new data on its impact and how early intervention can improve outcomes.
Managing the New Drivers of Workers' Comp Claim Severity
Listen to Enlyte's latest Envision Podcast as Ed Olsen and Michele Hibbert explore the trends behind rising workers' compensation claim severity, the warning signs of complex claims and practical steps to improve outcomes through earlier action.
Specialty Solutions Spotlight: When Shoulder Claims Stop Moving Forward
Shoulder injuries can look routine early in a claim. But when therapy progress or return-to-work planning stalls, they can become costly and difficult to move forward. For adjusters, the key to managing these claims is knowing the red flags to watch for, why they matter and what action to take next.
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