News Release

August 2022 Utilization Review Compliance Update

… a helpful resource. If you have any questions about any of the information presented, please do not hesitate to contact your client account manager. Or you may reach out to a member of the …
News Release

Advanced Driver-Assistance System Trends and Challenges

… the first seatbelts offered in the 1950s. Today's advanced driver-assistance systems (ADAS) do more than reduce the risk of injuries during a crash; some features are designed to help avoid … equipped most of their vehicles with AEB, [5] including the Chevy Malibu which earned an IIHS Top Safety Pick + Award when equipped with the Low Speed Forward Automatic Braking system. With …
Article

Physician Dispensing and Opioid Abuse: Drug Dilemma Prevention Strategies

… of opioid abuse. The challenge begins with mismatched incentives. Most physicians intend to do no harm and have a genuine interest in making sure their patients are not in pain. However, …
Article

StateWatch: Summer 2018
Article

StateWatch: Summer 2018
Podcast

Unpacking Drug Trends: Costs, Care and What's Next

… disease or risk factors. And that’s just one example among many. These medications do come at a significantly higher price point. So, the cost per claim for migraine medications …
Article

Six Key Concepts in Pharmacy Benefit Management

… 5. How do Formularies Work with Pharmacy Benefit Management? …
Article

The Opioid Epidemic: Using Opioid UDS to Empower Better Outcomes

… However, testing without an appropriate strategy for frequency and interpreting results can do significant harm and drive increased cost without significant improvement on the patient or …
Article

StateWatch Winter 2015
Article

Top Auto Casualty Trends to Watch in 2022

… trends expected to continue. To help you prepare and navigate what’s next, here are Enlyte’s top 2022 predictions: Miles Driven Will Fluctuate; Severity Will Continue to Rise Provider … Automation, no-touch claim processing and artificial intelligence will be top of mind for insurance carriers experiencing staffing shortages. … Many carriers will focus on integrating the knowledge of their top adjusters and claim specialists into their technology platforms to reduce the risk of that …
Article

2020 CPT Code Changes: What You Need to Know

… with codes 27091 or 27488. From a coding perspective, the code descriptors for these codes do not immediately provide adequate information as to why these codes should not be reported for …
Article

Using Integrated Solutions to Help Improve The Workers Compensation Claim Process

… not sure how he was supposed to pay for the prescription. The pharmacist knew exactly what to do. She was able to provide Joel with his prescription with no out-of-pocket costs. Additionally, …
Article

COVID-19 P&C Industry Update: Regulations, Telemedicine, Access to Care and Testing

… visits that could expose patients and providers to infectious diseases. But you can’t do everything through virtual visits. … and casualty lines of insurance. The pandemic quickly moved this mode of a visit to the top of the priority list, leaving everyone wondering why this had not happened sooner. … compensation and auto claims. Managing individual rules and legislation from 50 states on top of federal government guidance has created a quagmire of rules and welcomed changes. The …
Article

StateWatch Spring 2016

… Code Section 155.44 which focuses on insurance companies that have ratings below A- and do not have at least $200 million in surplus. Under the new law, these companies must require …
Article

2019 CMS Medicare Payments: Proposed Changes and What They Mean for P&C Insurers

… In the P&C industry, E/M services control the top 15 procedure codes utilized, and could have a greater impact on providers in casualty from a … the AMA guidelines are followed for the use of CPT codes billed. The proposed CMS changes do not support the AMA guidelines for using appropriate CPT codes as they only apply to CMS …
Article

StateWatch: Fall 2018

… reports that as of early July, only 38 out of 63 UR firms that do business in the state had received accreditation from URAC, formerly known as the Utilization …
Article

StateWatch: Fall 2018

… reports that as of early July, only 38 out of 63 UR firms that do business in the state had received accreditation from URAC, formerly known as the Utilization …
Article

StateWatch Winter 2016
Article

Five Qualities of an Effective Business Workflow Solution

… the payment. Insurance Company A’s adjusters will then have more time to focus on bills that do require their oversight and can give more attention to claims that need further negotiation …
Article

2020 in Hindsight: Clinical Trends and Predictions

… topicals increased an average of 379%. The largest price increase for a topical within the top 20 topical medications was for a combination cream of nystatin and triamcinolone, which …
Article

StateWatch Summer 2017

… These “company adjusters,” would be allowed to obtain a license but would not be required to do so. To obtain a license, adjusters must pass a background test as well as a licensing exam. … Evaluation of the Utilization and Cost Patterns of Compounded Drugs” also determined the top five dispensing pharmacies based on number of prescriptions accounted for 86 percent of all …
Article

StateWatch Summer 2017

… These “company adjusters,” would be allowed to obtain a license but would not be required to do so. To obtain a license, adjusters must pass a background test as well as a licensing exam. … Evaluation of the Utilization and Cost Patterns of Compounded Drugs” also determined the top five dispensing pharmacies based on number of prescriptions accounted for 86 percent of all …