Article

Balanced Regulatory Environment: A Key Component to Unlocking the Value of Specialty Bill Review

… Without the use of Specialty Bill Review (SBR), payers risk paying for errors or abuses created by providers with … regulatory climate in each state is a key component to ensuring fair and reasonable payment of medical bills especially in non-fee schedule states  Our team of regulatory professionals, including lobbyists and government relations experts, work … Lack of Data: … In some states, the lack of reliable data on provider charges and accepted payments makes it difficult to implement SBR …
Podcast

Using Risk Prediction Technology to Move Claims Forward

… role in helping comp claims progress. In today’s Inside Workers’ Comp, Bobbie Doyle, director of utilization management at Genex, explains the ins and outs of a program designed to do just that. It’s called Referral Expert. … risk tool, it's a scoring engine, and it scores existing claims for the appropriateness of clinical management. And it responds to claim events as soon as they're reported for immediate …
News Release

FDA Approval of Dsuvia: Why Now and What Might it Mean for Workers' Compensation?

… than morphine and 10 more powerful than fentanyl. Many people are asking why, in the midst of the opioid crisis, are we approving a new, highly potent opioid? FDA Commissioner, Scot … not be available in a retail pharmacy. It was developed in partnership with the Department of Defense to help provide rapid relief of pain on the battlefield in circumstances where an oral medication would not be practical or effective. For civilian use, Dsuvia is restricted to …
Podcast

What is a Pharmacy Nurse Champion?

…   Everyone knows nurse case managers play a vital role in reducing costs of workers’ compensation claims by guiding the continuum of care for injured employees. And now some programs are implementing the same approach to help … At Genex, these professionals are called pharmacy nurse champions, and Bobbie Doyle, director of utilization management, joins us today to explain how they’re making a difference in claims …
Virtual Event

Beyond Opioids: Current Alternatives for Pain Management [Podcast]

… The discussion of alternatives to opioids continues as the workers’ compensation industry works to find ways to … Freeman, Pharm.D., Chief Clinical Officer at Mitchell, and Helen Froehlich, Vice President of Case Management at Genex Services , provide insights. … With any claim, the management of pain can come with several considerations. Dr. Freeman underlines that pain, unlike blood … there are also psychological and social components that need to be considered when treating an injured worker. He says that previous understandings were that no one should be in any pain, …
News Release

Workers' Comp Data: Healthcare Industry Sector is the Source of the Majority of COVID-19 Claims
Article

Get the Most Out of FairPay Flex: Expert Tips and Tricks

… compensation medical bill review. Here are some expert tips and tricks to make the most of this powerful tool. 1. Shine a Light on the Grey Area  FairPay Flex shines in grey areas where … and New Jersey where FairPay Flex can be particularly impactful with average savings rates of 62%. 3. Optimize Bill Selection FairPay Flex has an automated, state specific, bill selection criteria for multiple bill types such as: ambulatory …
Article

Three Ways Technology Is Changing the Nature of the Property & Casualty Industry

… insurance industry is always changing, but continuous technological advancements have the pace of change occurring faster than ever before. Property & Casualty (P&C) market insiders are experiencing companies of all sizes undertaking major digital initiatives to add efficiencies and increase economies of scale. While change of any kind can add complexity, the claims and collision repair industries …
News Release

Genex Social Security Division Receives Supplier of the Year Award from Unum

…  Genex Services, LLC (“Genex”), the leading provider of case management services to the workers' compensation, disability, and auto markets, has announced that Genex Social Security, a division of Genex Services, LLC, has received the … Supplier of the Year Award for 2013 … , as part of Unum's 2013 Global Supplier Awards Program. Unum is a leading provider of financial protection … Unum's benefits help protect millions of working people and their families in the event of an illness, injury, or loss of life. The company works with a wide range of suppliers who assist …
Enlyte

2023 Heart of Case Management Award Winners
In the News

Comp sector widens scope of recovery efforts
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Examining the National Patchwork of Marijuana Laws
CE Webinar

Networks 2.0: The Evolution of Provider Networks

… agree, the U.S. healthcare delivery system is broken. But it is not all bad news. One element of care delivery that is seeing exciting reinvention is networks, which are evolving from … health delivery system has evolved and how workers’ compensation networks can address some of the challenges group health networks face including financial challenges, provider … injured workers back to work, and how work comp networks are evolving to meet the needs of employers and patients. …
Article

Auto Casualty Glossary of Terms and Definitions

… benefit management can be complex. Looking to learn more? Download our Auto Casualty Glossary of Terms to increase your knowledge of common industry terms such as fee schedule and peer review. …
Article

National Underwriter Property & Casualty: Drug of Choice
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3 For NWCDC: Pat Chavanu of Genex Services
Article

3 For NWCDC: Ron Skrocki of GENEX Services
News Release

Five Ways Mitchell Cloud Glass is Simplifying the Evolving Challenges of Glass Claims

… complex over the past few years, and it appears that even more complexity lies ahead. With an increasing number of vehicles equipped with Advanced Driver Assistance Systems (ADAS) that involve auto glass and more complexity in the composition of glass components on newer vehicles, it has become clear that new and improved solutions for … to file a claim online, offer immediate coverage verification and allow self-selection of a local vendor. There are even new options that allow sending consumers with a glass claim a …
News Release

Opioid Addiction Drug Buprenorphine Increases Risk of Dental Issues According to FDA

… The Food and Drug Administration ( FDA ) recently issued a warning concerning the risk of dental problems resulting from medications used to treat opioid addiction and pain. The warning concerns oral buprenorphine medications that are placed against the inside of the cheek or dissolved under the tongue. The use of this treatment has been reported to cause … important tool to treating OUD. In regard to the workers’ compensation industry, there may be an increased expense to clients associated with potential additional dental costs, especially in …
Article

Settling In: A Q-and-A with Mitchell’s General Manager of Auto Physical Damage, Debbie Day

… her role, where she sees the most opportunity to extend Mitchell’s value, and how the needs of Mitchell’s customers play in the company’s roadmap and offerings. Q: What excites you most … that is really exciting to me is how, from the very beginning, Mitchell has been a source of trusted innovation. I’ve spent more than ten years in the APD industry and have always … to the customer is essential. Since I started at Mitchell, I’ve been doing a tremendous amount of listening. I’ve interviewed hundreds of internal APD employees, and dozens of customers and …
Article

Dave Torrence Gives His Perspective on the Benefits of Bringing Technology, Clinical and Networks Together

… is unique in having brought technology, clinical services and networks together as one family of businesses. As the Pharmacy Solutions leader, how do you see these areas working together?  … and solutions like pharmacy benefit management (PBM). When medical providers belong to one of our networks, they receive certain benefits such as referrals. As participating members of our networks, we can include provisions designed to guide providers in complying with PBM …
Article

Ask The Pharmacist: FDA Approval of Non-Opioid Medication for Acute Pain

… a novel non-opioid medication developed by Vertex Pharmaceuticals for the treatment of moderate to severe acute pain in adults. This approval, announced on January 30, 2025, marks a significant milestone in pain management , introducing the first new class of oral medication for acute pain in over two decades. Journavx, a selective Nav1.8 sodium … pharmacist. Do you have a workers’ compensation or auto-related pharmacy question? Send us an email at AskThePharmacist@enlyte.com . To read more Ask The Pharmacist articles, please visit …
Article

Vertical Integration of Data and Clinical Services to Improve Physical Medicine Outcomes

… In a sea of claims, workers' comp professionals need help spotting cases headed for risky waters. Does a claimant have comorbidities or preexisting conditions, such as diabetes, which could hamper an injured employee’s ability to heal and recover? Are there psychosocial risk factors that can create roadblocks to recovery? The integration of data analytics and a full range of clinical services is especially important when it comes to …
Podcast

Do You Need a Medicare Set-Aside?

… pressure to consider and protect Medicare's interests when settling claims. In this edition of Inside Workers’ Comp, Deborah Robinson Stewart , National Manager of Medicare Services at Genex, breaks down the basics of MSAs and offers insight of when they should be established. … : Workers' comp payers are under increasing pressure to consider and protect the interests of Medicare when settling claims. This is especially true with claims shifting, which can result …
Article

OE Versus Aftermarket Part Price Deltas: In Search of the Big Deal

… When Priceline pitched Shatner off a cliff during a 2012 Super Bowl commercial, it signaled an end for the Big Deal. Admittedly, I was bummed. I always liked the Big Deal—he was a savings … makes. For insurers and price-conscious consumers, aftermarket parts have long played the role of the Big Deal, representing the largest opportunity for collision repair cost savings. But is this still the case? To answer this question, we analyzed millions of Mitchell estimate rows dating back to 2010, comparing OE and aftermarket part prices for six …
Article

Specialty Solutions Spotlight: The Critical Role of Quality Clinical Documentation in Workers' Comp

… How can I streamline the process of obtaining and reviewing clinical documentation?  In workers' compensation cases, timely and … Ensuring Continuity of Care: … Accurate records help prevent errors and complications by providing a clear picture of the injured employee's health status and treatment history. … ongoing specialty care Leverages electronic connections with providers for: Real-time receipt of completed notes Portal access for adjusters and case managers to facilitate easy review and …
Article

What is Ticket to Work?

… activity, nurturing our self-esteem, social connections, financial security, status, and sense of identity. When the ability to work is taken away from us due to a debilitating injury or … Genex became a certified Ticket to Work provider, so we asked Kevin Ufier, National Director of Disability, to tell us more about it. … : The Ticket to Work program is under the umbrella of the Social Security Administration to assist individuals who are on disability with Social …
Article

What is Ticket to Work?

… activity, nurturing our self-esteem, social connections, financial security, status, and sense of identity. When the ability to work is taken away from us due to a debilitating injury or … Genex became a certified Ticket to Work provider, so we asked Kevin Ufier, National Director of Disability, to tell us more about it. … : The Ticket to Work program is under the umbrella of the Social Security Administration to assist individuals who are on disability with Social …