Article

Mental Health Is the Hidden Factor Delaying Recovery

… In workers’ comp, not every injury shows up on an X-ray. Mental health challenges such as anxiety, depression, and trauma can quietly disrupt … Case managers are trained to look for what isn’t documented. Maybe an injured employee attends every appointment but seems emotionally withdrawn. Or maybe someone …
Article

Delivering The Most-Favored Nation Prescription Drug Pricing to American Patients

…     On May 12, the White House issued an executive order seeking to get most favored nation prescription drug pricing for American … will be interesting to see how this shakes out. We are definitely watching it. It does have an impact, broadly, on the workers’ comp market. This primarily impacts brand-name drugs. …
Article

Stop the Specialty Service Spiral

… find themselves dealing with unnecessary time drains and administrative headaches caused by an outdated, fragmented approach to coordinating specialty care that risks both … With an average 1-hour turnaround from referral to care coordination, injured employees receive the …
News Release

ODG Updates Muscle Relaxant Formulary

… as “Y” and those that are not as “N” or not recommended as first line treatments for an illness or injury. States and payers that use the formulary may require prior authorization for any non-Y drug to define its medical necessity for an approved injury. The formulary is organized to allow ready evaluation of medications in a …
News Release

Colorado Adopts New Prior Authorization and Payment Timeframes

… to the prescribed treatment in writing. A complete prior authorization request must include an adequate description of the necessity for the treatment, identification of the appropriate MTG … to be authorization for payment of the requested treatment, unless the payer has scheduled an independent medical examination (IME) and notified the requesting provider within 10 days. All …
Case Study

Home Team Advantage

… quickly identified resources, researched several facilities and coordinated his transfer to an acute rehab facility that would accept an out-of-state jurisdiction claim and the associated rates of reimbursement. She also …
Case Study

From Tragedy to Triumph

… in the care plan. As the injured worker progressed, Ramsey ensured a seamless transfer to an inpatient rehabilitation facility where he continued to recover until he was deemed safe for … returned to work far ahead of Official Disability Guideline estimates. Today, he works as an RN at the trauma center where he was treated. For their remarkable accomplishments, Ramsey and …
Article

Westfield Builds Deeper Connections with Innovative Solutions

… how Westfield would transform its business in 170 years, what has remained unchanged is an unwavering focus on relationships and a commitment to caring and respect for others. Outside … is what allows Westfield to continue innovating and thriving. Concentrating on providing an exceptional claims professional experience and disrupting the medical bill review space led to … The challenge for the group was to develop an accurate and consistent process that would benefit customers while also creating optimal …
Podcast

Using Remote Therapy Monitoring to Improve Compliance Costs in Comp

… takes what they learn in the clinic to home, both in a formal home exercise program or just an activity modification. But over time, as technology’s improved, you’ve gotten these … premise is the tool and/or device actually monitors the patient’s compliance or performance of an exercise or activity that has been prescribed from the physical therapist. It isn’t, like I … putting a device on a joint that is affected. So, you place it on the foot if you’re doing an ankle injury, or the calf if you’re doing a knee, and that monitors the motion and sends that …
Article

Ask The Pharmacist: Managing Benzodiazepine Tapering in Injury Claims

… motor vehicle accidents and workplace injuries. They can impair cognitive function, affecting an individual's ability to drive, perform job duties and manage daily activities. Even at … years, especially for high-dose or long-term users. Temporary withdrawal symptoms may affect an individual’s ability to work or perform daily tasks. Coordination among providers is critical … 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 …
News Release

Battery Electric Vehicle Collision Claims Continue to Rise Despite Sales Slowdown

… —Mitchell, an Enlyte company and leading technology and information provider for the Property & Casualty … when compared to their internal combustion engine, or ICE, counterparts. However, with both an ICE and small electric battery, mild hybrids are remarkably similar to gasoline-only powered … severity for repairable MHEVs was $4,726 in the U.S. and $5,302 in Canada. For vehicles with an ICE, it was $4,806 in the U.S. and $4,958 in Canada, a difference of $80 and $344, …
News Release

Enlyte’s Q2 Medical Price Index Shows Increases In Comp and Auto Injury Services

… medical bills during that span. The Enlyte Medical Price Index data is representative of the top 200 procedures billed under each coverage for professional services. The report provides … include rises in utilization and inflation, Hibbert said. Enlyte’s data also revealed an interesting trend in New York in comparing auto first party and workers’ comp MPIs. The state … are adopted a year later. So, the fee schedule change delay in first party auto contributed to an increase of 19% MPI from Q1 2020-Q4 2023, as opposed to a 3% increase in workers’ comp during …
Article

Ask The Pharmacist: Anti-Seizure Medications for Pain Management in Workers’ Compensation

… and salicylates (Aspirin ® ). These two categories are available in combination as well where an opioid is paired with a non-opioid analgesic to provide enhanced pain relief while allowing … effectively managed by opioid or non-opioid analgesics alone thus prompting the addition of an adjuvant medication. This information is meant to serve as a general overview, and any … 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 …
Article

Self-service tools can bring savings for both payers and providers

… Google or Amazon. Can you imagine if you had to call Amazon every time you wanted to place an order? Technology has provided much easier ways to communicate and get what we need. The same … questions are made over the phone every day. Of course, there are often good reasons to make an inquiry when it comes to medical billing. Inaccurate billing results in longer time to … time managing the bill is limited to a single person within a single transaction. Retrieving an EOR online takes less than a minute, whereas hold times and call duration could amount to 10 …
Blog

Top Therapeutic Classes by Age of Claim in 2019

… our ongoing drug trends series, in part two of our analysis we’re taking a closer look at the top therapeutic classes by age of claim. Stay tuned for more posts addressing specific trends … hydrocodone, or oxycodone products) continued to decrease year-over-year coupled with an increase in other 1 st -line treatments and are now #3 compared to last year when they were #2 … Now let's contrast some of what we have just reviewed for younger claims with the top therapeutic class trends for claims age 2 years and older. Again, there is a positive trend …
Article

Michigan No-Fault Reform: How to Prepare for the Utilization Review Administrative Rules

… under No Fault 500.3157a(6) , defines utilization review as “the initial evaluation by an insurer or the association created under section 3104 of the appropriateness in terms of both … Utilization review must be performed by an entity with a utilization program that operates using “medically accepted standards” with best … be contracted to perform the professional utilization review services for the carrier. Once an insurer contracts with a Medical Review Organization (MRO), they have 30 days to notify the …
Article

Six Ways TCMs Are Crucial During COVID-19

… prevention protocols. While the pandemic is tenuous for everyone, the high-risk set have an added layer of concern — how best to protect themselves from illness. We’ve increased our … and whether they’re receiving the most appropriate care. The COVID crisis has added an additional layer of anxiety as individuals deal with stress of cancelled appointments, … access to care, employment issues and treatment protocol. By easing these fears and providing an empathetic ear, the TCM can help the employee maintain a positive mindset about his or her …
Article

How COVID-19 is Impacting Prior Auth Rules in Comp

… and time frames for workers’ compensation claims handling. New York recently issued an emergency order , guiding stakeholders to conduct claim-handling activities remotely where … therapy, as we’ve seen the Washington State Department of Labor and Industries publish an emergency policy to guide and guarantee payment for therapy provided via telemedicine. New … to reshape our lives and our livelihoods, what is clear and worth emphasizing is that we, as an industry, are united in ensuring claims professionals and injured workers continue to have …
Article

Average Length of Rental for Repairable Vehicles: Q3 2019

… Average Length of Rental (LOR) for Q3 2019 landed at 12.4 days in the United States, an increase of 0.4 days compared to Q3 2018 . Once again, there was very little consistency … LOR decreases over Q3 2018. Meanwhile, New Brunswick, Newfoundland and Quebec each posted an increase over last year. Interestingly, Canada’s most populous province (Ontario), remained … between “average” and “best-in-class” results for Canada. Collision Centres that adhere to an effective scheduling strategy, invest in extensive employee training, and utilize the ARMS® …
News Release

Mitchell l Genex Acquires CompAlliance, Expanding and Enhancing Managed Care Services

… cost containment and disability management has announced its acquisition of CompAlliance, an established provider of managed care services, including its Preferred Provider Organization … President. “This combination will provide CompAlliance the ability to provide our clients with an expanded and strengthened service offering that we are confident will create increased value … broadest continuum of technology and services, best-in-class clinical and pharmacy solutions, an expansive range of networks and unparalleled access to data analytics that drive better …
News Release

Mitchell | Genex Acquires CompAlliance, Expanding and Enhancing Managed Care Services

… cost containment, and disability management has announced its acquisition of CompAlliance, an established provider of managed care services, including its Preferred Provider Organization … President. "This combination will provide CompAlliance the ability to provide our clients with an expanded and strengthened service offering that we are confident will create increased value … broadest continuum of technology and services, best-in-class clinical and pharmacy solutions, an expansive range of networks and unparalleled access to data analytics that drive better …
Article

Quarterly Drug Update: Pharmacy Drug Spend

… broadly defined as chemically related to the prototype, or other chemical compounds which have an identical mechanism of action." ‘Me-Too’ drugs are those that are very similar to a previous … of drugs that had not previously existed. While neither of these are negative per se, there is an opportunity for payers to look for equally clinically effective medication and or medication … 100, and 150 mg capsules. Silenor® is marketed for sleep uses. Doxepin generic is utilized as an anti-depressant and sometimes for anxiety. Cost of 10 mg doxepin vs. 6 mg Silenor® for 30 days …
News Release

PRIUM's Mark Pew Receives IAIABC Gompers Award

… . As one of six esteemed IAIABC President's Awards, the Gompers Award is given to an industry leader who has advocated for the improvement of occupational health, safety, and … message is to treat injured workers with respect; injured workers are people, too.” “Mark is an incredible asset to the IAIABC Medical Issues Committee,” she added. “He has taken the lead on … than 2,900 employees and 41 service locations throughout North America. The company serves the top underwriters of workers' compensation, automobile, disability insurance, third-party …
Article

Reduce Workers Compensation Claims By Using Wearables in The Workplace

… Resource Center, 1 in 6 Americans currently own a wearable device. While fitness is still the top priority for most wearable owners, when used in the workplace, these devices have the … claims. Further, the devices hold promise as a tool to speed recovery times, reducing the time an injured party is away from the job. The caveat—these advances come with some important … There is an explosion of workplace-focused wearables coming to market that go beyond smart watches and …
News Release

Genex Services Launches New Approach for Workers' Compensation Rx Safety

… a customized and integrated approach to prescription drug management in workers' compensation. An enhancement to Genex's current PBM management program, Medication Safety 2.0 includes … in claims with pharmacy prescriptions by using the proactive early intervention model and an integrated medication safety program designed to eliminate waste and abuse. This carrier also … check out an interview on medication safety issues and solutions with Ron Skrocki at …
Article

Legislative Updates in Workers' Comp: Boosting Industry's Political Voice

… In this WCI-TV interview, Brian Allen, VP of Governmental Affairs, offers an update on top regulatory and legislative initiatives that could impact workers’ comp, such as …
News Release

Risk & Insurance: Empowering Injured Workers to Heal

… injured workers provides them with a sense control over their care and their recovery. An encounter with a patient early in her career as a case manager taught Lisa Armstrong a lesson …
Article

StateWatch Fall 2016

… word recognition, all of which could be affected by a head injury. The results are compared to an age-matched control database or to a patient’s pre-injury baseline scores, if available. In … prescription opioid abuse and heroin use crisis. Professional employer organizations now have an option to become certified by the … certain treatments provided by medical provider network doctors within the first 30 days of an injury. …