Article

The Art of Creating a Physician Peer Review Panel - Part 1

… you know if a physician is qualified to perform peer review work? Many physicians think it’s an easy task because they treat patients daily – or did at one time. However, performing as a … efficacy of the treatment being proposed based on the clinical documentation. This includes an injured worker’s current and past treatment that has been submitted along with the request. …
Article

Diagnostics Systems Key to Proper and Safe Repairs for Fountain Valley Body Shop

… make ‘em like they used to,” now translates to “you can’t repair ‘em like you used to.” In an age where damage is no longer a predictor of specific necessary repairs, it’s vital that … insurance companies. And now we have something that’s efficient and easy to use.” Getting in an accident is certainly nothing to smile about, but diagnostics systems contribute to a more …
News Release

Case in Point Names Genex's Chris Burgess Platinum Award Winner

… at the time of injury, the injured worker was placed on life support and was implanted with an automated defibrillator. Gradually, he started to respond to treatment in ensuing weeks, but … Compensation is a tremendous honor, and Chris is certainly deserving of it. She is not only an excellent care coordinator, but a true leader in her field.” *** …
Article

Trends in Paintless Dent Repair

… that require straightening, filling, sanding and repainting. In fact, according to AAA, an estimated 80% to 90% of minor dents and dings may be fixed using PDR. In this white paper, we …
Conference

AASCIF Annual Conference

… AASCIF Annual Conference brings together state funds from across the country every year for an event full of insights, education and networking. Join Mitchell | Genex for a variety of …
Case Study

2022 Disability Heart of Case Management Award Winner

… this quick action avoided overpayment of short-term disability benefits as the SSDI applied as an offset to the wage replacement benefit. Nicole utilized resources to benchmark estimated …
Case Study

Next Stop = Return to Work

… 20 years’ experience in nursing. She utilized those skills when faced with a case involving an injured worker who worked for a city transportation department.   …
Conference

Guidewire Connections 2018

… the benefits that can be achieved by improving those integrations. Click here to read an article from Rebecca and Bill for a preview of the presentation. …
Article

From Reactive to Proactive: How to Leverage Data to Capture Savings

… so many views into what's going on with the claims and I think it's imperative that we have an obligation to take advantage of that, whether it's the injured party’s demographics, the … right. Well, Jim, here's a question for you. What are the main cost drivers you focus on from an analytics perspective to help clients better manage their claims? … if they always are having to bend down to pick up towels, why not put the towels at the top of the cart and then they don't have to bend over. Little changes like that can make a big …
Article

Automate the Chaos: AI, Dashboards, and the Future of Claims

… on them and when is something going off the rails that we need a human to intervene? That's an excellent use case for AI as well.   Highlighting relevant data for claims professionals, … our customers faster and better than we ever have.  And that means we're going to start to see an acceleration. It's about accelerating the data and accelerating the technology solutions that … We talked about the blue man visualization of the body parts. Again, visualizing what is an authorized body part versus a non-authorized body part is quick and easy for them to see. And …
Article

Enlyte Pharmacy Experts Speak on Turning Challenges Into Opportunities

… then they also mandate utilization review. And it's extremely important that you have an integrated model. To where the PBM is connected to utilization review. And that's for a number … And then often there's, you know, very quick turnaround times that are necessary. And in an integrated model, that can quickly get to utilization review, can be evaluated, the … really sure what blocking and tackling to put in place? I think that's where partnering with an expert in the pharmacy benefit management space is helpful. Setting up things like a drug list. …
Article

Five Business Trends that Will Become “Business as Usual”

… A business crisis is when something prevents an organization from conducting “business as usual.” That definition has never been more true for … An Industry Ready for Change … report said the mental model we need to have is to “think about developing a new ‘muscle’: an enterprise-wide ability to absorb uncertainty and incorporate lessons into the operating model …
Article

Keeping Injectable Spend in Check with Smarter Utilization Review

… these injections are “usually indicated only after oral medications, physical therapy, and an adequate time for healing has been allowed.” That is practically a blueprint for UR: verify … Even when an injection is indicated, repeat procedures can become the cost and variation driver. UR sets …
Article

Predictive Power: How AI Is Helping Workers' Comp Insurers Stay Ahead of Demographic Shifts

… employees under 25 and over 55 now comprise nearly 40% of the labor market . This dual trend—an influx of employees newer to physically demanding roles alongside experienced employees … will be those who view these challenges as opportunities to innovate and differentiate in an increasingly complex market. The organizations that thrive will develop integrated approaches …
Article

Ask The Pharmacist: Bird Flu and Its Growing Impact on Public Health

… How serious is the threat of bird flu in North America?  Bird flu, or avian influenza, is an emerging public health and industry concern across North America. While the virus primarily … 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

Progressive Pathways: Exploring Workers’ Comp Legislation in Texas, New York, Illinois, California and Tennessee

… compensation claims. Michele shared that “Between Q1 2017 and Q2 2023, New York demonstrated an 11% increase in charge per unit, while Florida has seen a 7% increase, California a 9% … costs and the total number of prescriptions have decreased significantly, and there has been an 86% decrease in opioid prescriptions. Brian further stated, “We were involved in the …
Article

StateWatch: Bill Review December 2018 / January 2019

… to U.S. jurisdictions. EDI Claims Release 3.1 is the most current release and is maintained on an ongoing basis. Below is the schedule of states updating to 3.1: Oklahoma, September 2018 … the New York State workers’ Compensation system. WATCHLIST : On Dec. 5, the WCB chair released an amendment to the Pharmacy Fee Schedule which would change the method for determining fee …
Article

StateWatch: Bill Review December 2018 / January 2019

… to U.S. jurisdictions. EDI Claims Release 3.1 is the most current release and is maintained on an ongoing basis. Below is the schedule of states updating to 3.1: Oklahoma, September 2018 … the New York State workers’ Compensation system. WATCHLIST : On Dec. 5, the WCB chair released an amendment to the Pharmacy Fee Schedule which would change the method for determining fee …
News Release

Mitchell International Transforms Utilization Management with the Launch of ReviewStat Solution

… and free up time for clinical professionals to focus on helping restore people's lives after an injury.” The ReviewStat solution's straight-through processing capabilities allow users to … treatment guidelines inherent in the ReviewStat solution bring clients the opportunity to see an increased percentage of their case work flowing hands-off through the system, either as …
Article

Implications of Epidiolex FDA Approval on Workers' Compensation

… Epidiolex is an oral, plant-derived cannabinoid medication approved for use in severe childhood epilepsy … result from the approval of Epidiolex. In the near future, we expect additional trials and an expansion of approved conditions for treatment with Epidiolex. Additionally, this approval …
Article

Average Length of Rental for Repairable Vehicles: Q3 2017

… Average Length of Rental (LOR) for Q3 2017 landed at 12.1 days in the United States, an increase of just 0.2 days compared to Q3 2016. This is a continuation of the general course … a low of 10.6 in the Pacific." LOR continues to climb each quarter in the U.S — mostly due to an ongoing increase in the number of miles driven and claim frequency as well as in the level of …
Podcast

On the Border - State Regulations & Comp Costs

… Well, one of the primary ways is that there may be an injured worker who may not end up having case management services, the benefit of someone to … not aware of that. I'll use the example of the states of Georgia and South Carolina — you have an area where if you just go across the bridge, you're in South Carolina, or you go across the …
Article

Bone-Connected Prosthetics: What Adjusters Should Know About Osseointegration

… implant inserted directly into the bone. Once the implant heals and integrates with the bone, an external connector allows the prosthesis to attach directly to the skeleton. The result? A …
Article

Managing Michigan Auto No-Fault Claims with Confidence

… review, enabling faster processing and response times  The results speak for themselves: an appeal rate of just 4% and average billing adjustments ranging from $537 to $1,375 per review. …
Case Study

Breaking Down Barriers

… case to make certain each injured employee was evaluated for return-to-work capabilities at an occupational clinic and managed accommodations for follow-up appointments and treatment. Diaz …
News Release

New York State Workers' Compensation Board Provides Updates on Prior Authorization Requests

… Any requests that are not handled in the appropriate time frame are subject to review and an Order of the Chair to mitigate the delay. Administrators using the portal should ensure that …
News Release

Mitchell Announces New Automation Capabilities to Address Florida Deductible Ruling

… directly against provider charges before applying the fee schedule. This ruling has had an effect on how carriers calculate claim payments in Florida, in many cases resulting in a …
Conference

America's Claims Executive Leadership Forum & Expo

… Mitchell will be hosting an exclusive cocktail reception at the ACE conference. Contact your Mitchell representative or …