Podcast

How Service Impacts Claim Costs

… The speed, costs and reliability of diagnostic services can seriously impact the progression of a claim, especially if the exams are hampered by poor customer service. On today’s Inside Workers’ Comp, Bob Smith, CEO, of Priority Care Solutions, a division of Genex, explains why quality customer service is so … : Well, one of the ways it's going to help is by getting that in the pipeline right away to a group like us. …
Conference

National Workers' Comp Conference 2017

… trends and heard from our partners and other industry experts around the country about all of the happenings in the workers’ compensation space. Here are some of Mitchell’s highlights and main takeaways from the conference. … At the start of the conference, Mitchell published the results of a workers’ compensation industry survey that we conducted in collaboration with Risk & … Click here to see the full results of the survey …
Article

Third Party Auto Cost Drivers: Medical Inflation and More

… from the beginning with claims created in our bill review system from 2017 through the end of 2021. Below, we’ve outlined Enlyte’s observation of trends in this data:  Medical Inflation at the National Level Third Party Medical Inflation at … majority of the pandemic, physical medicine and chiropractic manipulative therapy experienced an uptick starting in Q3 2021, which amounted to a 33% and 21% increase. Surgery services saw a …
Article

Beyond the Buzz: Do You Have GenAI FOMO?

… Growing mainstream use of GenAI tools like ChatGPT have supercharged the desire to adopt this technology in every … the technology community to invest significantly in more powerful computing solutions. All of this creates a powerful, virtuous cycle of advancement that is very exciting and as a result, tech leaders are being pressed now more … If businesses don't stay on top of the latest trends and start delivering value immediately, they risk alienating customers …
News Release

Serving the Customer and the Community Builds Trust in Randy’s Body Shop

… the brothers have since performed nearly every job at the Paducah, Kentucky facility. Decades of hands-on experience meant that when it was time, they were more than ready to take over the … the same on a vehicle today as ten years ago." —Kyle Wiersma Kyle Wiersma, now vice president of the business, has seen the evolution of vehicles firsthand. “From the materials to the technology to the electronics—from bumper to …
Blog

For Coventry NT24 and Nurse Educators: It Takes a Village

… Continuing the Nurses Month celebration , we’d like to share personal stories about some of our nurses.  … UR should need assistance again at some point. It was a huge team effort and a prime example of working together for the organization.  Meet the Telephonic Case Managers who stepped up to … to you because we admire their spirit and passion for nursing, and the never-ending stream of positivity and encouragement they offer their injured workers and co-workers alike. They were …
Article

The Black Lives Matter Movement Is Changing Us for the Better

… The first half of 2020 has been unprecedented. There has been some good, a lot of bad and even some ugly. But when I step back and think of one word that sums it all up, it is change. Looking back at where we were as recently as … With the amplification of the Black Lives Matter movement, businesses and leaders in all industries were forced to take … “Am I doing enough?” The heightened focus on social injustice in this country inspired some of the biggest names in insurance, including us, to take public stands on the importance of …
News Release

Mitchell Secures New Investment Partner in Stone Point Capital in its Continued Commitment to Growth and Innovation

… Mitchell International, Inc. (Mitchell), a leading provider of technology, connectivity and information solutions to the Property & Casualty (P&C) claims and … which funds managed by private equity firm Stone Point Capital LLC ("Stone Point") are making an investment in Mitchell and acquiring the equity position held by KKR and Elliott Management. … customer-driven company built on strong values," said Alex Sun, President and CEO of Mitchell. "We are extremely appreciative of the role KKR played in our growth over the years, …
Article

Turning Regulatory Obstacles into Strategy Advantages Using Informed Decision-Making in Workers’ Comp & Auto Casualty

… Following our examination of President Trump's health care executive order and its implications for workers' compensation and auto payers in Part 1 of our series, this article explores how advanced bill review technologies can help position … changes create new complexities in workers' compensation and auto casualty, the integration of advanced analytics, artificial intelligence and regulatory expertise offers a powerful …
News Release

Mitchell Issues 2nd Quarter 2019 Industry Trends Report

… —Mitchell International, a leading provider of technology, connectivity and information solutions to the Property & Casualty (P&C) Claims and … Repair industries, today released its Industry Trends Report (ITR) for the second quarter of 2019. In this quarter's report, Mitchell executive experts share insights on achieving humane automation, avoiding “decision fatigue” in claims management, and the impact of weather on auto-related claims. …
News Release

Mitchell Congratulates 2019 mPower Award Winners

… Mitchell, a leading provider of technology, connectivity and information solutions to the Property & Casualty (P&C) claims and … Casualty Conference September 30—October 2, 2019, in Boca Raton, Florida. During the gathering of experts in auto physical damage, auto casualty and workers' compensation insurance claims, Mitchell's president and CEO Alex Sun announced the winners of the third annual Mitchell mPower Awards . The program is designed to highlight and celebrate …
Article

Top Five Automotive Trends for 2020

… With each new year, we seem to be faced with another salvo of changes in the automotive industry, far surpassing trends experienced over the past few decades. 2020 appears poised to be a pivotal year for both the furtherance of development already in place and fresh forces of disruption. … 1. Continuing Growth of Electrification … Fuel Economy (CAFE) standards by ramping up electrification strategies with the expansion of mild hybrid programs as well as new plug-in hybrid and fully electric vehicle (EV) offerings. …
Article

Medical Inflation: Effects for First Party Auto Casualty Claims

… expenses have been on the rise for the past 60 years. In 1960, healthcare made up just 5% of United States GDP, compared to 20% in 2020. On top of that, general inflation experienced the most dramatic increase in 40 years in February … this change, it is our hypothesis that the focus on control of opioid prescriptions may have an effect the increase of pain management services. Medical Severity by Service Group First Party …
Article

Cracking the Code: What DTCs Tell Us About Vehicle Repair Trends

… are now more routinely performing pre- and post-scans. Just two years ago, less than 10% of vehicles were scanned. 1 Fast forward to Q2 2020 and nearly 50% of vehicles repaired include a charge on the estimate for Diagnostic Trouble Code (DTC) scanning. 2 With rapid advancements in vehicle complexity and the prevalence of Advanced Driver Assistance Systems (ADAS)—which can now be found in 92.7% of new U.S. vehicles …
Article

Cut the Friction: Reducing Claim Costs Through Integration

… continue to rise. While catastrophic claims and fee schedule changes draw attention, much of the financial pressure often stems from factors less visible: fragmented systems, delayed … to simulate how a network configuration will perform before changes are implemented. Instead of relying on static averages or assumptions, organizations can test “what if” situations in a … PTs may document these indicators, the information often remains buried in narrative notes.  An integrated approach changes this dynamic. When bill review data, predictive analytics, …
Article

What’s Driving P&C Executive Decision-Making in 2026

… and familiar operational demands. Inflation continues to influence costs in key areas of the business. Claims remain medically and legally complex, requiring greater coordination and … supported by technology, tighter integration across the value chain and more effective use of data. The Executive Mindset: Pragmatic Focus, Shaped by Line of Business The outlook among … expert roles. For executives facing persistent talent constraints, this shift represents an opportunity to scale expertise more effectively while creating more sustainable, analytically …
Article

ADAS Vehicles Are Here...But Are You Ready?

… The Importance of Education and Training … “Investments need to be made in technician training,” explains Mike Croker of Chief Automotive Technologies . “We need to educate techs on the importance of proper ADAS repair and empower them with the tools they need to do the repairs.” Whether your … A recent survey by the Equipment and Tool Institute (ETI) found that 38% of new car dealer shops are not equipped to manage the repair and diagnosis of ADAS and passive …
Article

Streamlining Medical Bill Disputes: Inside FairPay Flex's Efficient and Adaptable Process

… Protecting your organization’s precious time and resources requires effective management of medical bills and optimal dispute resolution. Diminishing the threat of overpayment and capturing additional savings has historically been a daunting task for claims … Enter the FairPay Flex dispute process—a unique service that streamlines the handling of formal legal disputes to keep you on the right side of regulations while reducing claims …
News Release

Enlyte Acquires Therapy Direct from Upstream Rehabilitation

… Deal presents a natural extension of Enlyte’s services in the P&C industry … management (PBM), and disability management, announced it has finalized its acquisition of Therapy Direct, a national physical therapy provider network, from Upstream Rehabilitation Inc. The acquisition offers a natural extension of Enlyte’s position as a market leader in provider network access, care management and workers’ …
News Release

Colorado Adopts New Pharmacy Fee Schedule Along with Other Changes

… The Colorado Department of Labor and Industry Division of Workers' Compensation adopted changes to Rules 16 and 18 that will become effective on January … to deny care rather than simply contest it when certain standards are met. Another change of note is the elimination of the “telehealth” definition while keeping the definition for “telemedicine”. They also added … There were a number of changes in the medical fee schedule, including adoption of the 2019 RBRVS scale, adjustment of …
Article

Proposed Utilization Review Amendments to California Workers' Compensation: What to Know

… The California Division of Workers' Compensation (DWC) has proposed amendments to regulations relating to utilization … Proposed amendments to 8 CCR § 9792.24.2 and adoption of 8 CCR § 9792.24.8, regarding proposed evidence-based update and adoption to the Medical … 12/19/2024) into the MTUS from the ACOEM Practice Guidelines for the treatment and evaluation of patients who have chronic pain; and Adopts and incorporates by reference the Cannabis …
Author

Peter Madeja

… Peter Madeja is president and chief executive officer of Genex, as well as a member of the Office of the Chairman and Board of Directors of Enlyte. Mr. Madeja was originally a partner in Genex …
News Release

Texas DWC Announces Formal Rule to Amend Compounded Medication Definition

… The Texas Division of Workers' Compensation (DWC) released a memo on January 11, 2018, announcing the publication of a formal rule proposal changing the definition of compounded medications to include any compounded medications, not just those with “N” drug …
Author

Kim Radcliffe, DHA, MHA, PT

… Kim Radcliffe, DHA, MHA, PT, provides clinical and strategic direction as senior vice president of product management of Enlyte Specialty Solutions. As a licensed Physical Therapist, Kim has over 25 years of experience in leadership within the health care industry, with a focus on evidence-based …
Author

Steven Peters

… Steven Peters is the director of government relations for networks at Coventry/Enlyte. In this role, Steven develops … government officials with questions about network products or implementation and as a point of contact for team members needing to connect with government officials or with questions about … rules. Prior to joining Enlyte, Steven spent a decade as legislative staff for various members of the Wisconsin State Legislature, working on policy issues related to insurance, workforce, …
Article

Not All PBMs are Created Equally: Examining the Differences Between Traditional Health Care and Workers’ Compensation PBM

… years there has been a concerted effort in state legislatures to regulate the activities of Pharmacy Benefit Managers or PBMs. The focus has primarily been on the activities of PBMs in the commercial and government health space. However, workers’ compensation PBMs are … benefit.  In most cases the covered individual has to pay a co-pay or deductible as part of the transaction.  Traditional health care PBMs develop formularies based on negotiations with …
News Release

California DWC Publishes Draft Pharmacy Fee Schedule Rule

… The California Division of Workers' Compensation (DWC) recently published a long-awaited draft pharmaceutical fee … schedule that increased the dispensing fee and created a two-tier amount based on the volume of medications dispensed by a pharmacy. The DWC adopted that methodology in the new proposed rule … , including a mail-order pharmacy, the reimbursement is the lesser of the drug's ingredient cost plus the professional dispensing fee or the pharmacy's usual and …
News Release

Two More States Look to Workers' Comp Drug Formularies

… legislation focuses on enhancing the state's efforts to mitigate the negative impact of opioids on their citizenry. The bill addresses a wide array of issues from treatment facilities to education. Included in the various provisions is language that would authorize the Department of Industrial Accidents to “establish a formulary of clinically appropriate medications...” for … implementation no later than January 1, 2019. The bill also provides for a transition period of 18 months for workers injured prior to January 1, 2019, to “enter into a written agreement …