Article

Enhancing Provider Networks: Coventry's Quality Improvement Program

… and compliant with provider network regulations. The program's goal is to optimize the quality of the provider network available to injured individuals while maintaining cost-effective utilization of resources. The key objective of program is to continuously review and evaluate the accessibility, availability, …
Blog

Positive Compound Trends Continue in Work Comp

… and 2017. The decreases were notable in California, New York, Pennsylvania, and Texas. Each of these states saw the percentage of all claims using compounds drop by more than half for the last two years. Unmanaged compound … managed compound costs also registered sizable drops in unmanaged compound costs. Eight of the top 10 states experienced at least 40% reductions in the number of injured workers using …
News Release

Genex Announces Case Manager Scholarship Award Recipients

… Genex Services, LLC (“Genex”), the leading provider of case management services to the workers' compensation, disability, and auto markets, has announced the recipients of its third annual Case Manager Scholarship Award Program. The program will provide $100,000 in … are intended to recognize the Genex graduates from these schools, strengthen awareness of the case management profession, and invest in a new generation of future graduates to fill a …
Author

Michele Page, RPh, MBA

… Michele Page graduated from the University of Utah College of Pharmacy and obtained a Master of Business Administration (MBA) from Westminster College, Salt Lake City, Utah. Michele has over …
Blog

Catastrophic Case Management: Immediate coordinated response by clinical experts

… injuries progress well with traditional case management services. However, a small percentage of cases require more intense and careful management. Early intervention and proper procedure are imperative in the treatment of catastrophically injured people. Clinical situations that require catastrophic case management are characterized by diagnosis, complexity of treatment, and high dollar exposure. Examples of diagnostic candidates for catastrophic …
Case Study

Case Management and You: What to Expect & What to Demand

… cm-you-call-out.png Getting injured employees back to work is the top priority for adjusters and case managers. When working together, you and Genex’s nurse case … the injured worker and your organization.  A large claims analysis shows that more than half of injured workers referred to nurse case management are back to work within three months, which … case managers are experienced and credentialed, who are committed to the health and well-being of the injured worker and partnering with you to meet employer and carrier RTW guidelines. Here’s …
News Release

South Carolina Approves Fee Schedule Changes

… in the proposed rules for pharmacy released by the Commission in December 2021. One of the biggest changes from the proposed rule to the adopted language involved prescription … prescription topical medications is $240 for a 30-day supply, pro-rated based on the number of day supply dispensed, not to exceed 90 days, plus a single dispensing fee of $5. Additionally, physicians are urged to prescribe therapeutically equivalent medications or …
News Release

South Carolina Approves Fee Schedule Changes

… in the proposed rules for pharmacy released by the Commission in December 2021. One of the biggest changes from the proposed rule to the adopted language involved prescription … prescription topical medications is $240 for a 30-day supply, pro-rated based on the number of day supply dispensed, not to exceed 90 days, plus a single dispensing fee of $5. Additionally, physicians are urged to prescribe therapeutically equivalent medications or …
Blog

Introducing Networks 2.0: Part Four

… providers are clear. What’s most interesting is how networks are evolving to meet the needs of employers and patients. These next-generation networks often are tighter, specialty-focused, … smaller — right-sized — networks that benefits providers by grouping together the best of the best. Many such networks pull together smaller groups of providers with specific expertise … efficacy and efficiency. They allow the best providers, with the support of payers, to deploy top clinical skills to help injured workers return to work. This paper is based on articles …
News Release

Enlyte Launches Apricus Physical Medicine, Offering End-to-End Specialty Service Solution for Industry

… have a new option for physical medicine services. Today the company is announcing the launch of Apricus Physical Medicine , a network for rehabilitation services including physical and occupational therapy. As the specialty network brand of Enlyte, Apricus’ new program provides injured employees and payers access to a complete … network. It’s integrated with bill review and data analytics programs to establish a full view of medical spend trends and additional vertical integration capabilities across utilization …
News Release

Mitchell Issues First Quarter 2019 Industry Trends Report

… Mitchell, 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 first quarter of 2019. The impact of 5G wireless, automobile design changes that are good for the environment, and how technology … Buckle Up for Warp Speed with the Advent of 5G … Repair Industries?” Mitchell President and CEO Alex Sun explains how 5G—the fifth generation of wireless capabilities—is set to turbocharge communications and the Internet of Things. 5G …
News Release

Mitchell Survey Identifies Technologies Most Adopted by Workers' Compensation Organizations During COVID-19 Pandemic

… SAN DIEGO, CA—Mitchell, a leading provider of technology, connectivity and information solutions to the Property & Casualty (P&C) claims and Collision Repair industries, today announced the results of a survey of workers' compensation professionals in the U.S., revealing how the COVID-19 … (22%) of participants ranked adapting to challenges from the COVID-19 pandemic as the top obstacle their organization is facing today, followed by workflow efficiency (19%) and cost …
News Release

Genex Services Acquires Leading Case Management Firm ICM

… Combination of industry leaders will enhance excellence in managed care services … — Genex Services, the nation's largest provider of workers' compensation clinical services, has announced its acquisition of Integrated Care Management (ICM), a leading case management firm for the workers' compensation … employees and 47 service locations throughout North America.  The company serves 381 of the top Fortune 500 companies in the U.S. today. In addition, Genex is the only company that delivers …
News Release

Genex's Podcast Strikes Gold at Communicator Awards

… ‘Inside Workers' Comp' receives top honor from major communications award program … Communicator award 2020-audio-exc Wayne, PA – May 26, 2020 – Genex Services has earned top honors for its podcast, "Inside Workers' Comp," receiving the Award of Excellence from the Academy of Interactive and Visual Arts (AIVA). The distinction is the … and disabled workers. Genex, a clinical management leader throughout North America, serves the top underwriters of workers' compensation, automobile, disability insurance, third-party …
News Release

Kentucky Releases Revised Pharmacy Fee Schedule Draft Rule

… The Kentucky Department of Workers' Claims released a revised version of their draft pharmacy fee schedule rule, 803 KAR 25:092 . This latest version responds to … draft contains substantive changes from the original proposal, including: Updated definitions of brand and generic drugs and the addition of a definition of “usual and customary” Fee schedule …
News Release

Texas Publishes Final Drug Formulary Rule Change

… By Brian Allen, VP of Government Affairs … On Friday, April 13, 2018, the final adopted version of the workers' compensation drug formulary rule was published in the Texas Register. This marks … becomes effective on July 1, 2018. The long-awaited rule change re-defines the definition of compounded medications so that now all compounded medications will require prior authorization before they can be prescribed and dispensed.   We commend the Texas Division of Workers' Compensation for their thoughtful and thorough approach as they evaluated the use and …
Blog

How Differences in Claim Age and Population Affect Opioid Trends

… Management of opioid therapy can be influenced by the types of drugs filled, differing patient populations, and the nature of the injury. Don’t miss our latest video blog where we will review some of the differences that …
News Release

Stone Point Capital to Acquire Genex Services from Funds Advised by Apax Partners

… Genex Services (“Genex”), a leading provider of cost containment services to the workers' compensation, disability, and auto industries, … a global private equity firm. The transaction is expected to close in the first quarter of 2018. Founded in 1978, Genex helped introduce the medical management concept and has become one of the largest and most experienced medical cost containment and disability management providers …
Article

When to Place a Referral for Field Case Management

… when a claim should be considered for field case management. Genex takes the guesswork out of when to refer a case and helps get your injured employees on the road to recovery and return to work. Reasons You Might Need a Case Manager History of multiple work injuries Pre-existing conditions affecting recovery Potential lost time of 60 days or more Cases exceeding $2,000 in medical expenses Multiple medical providers or …
Blog

Spread the Kids’ Chance Mission

… 11-15, 2019 is Kids’ Chance Awareness week. It’s a time to highlight and raise awareness of this ever-growing organization that provides educational opportunities and scholarships for children affected by workplace injuries.  Coventry is a proud supporter of Kids’ Chance of America and actively participates with many of the organization’s state chapters. Earlier this …   Kids’ Chance of America is a 501 (c)(3) organization that represents a collection of state-level non-profit …
White Paper

Healing at Home: A Holistic Guide to Workers' Compensation Recovery

… patient experience, and lower care expenses. This growing sector offers a dynamic array of services designed to cater to the diverse needs of individuals, encompassing both medical interventions such as skilled home nursing and various forms of in-home therapy, as well as non-medical services like companionship and homemaking. This broad …
News Release

FDA Approves Higher Dose Naloxone, Kloxxado

… Naloxone has been known by different brand names over the years as the primary treatment of opioid overdose. With the FDA's recent approval , Hikma Pharmaceuticals introduces a new formulation of naloxone, Kloxxado , to treat known or suspected opioid overdose in adult and pediatric patients. The new addition of Kloxxado to the market in the second half of 2021 will give prescribers more options to …
Blog

Quality Control in Clinical, Interview with Sharon Riley

…   Recently I had the opportunity to interview Sharon Riley, Coventry’s Director of Field Case Management (FCM) Service Operations, about clinical case management quality assurance best practices. Sharon has been with Coventry for 28 years, seven of which she has been in this role overseeing quality, including meeting URAC Case Management … and mechanism to communicate results for ongoing improvement. It supports the identification of quantifiable measures used to establish acceptable levels of performance. It also supports the …
Blog

Unlocking the Benefits Behind Custom Networks

… In this era of rapid changes to health care, networks are becoming more important than ever. They’re evolving … controlling costs to collaborative partnerships between clients, networks and providers. Part of this evolution involves the development of custom networks, which have grown nearly 30% over … prioritize both efficacy and efficiency. The best clinicians can more easily rise to the top thanks to deeper insights into patient trajectories. In the emerging landscape, powerful …
CE Webinar

Embracing Diversity and the Changing Workforce in Workers’ Comp

… This session focuses on the changing landscape of workforce demographics. We define what makes a diverse workforce, how diversity is good for … for attracting and retaining diverse talent. We also discuss the changing demographics of injured workers and the importance of recognizing and respecting this evolution to ensure we can meet the needs of our clients now …
Author

Dawn Moore

… Dawn Sora Moore, RN, MSN, CCM, serves as vice president of utilization management at Enlyte and is a member of the company’s senior leadership team. She provides national leadership for Enlyte’s telephonic … and ClinicalCare24, the organization’s 24/7 nurse triage service. With more than 30 years of experience in case management and clinical operations, Dawn brings a strong blend of clinical …
News Release

Apricus Launch Announcement

… clinical services, pharmacy benefit management and disability management, announced the launch of the organization’s new specialty networks business, Apricus. The business will combine the best of what has been historically known as DMEplus and Priority Care Solutions. Bob Smith, who has led Priority Care Solutions, will be the president of Apricus with locations in Tucson, Arizona and Tampa, Florida. “One early win associated with …
Article

Why Transparency in Healthcare is Important: FAIR Health Methodology

… 1 They strive to develop robust, unbiased data products and solutions to meet the needs of those they serve. FAIR Health is widely recognized as a reliable, objective source of data, frequently cited in media reports and honored for its leadership in promoting and … majority of charges we will see in relation to the industry will be actual charge data as the top codes used represent approximately 150 of the approximate 10,000 Current Procedural …