Article

New York Provides Data-Backed Proof That Stronger Utilization Review is a Cost-Control Strategy

… At 12 months, the share of claims with UR services increased from 27% to 57%. … UR is a larger share of cost containment spend. … For 2023/2024 claims, UR payments represented about one-quarter of overall medical cost containment expense, up from 7% to 10% earlier in the study period. … WCRI’s multi-state research reports medical costs per claim rose 5–12% across a majority of states, reflecting non-COVID claims through March 2024.³ …
News Release

Hurricane Dorian Spawns Emergency Declarations and Evacuations along East Coast

… Florida, Georgia, South Carolina, North Carolina and Virginia have declared states of emergency and are, in some cases, ordering residents to evacuate in advance of Hurricane Dorian. Mitchell Pharmacy Solutions is announcing processing changes for injured … disaster areas will be allowed to obtain early refills and to receive up to a 90-day supply of currently prescribed medication subject to limits based on remaining approved refills or other …
Author

Brooke Kirby

… Brooke Kirby is senior director of Enlyte’s Tech-Enabled Services (TES) where she oversees the FairPay Flex, AuditPro, and Negotiations departments, managing a workforce of over 400 employees. With more than 30 years in the P&C industry, Kirby’s expertise spans workers' compensation, auto, group health, and PPO, including serving as VP of Specialty Bill Review at FairPay Solutions. Her hands-on approach has contributed to product …
Author

Nikki Wilson, Pharm.D., MBA

… Wilson, Pharm.D./MBA, provides clinical leadership and strategic direction as senior director of clinical pharmacy services at Enlyte. As a licensed pharmacist, Nikki has over 13 years of comprehensive industry experience through leadership roles across prescription home delivery … contributor to industry presentations and publications. Dr. Wilson received her Doctor of Pharmacy and a Master of Business Administration degrees from Creighton University in Nebraska. …
Article

Enlyte’s Medical Price Index – Q1 2025 Report

… As reported by the Bureau of Labor and Statistics (BLS) in January 2025 for December 2024, the United States consumer price … price index” (MPI) specific to P&C claims. This information is based on our own observations of charges and trends from professional service medical bills. These observances are anchored in 2020 to include data from the period Q1 2020 through the end of Q3 2024 by coverage type. We are providing national changes per unit index year over year and …
Article

CMS Commercial Repayment Center (CRC) Contractor Transition

… Genex provides. On Thursday January 18, 2018 CMS held a webinar to review the transition of Medicare Secondary Payer contractor operations from CGI Federal to Performant Recovery Inc. … Center ( BCRC). Performant is not a newcomer to the recovery arena and has over 40 years of recovery and collections experience. They presently serve as the Recovery Audit Contractor … turned on effective 8:00 AM EST on Monday February 12 th . Webinar attendees were made aware of the upcoming CRC operations “Dark Days” on February 8-9, 2018. During this time frame: …
Article

CMS Commercial Repayment Center (CRC) Contractor Transition

… Genex provides. On Thursday January 18, 2018 CMS held a webinar to review the transition of Medicare Secondary Payer contractor operations from CGI Federal to Performant Recovery Inc. … Center ( BCRC). Performant is not a newcomer to the recovery arena and has over 40 years of recovery and collections experience. They presently serve as the Recovery Audit Contractor … turned on effective 8:00 AM EST on Monday February 12 th . Webinar attendees were made aware of the upcoming CRC operations “Dark Days” on February 8-9, 2018. During this time frame: …
News Release

Press Release - Pam Gore Receives Beverley Boesch Legacy Award

… IN TOUCH as a platform to recognize the outstanding commitment, care, and service performance of Nurse Case Managers working within the workers’ compensation industry. Once again Pam Gore was … to secure treatment plans for Maximum Medical Improvement (MMI). Pam is a four-time recipient of the In Touch Making a Difference Award (2014, 2017, and 2018), and also received their … Nurse Case Management in both 2011 and 2015.  “Pam consistently maintains the highest standard of excellence in her role, and we are thrilled that she is being recognized again for her …
Article

Auto Casualty Medical Price Index: Q4 2017

… The National CPI for All Services, as reported by the Bureau of Labor Statistics in February 2018 is 123.56, which reflects a 2.7 percent decrease since Q2 … 2017 and eliminates the decrease experience seen in the previous quarter. For the same period of time, Q2 2017 to Q3 2017, the National Auto Casualty MPI decreased 1.37 percent and as of February 2018, sits at 118.2. Since Q1 2006, the MPI has increased 18.2 percent while the …
Article

Taking a Position on Pre- and Post-Repair Vehicle Scanning

… repair diagnostics has taken center stage in the collision repair industry. 4 With millions of lines of code, repairers must be prepared to fix a computer network on wheels. Read more about the Importance of Automotive Diagnostics in Collision Repair . Industry experts like Mike Anderson recommend … Source:  oemonestop.com/position-statements   Bottom line, if you’re in the business of collision repair, you’re now in the vehicle diagnostic business. 7 4 I-CAR Best Practice: …
Author

Cameron Hannum, Pharm.D.

… for Enlyte Pharmacy Solutions. In his role, he serves in a client-facing capacity as part of the pharmacy benefit Management (PBM) team and is responsible for supporting and partnering … the workers' comp PBM industry. He has a strong clinical background and demonstrated history of process improvement. His Doctorate of Pharmacy (Pharm.D) is from the University of Arizona and he has a Bachelor’s in Business …
Author

Jill Harris

… Jill Harris is the senior vice president of network operations for Enlyte and is responsible for network development of the Enlyte and Qualcare networks and Operations management of the Enlyte and Qualcare networks. The Network Operations team, under Jill’s leadership is …
Author

Dave Torrence

… Dave Torrence is executive vice president and head of corporate strategy for Enlyte and also serves as the general manager for the Pharmacy … compensation and automobile injury claims. Dave joined the company in 2005, bringing a wealth of experience in the casualty claims and auto physical damage markets. As the head of Enlyte’s Strategy & Corporate Development team, Dave works across the organization to define …
Author

Brian Allen

… compensation and insurance issues across the country. Allen currently serves as vice president of government affairs for Enlyte's Pharmacy Solutions team. In this role, Allen provides clients … nationally for workers’ compensation issues for more than 16 years and has more than 25 years of political experience. He has been instrumental in the development of drug formularies around the country including Texas, California, Tennessee, Montana and …
CE Webinar

Dental Trauma and Facial Injuries

… Each year, thousands of employees sustain on-the-job facial or eye injuries from accidents that could have been prevented with the proper selection and use of face protection. Such injuries cost industries more than $300 million per year in lost … time, medical expenses and compensation. This course is designed to increase awareness of dental and facial injuries in the workplace while highlighting the latest advances in surgical …
Article

Workers' Compensation Medical Price Index: Q4 2017

… The National CPI for All Services, as reported by the Bureau of Labor Statistics, in February 2018, is 123.56, which reflects a 2.7 percent increase since Q2 2017 and eliminates the decrease seen in the previous quarter. For the same period of time, Q2 2017 to Q3 2017, the National Workers’ Compensation MPI increased 2.3 percent and as of February 2018, sits at 113.03. Since Q1 2006, the MPI has increased 13.3 percent while the …
Author

Tammy Bradly

… Tammy Bradly serves as the senior director of clinical product marketing at Enlyte. Leveraging over 30 years of experience spanning product development, case management, operations and clinical product … Her expertise lies in medical case management, disability management, and the integration of health, disability, and workers’ compensation, and is underpinned by national certifications …
Article

Reliable Transportation Means Better Injured Worker Outcomes

… For many of us, finding a ride is easier than ever. Services like Uber and Lyft have made it simple to … window or perhaps for much longer. Without timely and reliable transportation, those in need of medical care can miss appointments. This can jeopardize the pace of their recoveries and add up to poorer health outcomes. That’s why it’s essential for injured …
White Paper

Reliable Transportation Means Better Injured Employee Outcomes

…   For many of us, finding a ride is easier than ever. Services like Uber and Lyft have made it simple to … window or perhaps for much longer. Without timely and reliable transportation, those in need of medical care can miss appointments. This can jeopardize the pace of their recoveries and add up to poorer health outcomes. That’s why it’s essential for injured …
News Release

Washington State Updates Workers' Compensation Drug Formulary

… The Washington State Department of Labor and Industries adopted updates to its workers' compensation drug formulary. The changes … effective on April 1, 2020. Mitchell ScriptAdvisor will have these changes deployed in advance of the effective date. View a complete listing of the Washington State workers' compensation Outpatient Drug Formulary that includes these …
Virtual Event

Michigan Fee Schedule Draft Administrative Rules: What You Need to Know

… Ever since the state of Michigan released its new auto no-fault fee schedule legislation, insurance carriers and others in the industry have had a variety of questions to help clarify details of the new law. …
Article

CMS to Add Correspondence Printing Functionality to the Medicare Conditional Payment Portal

… MFA process. Those that have not completed the MFA process will need to wait for a mailed copy of all CMS correspondence. Additional information on how to use this new functionality will be available in Section 14.1.1.4 of the July version of the MSPRP User Guide. To view the current version of the MSPRP User Guide   please click here. …
Author

Tim Howard

… Tim Howard is the senior vice president of Genex’s Field Case Management program where he is responsible for oversight and delivery of the company’s national field case management services. Mr. Howard has focused his team on a … managed care services. Mr. Howard holds a bachelor's degree in marketing from the University of Alabama. Location Nashville, TN Areas of expertise Case management Claims management COVID-19 …
White Paper

Unlocking the DME "Black Box"

… to this definition, Durable Medical Equipment (DME) has traditionally operated as a black box of sorts for claims adjusters in the workers’ compensation space – and with justified reason. As a specialized area of ancillary services, DME’s inner workings are complex. There is a wide range of equipment. Within each category, there’s a significant number of products that vary in nuanced …
News Release

WorkersCompensation.com: Attention to Comorbidities, Engaging the Injured Worker Can Drive Down Claim Costs

… to $46,000. If the 50-year-old is obese, the expense jumps to more than $61,000. If he is of normal weight but has been on opioid therapy for at least 30 days, the pricetag tops out at $73,500 — almost twice the initial cost of the claim. Comorbidities play a tremendous part in the costs — and outcomes — of workers' compensation claims. They can create enormous challenges for adjusters and others …
White Paper

Transforming Big Data into Applied Analytics

… Over the past few years, Big Data has captured the interest of the nation’s top business leaders. Organizations seeking new strategies to improve workers’ compensation programs are also beginning to explore the concept of Big Data. They are examining the potential of Big Data to become a strategic initiative to …
News Release

Mitchell | Genex | Coventry Signs Agreement to Acquire QualCare Alliance Networks Inc.

… has entered into a definitive agreement to acquire QualCare Alliance Networks Inc. (QANI), one of the largest managed care organizations serving the New Jersey, Pennsylvania and New York … network access, care management and workers' compensation services. QANI will become part of the Coventry organization, expanding its network footprint in that region. “Both Coventry and QANI have proud traditions of maintaining excellent provider networks,” said Art Lynch, Coventry President. “Our …
News Release

Mitchell | Genex | Coventry agrees to acquire QualCare

… has entered into a definitive agreement to acquire QualCare Alliance Networks Inc. (QANI), one of the largest managed care organizations serving the New Jersey, Pennsylvania and New York … network access, care management and workers' compensation services. QANI will become part of the Coventry organization, expanding its network footprint in that region. "Both Coventry and QANI have proud traditions of maintaining excellent provider networks," said Art Lynch, Coventry President. "Our …