Article

When Do You Need an MSA?

… In its simplest form, the Medicare Set-Aside (MSA) is a pool of funding reserved for future accident-related treatment once a workers' compensation case is settled. However, because of its complex nature, some employers will go the MSA route when there are better options …
Article

Current Used Vehicle Market Conditions: Q1 2024

… Wholesale Market Trends* According to ADESA US Analytical Services’ monthly analysis of auction industry used vehicle prices by vehicle model class, wholesale prices in February … and stood at $25,348 for the week ending March 17. These rapid price rises are indicative of interest by consumers, and therefore dealers, in more-affordable substitutes for high-priced … Market Trends The following graph and table summarize ADESA US Analytical Services’ analysis of NADA and Motor Intelligence data, respectively, on retail used vehicle and certified pre-owned …
Blog

Overview of the 2019 Texas Department of Insurance Workers’ Compensation Network Report Card

… The Texas Department of Insurance recently released its annual Workers’ Compensation Network Report Card . The 2019 … were running over $12K per claim 1 .  Texas was leading the nation in utilization for nine of the ten top diagnostic groups. Return-to-work rates were running in the low 60 th percentile and injured … In some situations, claims treated within a network may see higher utilization of services during the first six-months of injury than those treated outside a network. However, …
Article

The Evolution of Claims Automation

… COVID-19 has hastened the pace of digital transformation in many industries, including auto insurance. When the pandemic began, … in-person interaction between their employees and customers. This led to the rapid adoption of virtual, or photo-based, estimating . For insurers and repairers, virtualization supports the … efficiency and increases customer satisfaction. According to LexisNexis Risk Solutions , 95% of auto insurance carriers are embracing virtual claims handling, with many setting their sights …
Article

The Power of Streamlined IT Investment: Simplifying Claims Technology Implementation

… and the iPhone were only a year old. Flash forward a little more than 10 years later, and most of us can’t imagine the world without these and other technologies that we have come to rely on. … will reach nearly $4 trillion, a 3.2 percent increase from 2018. Due to the quick rate of change, businesses need to be prepared to keep up with new innovations and technologies, both … for improving operational efficiency and overall outcomes, but can also be a challenge to purchase and implement. For many claims organizations, this process can be time consuming, …
Article

Inside Texas Workers’ Comp: How Certified Health Care Networks Shape Outcomes

… containment, access to care and injured worker satisfaction. Q. Can you give us a quick review of the workers’ compensation system overall in Texas?  A. The State of Texas is unique in that private employers are not required to purchase workers’ compensation insurance. Employers who decide not to purchase a policy are known … Texas employers who provide workers’ compensation coverage for their employees through an insurance policy or self-insurance program. In 2006, House Bill 7 reformed the system, …
News Release

Enlyte’s 2025 Trends Report Examines ‘The Year of Generative AI’

… Industry leaders discuss impact on the growing utilization of gen AI and data analytics as well as strategies addressing clinical and auto challenges across … As the use of generative AI continues to expand, 2025 is poised to be the year this technology significantly … publication delivers valuable insights from prominent subject matter experts at Enlyte through an extensive report covering today’s most pressing issues. Aside from AI, this also includes …
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.   … included discovering the man’s need for ostomy supplies and care, which she coordinated its purchase and management. Daney also educated the injured employee and his family and ensured all … license and, nine months earlier than expected, the injured driver was back behind the wheel of a city bus, resulting in a cost savings of more than $27,000.   View More Stories …
Article

CPT 2022: Care Management and Other CPT Coding Updates

… CPT Copyright 2021 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association. It's that time of year again! The American Medical Association (AMA) recently updated its CPT® codes. The most … with individuals from certain populations will reduce health risks and decrease the cost of care, is a team-based, patient-centered approach to assist patients and their support systems …
Article

CPT 2022: Care Management and Other CPT Coding Updates

… CPT Copyright 2021 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association. It's that time of year again! The American Medical Association (AMA) recently updated its CPT® codes. The most … with individuals from certain populations will reduce health risks and decrease the cost of care, is a team-based, patient-centered approach to assist patients and their support systems …
News Release

Industrial Commission of Arizona Adopts New Pharmacy and Physician Fee Schedules

… The Industrial Commission of Arizona (ICA) recently posted the newly adopted pharmaceutical and physician fee schedules for … and solicited written comments on their staff proposal. The final rules incorporate many of the suggestions received during the rule development and comment period. … Added language clarifying the adoption of the Official Disability Guidelines (ODG) drug formulary on October 1, 2018. …
Article

The Power of Technology: Six Ways to Improve Casualty Claim Outcomes

… into technology adoption, there remain vast opportunities for the sector to reap the benefits of technology to achieve better, faster results. Insurers and claim organizations at large still … their current business operations, according to a McKinsey report . There are a vast number of different technologies available to workers’ compensation and auto casualty claim … McKinsey makes it clear that adding automation into the claims process can reduce the cost of a claims journey by as much as 30 percent. In today’s technology-enabled world, insurance …
White Paper

Ten Workers’ Comp Specialty Services You Should Know More About

…   Recovering from an injury at work doesn’t unfold in a straight line and specialized services are often needed to achieve the best possible outcome. Specialty services provide a breadth of products and services, ranging from durable medical equipment to diagnostics or physical … when they need it. This on-point, on-time care is more important than ever. High-cost injuries account for a larger share of claims – and specialty services account for a significant share of …
News Release

Enlyte Drug Trends Report Indicates Significant Drop of Opioid Use in Comp

… and professionals to control opioid prescriptions and distribution are resulting in one of the largest drops in utilization the workers’ comp industry has seen in years, according to … pharmacy management. Enlyte’s 2024 series reflects on trends clients experienced in 2023, with an overview of both in- and out-of-network prescriptions.  Among opioid categories, the report … in workers’ comp among therapeutic classes ranked by cost in 2023. Though eight of the top 10 therapeutic classes experienced increased costs per script — with two classes rising by …
Author

Jim Begg

… Jim Begg is the vice president of national accounts for Specialty Solutions. He has worked in the workers’ compensation industry since 1987 and has extensive experience in various account management and sales roles. Jim is responsible for the oversight of the Specialty Solutions account management team, directly oversees key accounts and works …
Article

Average Length of Rental for Repairable Vehicles: Q1 2022

… U.S. Length of Rental—Q1 2022 … The first quarter of 2022 saw average Length of Rental (LOR) for collision replacement-related rentals increase 4.9 days when compared to … nearly five-day increase continues the trend of unprecedented industry increases, including an almost four (3.9) day increase in the fourth quarter of 2021. While January is a traditional … In the U.S., Q1 2022 LOR was up to 18.2 days, an increase of 4.9 days compared to 13.3 days in Q1 2021. This includes replacement rentals for Drivable and …
News Release

New York Adopts New Pharmacy Fee Schedule and Proposes New Draft of Drug Formulary Rule

… in the Empire State. The first is a new pharmacy fee schedule and the second is a new draft of the state's drug formulary rule. … or when applicable, drugs that received Prior Authorization in accordance with section 441.4 of this Chapter, including all brand name and generic prescription drugs or medicines, shall be … to pass through any rebates received to the employer or insurance carrier and to provide an annual accounting to the carrier or employer of those rebates. Carriers or self-insured …
Podcast

Gauging the Impact of High-Impact Drugs in Workers’ Comp

… : Welcome to part 4 of our media series focusing on the Enlyte Drug Trends Report. Today, we’ll highlight the so-called high-impact drug classes with Cameron Hannum, senior clinical account pharmacist. Cameron, thanks for joining us today. … So, let’s start with the broad definitions of what is included in this report. What categories make up the high-impact drug classes? … analgesic products, compound kits, combo or convenience packs, specialty medications, things of that nature. As a whole, these categories represent relatively low utilization but are …
Article

Guide to Selecting an Electronic Payments Vendor

… effective and relatively simple method to move toward a paperless approach is implementing an electronic payment system to create a medical claims workflow where payment, fulfillment, … As a result, we have compiled a guide to help you as you navigate through the process of choosing the right payment vendor for you. … medical bills virtually. By asking the right questions, you can get a more accurate picture of the way an ePayment vendor operates and make sure you are selecting the best option for your …
Article

Decoding Functional Restoration Programs: Ensuring Accurate Billing Practices

… to help workers' compensation claimants get back to work. Just as a meal is made up of various dishes, an FRP includes multiple services tailored to each individual's unique needs based on their … be billed separately if performed, rather than bundled under the unlisted code 97799. The American Medical Association (AMA) provides clear guidelines on how to select the correct CPT …
News Release

Bosch and Mitchell Collaborate on New Tool That Provides Repairers with an All-in-One System for Diagnostic Scanning, Calibration and Estimating

… —Mitchell, a leading provider of technology, connectivity and information solutions to the Property & Casualty (P&C) claims and … Collision Repair industries, and Bosch Automotive Service Solutions, a leading global supplier of technology and services, today introduced the MD-500, a new wireless tablet that technicians … of Ben Clymer's The Body Shop, a five-location MSO in Southern California. Brett Clymer, also an owner, said: “When repairs are complete, the MD-500 capabilities for resetting systems and …
Article

CPT Code Changes for 2018: Things to Look Out For

… A new year means new Current Procedural Terminology (CPT) code changes! There are a total of 314 code changes in the 2018 code set, and with 2018 just around the corner, it’s time to start thinking about how these changes will impact the casualty industry. After an intensive review of the new CPT code book, 1 we’ve identified a few items that may be of interest to your business … A new parenthetical note has been added to the guidelines for code 64450: The inclusion of this example may not seem like much at first glance, but it could lead to some confusion in …
Article

Impact of Drug Formularies on Workers' Compensation State Laws

… greater concern over the opioid crisis. Texas and Ohio were pioneering states in the creation of drug formularies and several states have followed suit recently. Oklahoma, Washington, Ohio, … the issue is not as cut and dry as it may seem. Though many states have shown the benefits of their respective formularies, some lawmakers are hesitant to implement formularies in their … discussions, it is important to understand what a drug formulary is and the role it plays in an injured worker’s recovery. …
News Release

Press Release - Drug Formulary Hearing

… DWC ISSUES NOTICE OF PUBLIC HEARING FOR DRUG FORMULARY REGULATIONS  … DOWNERS GROVE, Ill. (March 20, 2017) - The Department of Industrial Relations’ Division of Workers’ Compensation (DWC) published the California … implements Assembly Bill 1124 (Statutes 2015, Chapter 525), which mandated the adoption of an evidence-based workers’ compensation drug formulary into the Medical Treatment Utilization … Coventry client specific information regarding formulary adoption will be provided through our Account Management Team. If you have additional questions, please contact your account manager or …
News Release

Rising Opioid Abuse, Increasing Acceptance of Marijuana and COVID-19 Continue to Shape Pharmacy Programs

… —Mitchell, a leading provider of technology, connectivity and information solutions to the Property and Casualty (P&C) claims and Collision Repair industries, today announced the release of the Mitchell Pharmacy Solutions 2020 Annual Clinical Review. The Clinical Review collects data … important current research and clinical studies available to assemble this report, making it an essential planning tool for the industry.” …
Article

2019 CPT Code Changes: Technology is King

… The American Medical Association (AMA) 2019 Current Procedural Terminology (CPT) code set is here! There are a total of 335 code changes in the 2019 code set. How will these changes impact the casualty industry? After an intensive review of the new CPT code book, the most notable changes are technology-based. … be reported for 30-day time periods. Code 99091 has also been moved from the Medicine Section of CPT to the Evaluation and Management section. Industry advocates have held that this …
Article

The Compliance Corner: Understanding MACRA in the P&C Industry: Medicare Access and CHIP Reauthorization Act of 2015

… particularly on the payment side. In 2019, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will be introduced requiring new quality measurements. In a “be careful what you … from Medicare to physicians. In 2019, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will be introduced requiring new quality measurements. Since the SGR method of paying physicians is being eliminated, MACRA will be implementing a new payment framework that …
Article

CMS Issues Electronic Payments Frequently Asked Questions and Answers Document

… been able to submit payments electronically via the MSPRP. CMS has emphasized that the use of the portal is an enhancement and not a requirement. Below are a few of the 17 most frequently asked questions … a demand letter? I would like to use the electronic payment option to make a payment with an account that’s in a corporate or trust’s name rather than my own. How do I do this? The demand I …