Article

Ask The Pharmacist: Pain Pumps in Workers’ Compensation

… How do PCA pumps support pain management, reduce costs and speed recovery for injured employees?  For … with a health care professional such as the prescribing doctor or dispensing pharmacist. Do you have a workers’ compensation or auto-related pharmacy question? Send us an email at  …
News Release

Genex's Delphia Frisch Among 2016 Women to Watch

… a company grow from infancy to industry leader is a journey very few experience. Those who do are often pivotal players in the company's success. Their contributions help blaze the trail … throughout North America. The company serves 381 of the Fortune 500 companies as well as the top workers' compensation and disability carriers and third-party administrators in the U.S. In …
White Paper

Mental Health Challenges

… whole person, including whatever mental-health toll the episode might be exacting. Failing to do so risks treating only part of an injury and achieving an insufficient recovery. Today, a …
Article

Workers’ Compensation: 2022 Trends & Predictions

… regulatory changes and more. To help you navigate what’s next and understand this year’s top trends, we’ve outlined Enlyte’s top 2022 workers’ compensation predictions: Staffing Shortages Will Affect Employers and Payers … employees back to work and reduce the need for temporary labor or overtime. “When injuries do occur, having a return-to-work program that allows for transitional duty during the recovery …
Podcast

An MVP Approach

… faces is how and where can we put people back to work when they have work restrictions? They do not have a full‑duty work release. “If we don't put people back to work and they sit at home … to get people back and keep them engaged in society by having them go back to work. Again, how do you do that when you don't have a vehicle — light duty return‑to‑work — to get people back to work? … to this opportunity to work within a nonprofit. We see people that decline — they absolutely do not want to be in the nonprofit environment. That's fine. That impacts your ability to receive …
Article

How COVID-19 Presumption Laws Might Affect the Workers' Compensation Industry

… How do COVID-19 presumptions laws affect workers’ comp? … window and the strength of the presumption language. Additionally, there is still a lot we do not know about the novel coronavirus, especially as it relates to long-term health effects. … billion as compared to pre-COVID annual premiums of roughly $63 billion. Most of these studies do not anticipate any permanent disability claims as a result of the virus. The California …
Article

The Future of Technology in Work Comp: 2020 Survey Results

… 1. Which technology do you think will have the biggest impact on the workers’ compensation industry in the next five … organizations solve many of these goals. Q1 2020 In our 2017 survey , telemedicine came out on top, but with a much larger plurality (45%). Artificial intelligence came in second in the 2017 … 4. Which of these factors do you think is the most influential reason the workers' compensation industry is adopting …
Article

State-Mandated Formulary Implementation: Four Key Considerations

… cost, then it will automatically be approved. Medications or combinations of medications that do not fall under these requirements will require additional authorization before they can be … publication and go-live, including: What is the implementation date for the formulary and when do all claims need to be switched over to the new formulary? What is the state’s policy for … kinds of medications (e.g. opioids or compounds) are included on the mandatory review list? Do you need to update your current formulary to be compliant? If any updates need to be made, …
Article

Pharmacy Management: A Proactive Approach

… offer solutions for my organization that give me transparency across the claims process? How do they integrate with my systems? Am I able to see claims from beginning to end, including … considerations for your program: Does this partner understand my business needs and goals? Do they provide consistent communication and listen to our feedback? Do they offer support when challenges arise and are they proactive in fixing problems? Can I …
Podcast

Managing the Seismic Shift from Inpatient to Outpatient Physical Medicine Services

… to work on coordinating with the adjusters to understand when that date’s going to happen and do pre‑coordination of services. And that way, as soon as the patient is released, if needed, the … up, the staff will write the orders and push them out to a network. So as much as you try to do early intervention or prepare, sometimes you get those orders same day. So, another critical …
Article

Using Negotiation Services for Best Third-Party Claims Savings

… bills. Adjustments are traditionally fairly tough, to get on bodily injury claims. Adjusters do struggle to realize savings on those bills. That can be for a lot of reasons. But we’ve really … way. Again, some of the unique challenges a lot of the processes are very similar to what we do in first‑party, but sometimes the process is a bit different, and we’ve developed procedures …  [You know that’s something that an adjuster certainly can do, however, it’s very difficult for an adjuster or teams of adjusters to be really consistently …
Podcast

Using Negotiation Services for Best Third Party Claims Savings

… those bills.  Adjustments are traditionally tough to get on bodily injury claims - adjusters do struggle to realize savings on those bills for a lot of reasons. We’ve really seen a lot of … way. Again, some of the unique challenges a lot of the processes are very similar to what we do in first‑party, but sometimes the process is a bit different, and we’ve developed procedures … You know that’s something that an adjuster certainly can do, however; it’s very difficult for an adjuster or teams of adjusters to be consistently good at …
Article

How Intelligent Automation Is Changing the Nature of Work in Insurance, Collision Repair, and Beyond

… process automation (RPA) is simply the automation of repetitive tasks that humans typically do, including things that happen all the time in the Property and Casualty and collision repair … , for example. Our nurse case managers tell us that one of the most important things they can do to positively influence workers’ compensation claims outcomes is to build strong relationships … with injured workers. Yet, they spend a good deal of their time on repetitive tasks that do not contribute to these essential relationships. If knowledge workers in the claims ecosystem …
Article

Property Damage Appraisers Gets Customers Back to Their Lives Faster by Helping Carriers Deliver on Their Promises

… on them.  Bryan Goodwin   At PDA all the way from corporate down to our franchise team, we do everything by structure, execution, and accountability. We have a saying around here, reveals … accountability. The metrics that we bring to the table set us apart. When a client asks us to do something, we provide that service, and we do it with metrics so that there’s no question as to how we define success. We sell value, but we …
Article

Five P&C Hot Topics and the Trends Fueling Them

… virtual reality Connected home devices can enhance safety, security and energy efficiency, but do they present a cybersecurity risk? And will people need insurance for that? Wearables can help … need to implement new programs to attract and retain them—especially since 65 percent of them do not have a positive take on the industry. insurance professionals Another thing to think … so an engaged workforce can have an important impact on a company’s overall success. But how do companies create an engaged workforce? As MG Kristian, Senior Vice President of Human …
Podcast

Case Severity: What Factors are You Missing in Delayed RTW Cases?

… multimedia series in which subject matter experts discuss problems and offer solutions to top issues affecting our industry. I’m Tom Kerr and today we’re speaking with Mariellen Blue … multimedia series in which subject matter experts discuss problems and offer solutions to top issues affecting our industry. I’m Tom Kerr and in part two of our series, Mariellen Blue … their regular group health provider or other type of educational initiatives that they can do to try to reduce that risk in their current employee population. …
Blog

3 Takeaways from WCRI

… : What do these statistics mean to labor? … to be a big theme at this year's event. Based on some of the discussions at the conference, do you think the industry will become more committed to early intervention? … 2019 involves the potential growth of telemedicine. Based on what you heard at the conference do you think the time is right for the industry to truly invest in its services? …
News Release

West Virginia Governor Signs Opioid Reduction Act

… the condition being treated. Before issuing an initial opioid prescription the prescriber must do the following: Document the patient's medical history including their experience with … make continued efforts to reduce or eliminate the use of opioids. The prescribing limitations do not apply to: Cancer patients Patients in hospice care Palliative care Residents of a … in the state shall provide coverage for 20 visits of the alternate therapies. Patients do not require a referral from a practitioner to access the alternate therapies. The law does not …
Article

Ask The Pharmacist: The Role of Topical Medications in Workers’ Compensation

… 22% of total medication payments. Dermatological agents and NSAIDs continue to be top cost drivers, and both the number of injured employees using topical medications and the … Top 3 Topicals by Cost … Nulido, Nuvira, Synoflex, Terocin, Triceptin, Trubrexa, Viva Patch, and Zylotrol. What You Can Do When evaluating topical medications in a claim: Assess true medical necessity Compare costs … with a health care professional such as the prescribing doctor or dispensing pharmacist. Do you have a workers’ compensation or auto-related pharmacy question? Send us an email at …
Article

A Guide to Making Specialty Bill Review a Good Fit for You: An Account Manager's Perspective

… on how he coaches clients to understand and implement FairPay Flex effectively. Q: How do you explain the powerful value that FairPay Flex delivers? … provider noise. Many times the noise is in the form of reconsiderations or legal disputes that do not outweigh the savings achieved by the solution. Adjusters need to send all those phone …
Article

Frequently Asked Questions About Medicare Set-Aside

… Q: If MSA submission is voluntary what happens if we do not submit the MSA to CMS for review? … Q: Do Medicare Conditional Payments apply to Medicare Supplemental Plans as well? …
Article

Ask The Pharmacist: Steroid Medications in Workers’ Compensation

… with your health care professional such as the prescribing doctor or dispensing pharmacist. Do you have a workers’ compensation or auto related pharmacy question? Send us an email at …
Article

Healthy Eating Even When You're Stressed

… could start by making a small commitment to yourself. This might mean picking one thing you'll do this week to make healthy eating a bigger priority. Or you might make a small change to help … ready to eat on busy weekdays. Commit to a small change Are you ready to pick something you'll do this week to make healthy eating easier? It can be something small, something that works for …
Article

Ask The Pharmacist: Medication-Assisted Treatment (MAT) for Opioid Use

… as diabetes or heart disease. Methadone and buprenorphine are both opioids, therefore, they do carry the risk of addiction themselves. However, when used properly as part of an overall … with your health care professional such as the prescribing doctor or dispensing pharmacist. Do you have a workers’ compensation or auto related pharmacy question? Send us an email at  …
News Release

The Impact of Rutledge v PCMA on Workers' Compensation

… will therefore remain in effect. In its ruling, the Court noted that the provisions of Act 900 do not have “a connection with or reference to” an ERISA plan. The Court further noted that Act … laws. It could also embolden states to become more aggressive in their regulation on how PBMs do business. As we approach the new year and a new round of legislative sessions, our government …
Virtual Event

Work Comp: COVID-19 Effects and Lasting Impacts [Podcast]

… will be a little bit more investigative work done into it to see if it is the right thing to do in the scope of practices for the providers. Did we do the right thing when we implemented those emergency regulations?” …
Blog

3 Important Factors in Handling a Catastrophic Case

… addressing them in a timely fashion. A third factor in handling catastrophic injuries has to do with lag time in engaging catastrophic case management. Statistics show that the two optimal … : What unique aspects do case managers bring to catastrophic injury management? …
Article

Guide to Selecting an Electronic Payments Vendor

… An electronic payment vendor should do more than just transmit payment for medical bills virtually. By asking the right questions, … with providers. Does the payment vendor have an opt-in or opt-out model for providers? Do providers have the option to select from multiple payment methods before payments have been … reducing paper costs and increasing electronic penetration, according to Mitchell data. How do providers know they have received payment? This can be especially problematic if a compliant …