Get A Jump Start On Controlling Costs This Year

As adjusters and examiners are reviewing claims statistics and planning for 2018, take a look at some of these challenges and associated suggestions that are designed to help you get ahead on controlling costs for the coming year.

With every claim comes unique challenges and situations that are complex. Claimants who sustain catastrophic, orthopedic or soft tissue injuries because of a workplace incident or an automobile accident may require anything from surgeries to home health care services. These types of claims represent additional challenges because many providers choose to unbundle the Healthcare Common Procedure Coding System (HCPCS) codes.  The best practice on all claims is to reduce unbundling and the use of not otherwise classified (NOC) codes to increase transparency and reduce the chance of your company paying too much.

Discounted rates are vital to the success of an insurance company as well. The average wholesale price (AWP) of prescriptions is continuously rising as you have likely observed within claims you administer that require the use of claimant prescription medications. While you may not have the ability to control those prices, you do have the option of negotiating discounted rates for your company.

Those same providers that agree to give your company discounted rates could also offer access to prescription medicines at no out-of-pocket cost to your claimants. This suggestion has a more indirect impact on saving claims costs. When claimants are offered the opportunity to fill their injury-related prescriptions without the need to pay up front and submit reimbursement requests to their insurance company, their satisfaction with the claim and with the company increases significantly. Over time this translates into increased claimant loyalty and additional premium dollars for your company.

These are things to consider as you look toward the remainder of 2018. The most efficient and practical way to implement these ideas and solve the challenges outlined above is to form a partnership with a third-party administrator (TPA) of both workers’ compensation and automobile no-fault claims. Northwood is one such TPA with more than 20 years of experience in saving money for insurance companies.

At Northwood, we strive to bring proven processes and procedures to our clients and their claimants. From an expansive provider network offering discounted rates and the elimination of out of pocket payments for claimants to pre-authorization processes and the practice of transparency in HCPCS use, Northwood brings innovative solutions to your company.

For a more customized look into how Northwood can help you get a jump start on cost savings for 2018, please contact Rosanne Brugnoni at 586-755-3830 ext. 3771 to schedule a call.

Benefits Of Working With An Experienced Third-Party Administrator

Insurance carriers administering automobile no-fault and workers’ compensation claims that encompass claimant use of durable medical equipment, prosthetics and orthotics services (DMEPOS) find themselves facing several challenges, especially in regard to claims involving multiple services and treatments.  

The Healthcare Common Procedure Coding System (HCPCS) is utilized by providers to code services and equipment used in claimant treatment regimens and request payment from insurance companies. The complex nature of HCPCS represents the potential for rising claims administration costs and overpayments to providers due to the common practice of unbundling services. Fortunately, a third-party administrator (TPA) such as Northwood is able to assist in minimizing costs and challenges. The following are three commonly seen challenges with unbundling along with efficient solutions that help mitigate them.  

One such challenge pertains to providers unbundling services since HCPCS procedure codes are available for individual components. The process of unbundling increases the number of claim lines and unnecessarily increases costs for insurance companies. Bundling services will have the opposite effect and assist insurance companies in reducing costs.  

Secondly, providers that unbundle services and utilize more claim lines also typically generate additional paperwork for adjusters and examiners. In contrast, the process of bundling actually significantly reduces the paperwork for insurance companies. This, in turn, allows adjusters and examiners to more efficiently administer claims which contribute to a reduction in claims administration costs.  

Finally, the use of not otherwise classified (NOC) codes drives up the cost of claims for insurance companies. With the thousands of HCPCS codes available there is almost always an accurate code to use for each and every procedure. The use of NOC codes represents an opportunity for insurance companies to greatly minimize them by partnering with a third-party administrator.  

While these three challenges are significant, working with an experienced TPA can mitigate these issues. Northwood has partnered with insurance companies for more than 20 years to proactively manage claims. We execute a pre-authorization process to reduce the utilization of not otherwise classified (NOC) codes, increase transparency and reduce unbundling. Insurance companies can confidently partner with Northwood as their DBM to assist with reducing claims costs due to unbundling. For additional information, please schedule a meeting with Rosanne Brugnoni at 586-755-3830 ext. 3771.