Insurance companies administering automobile no-fault and workers’ compensation claims deal with a multitude of challenges. Chief among these challenges can be confronting misunderstandings and lack of transparency within several areas of the claims administration process. Northwood is an experienced third-party administrator (TPA) of both auto no-fault and workers’ compensation claims and shares innovative processes and procedures it has developed over the years with the insurance companies it partners with. The following are three common areas generally lacking in transparency along with insights into increasing transparency.
Bundling
First and foremost, bundling services can be a highly misunderstood practice. Some providers unbundle services and use more claim lines, mistakenly believing that this is a more transparent practice. In reality, unbundling services generates additional paperwork for adjusters and examiners and greatly reduces their efficiency and drives up claim costs. For example, a rental wheelchair includes components (e.g., footrests, armrests, footplates) that a provider might otherwise unbundle since procedure codes are available for individual components. Northwood on the other hand practices bundling on all claims when appropriate, therefore significantly decreasing the amount paperwork for insurance companies and decreasing claim costs. This, in turn, allows adjusters and examiners to more efficiently administer claims which contributes to a reduction in claims costs. These benefits all combine to create additional transparency in billing as well.
Proper Procedure Coding
A second area in the industry generally lacking in transparency involves the Healthcare Common Procedure Coding System (HCPCS). The HCPCS is employed by providers to code services and equipment used in claimant treatment regimens and to request payment from insurance companies. The complex nature of HCPCS represents transparency challenges because of the potential for rising claims administration costs and overpayments to providers. Northwood draws upon its many years of experience as a TPA to utilize the correct HCPCS procedure codes for every claim. While this practice increases transparency, it simultaneously reduces costs for the insurance company because the proper procedure codes assist in reducing the incidence of overpayments and incorrectly coded procedures.
Pre-Authorization Implementation
Finally, Northwood always implements pre-authorization processes for the insurance companies it works with. All physician prescribed services are reviewed under the pre-authorization process to ensure that the prescribed services are directly injury related. The major benefit of this process is the fact that it reduces costs to the insurance company. However, claimants appreciate having the pre-authorization process in place because it also eliminates the need for them to pay out-of-pocket, especially as it relates to prescription medication, for their services that are related to their claim.
Increasing transparency within auto no-fault and workers’ compensation claims is an important part of providing better care for claimants. Northwood has partnered with insurance companies for more than 20 years to proactively manage claims, increase transparency and go above and beyond to ensure both insurance companies and their claimants experience better care and high levels of satisfaction. For additional information about how Northwood will go above and beyond for you, please schedule a meeting with Rosanne Brugnoni at 586-755-3830 ext. 3771.
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