Insurance carriers administering claims involving durable medical equipment, prosthetics and orthotics (DMEPOS) are confronted with increasing challenges and mounting regulations within the industry. Advances in technology and changes to the DMEPOS field often bring significant benefits and more favorable outcomes to claimants but also present considerably higher claims costs in addition to increased time spent on claims adjudication by adjusters. Furthermore, claimant satisfaction levels may considerably decrease due to these rising costs and longer claims cycle times which can ultimately have a negative impact on an insurance carrier’s earnings.
Fortunately, a durable medical equipment benefits manager (DBM) such as Northwood is able to assist insurance carriers with each of these potential problem areas. Northwood has partnered with insurance carriers as a DBM for more than 20 years to proactively manage claims involving DMEPOS. Throughout this management process, Northwood monitors and tracks each claim to provide reports and thorough analysis for each of its clients. This innovative approach to claims adjudication comprises systems customized for individual insurance carriers that enable them to achieve maximum cost savings and reduce overall claims cycle time.
As the nation’s leading DBM, Northwood has built an extensive network of providers throughout the nation. Each provider is subject to a thorough credentialing process before being accepted into the network. Once accepted and credentialed, providers dispense authorized DMEPOS products and services to insurance carriers and their claimants according to their agreed upon fee schedule with Northwood. Since Northwood is based in Michigan, the state contains over 250 credentialed DMEPOS providers; the remainder of its extensive network spans the entire United States and also includes medical providers in Puerto Rico. Insurance carriers will also appreciate the convenience and availability of Northwood’s call center that provides customer service support 24 hours per day and seven days per week. Northwood offers translation services within this call center, thus eliminating the need for insurance carriers to hire an outside language service which reduces vendor expenses for the carrier.
Northwood reduces claims cycle times in part by implementing a paperless claims adjudication system along with front-end authorization processes for insurance carriers. The use of paperless systems enables electronic claims payments to be sent directly to DMEPOS providers with no out-of-pocket costs for claimants. The Healthcare Common Procedure Coding System (HCPCS) is utilized by DMEPOS providers and Northwood executes their pre-authorization process to reduce the utilization of not otherwise classified (NOC) codes to ensure claimants receive the appropriate products and services while controlling costs.
Since 1992, Northwood’s clients have saved over $200 million with a nearly three-to-one return on investment ratio. Insurance carriers can confidently partner with Northwood as their DBM to assist with the reduction of claims cycle times in addition to an increase in cost savings. Innovative processes and systems developed by Northwood ensure satisfaction for both insurance carriers and claimants requiring the use of DMEPOS. Benefit managers interested in more information about partnering with Northwood as a DBM should contact a representative.Leave a reply →