Insurance carriers and estimators working within the workman’s compensation field have numerous challenges along with several obligations to their claimants. In addition to ethical responsibilities, estimators must have a working knowledge of medical providers and the Healthcare Common Procedure Coding System (HCPCS) for claims involving durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). As the DMEPOS industry continues to evolve and the healthcare field becomes increasingly complex, insurance carriers will benefit from partnering with a Durable Medical Equipment Benefits Manager (DBM).
As an experienced and trusted DBM, Northwood acts as a third-party administrator of workman’s comp claims for insurance carriers. As an objective partner, Northwood is better positioned to analyze costs and administrative time spent on workman’s comp claims. Through this analysis, Northwood identifies areas for improvement and implements cost and time saving strategies within claims adjudication.
Within workman’s comp claims are a myriad of medical codes and DMEPOS treatments that individual estimators may be unable to stay knowledgeable on due to time constraints and the intricate and progressively complicated nature of HCPCS. Northwood provides utilization management and HCPCS identification for its clients, and offers estimators access to its network of medical providers that have been through its stringent credentialing process to ensure maximum quality and lowest cost. Medical providers within this network must meet and adhere to Northwood’s high standards, including employing adequate staff 24 hours per day and seven days per week.
Northwood also reviews financial data in detail to ensure providers in its network are fiscally stable with sufficient reserves. This review includes verifying providers have satisfactory general liability coverage in place; any changes to this information are required to be submitted to Northwood promptly and in writing. Documentation from the Centers for Medicare and Medicaid Services (CMS) approving the provider along with an accreditation for Direct Medical Equipment (DME) are gathered from providers applying to become credentialed through Northwood. A copy of the business license and National Provider Identifier (NPI) notification are further requirements. If providers hold other certifications, documentation is required to ensure the highest level of excellence for Northwood’s insurance carrier clients.
Once providers have been credentialed and become part of this trusted network, they must apply for re-credentialing each year. Northwood maintains an electronic database of the providers’ insurance expiration dates and requests updated certificates annually. The Medicare De-bar and Opt-Out lists are examined to confirm providers have not been subject to corrective action or opted out of Medicare. Further reviews are conducted via organizations such as the System for Award Management (SAM) for Excluded Parties List (EPLS) to be sure no fraud, abuse or licensing board actions have occurred.
These examples of the rigorous credentialing and re-credentialing processes Northwood implements for its provider network are just a portion of the steps necessary for approval. The intense verification experience allows Northwood’s clients to securely rely upon this network to provide discounted rates along with the highest quality of service possible for both an insurance carrier’s estimators and claimants. Northwood has representatives available each day to provide further information to insurance carriers interested in partnering with them as a DBM.
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