Insurance companies administering claims are tasked with overcoming many obstacles and difficulties within automobile no-fault and workers’ compensation claims. When claimants sustain injuries and require the use of prescription medicines together with durable medical equipment, prosthetics and orthotics (DMEPOS) services, insurance companies and their adjusters and examiners are confronted with many additional challenges above and beyond the typical complexities associated with claims. If your insurance company hasn’t considered integrating medical and pharmacy benefits, you are likely negatively affecting your bottom line.
It is highly beneficial and impactful to the insurance company’s bottom line to integrate medical and pharmacy benefits by partnering with an experienced third-party administrator like Northwood. Northwood is thoroughly versed in both areas acts as both a durable medical equipment benefits manager (DBM) and a pharmacy benefit manager (PBM) to maximize benefits for the insurance company. Integrating these benefits will have a significant impact on the bottom line in the following notable ways.
Reduce Claims Cycle Time
When Northwood enters the equation, and takes on the role of a DBM and PBM for an insurance company, the burden of workload on examiners and adjusters becomes lighter. This is due to the resources that Northwood provides which save administrative time on tasks such as comparing the cost of prescription medications. A PBM will have agreements in place with providers that allow the insurance company and its claimants to access discounted prices for all injury related prescription medicines, which eliminates the need for adjusters and examiners to track down the lowest provider pricing. In turn, this translates to less time spent adjudicating claims because of increased efficiency.
Once the partnership between the insurance company and Northwood is cemented, claimant satisfaction levels will begin to increase. Northwood’s processes and procedures are meant to not only benefit adjusters and examiners, but also claimants. A pre-authorization process implemented for all physician prescribed services means that claimants will no longer need to pay out-of-pocket for injury related prescription medications or DMEPOS services which will lead to higher claimant satisfaction levels. Ultimately, this increase goes on to more indirectly impact the bottom line of the insurance company.
One of the most significant features of partnering with Northwood that provides DBM and PBM services centers on the direct impact to the insurance company’s bottom line. Systems such as pre-authorization processes, a credentialed network of providers, and a paperless claims adjudication system all play a role in controlling the cost of both workers’ compensation and auto no-fault claims.
Integrating medical and pharmacy benefits through Northwood has the potential to provide countless additional benefits to an insurance company. To ensure your insurance company isn’t taking a financial hit due to a lack of integration of benefits, schedule a meeting with Rosanne Brugnoni at 586-755-3830 ext. 3771.Leave a reply →