Insurance companies administering automobile no-fault and workers’ compensation claims know firsthand that claim abuse exists. Sometimes, it is unintentional but other times fraud can and does intentionally occur. There are a number of ways that your insurance company can be proactive about claim abuse. One incredibly efficient way to help reduce claim abuse is to work with Northwood.
Northwood is a third-party administrator (TPA) of both auto no-fault and work comp claims. Over the many years that Northwood has partnered with insurance companies as a TPA, they have developed several processes and procedures that assist with significantly lowering the incidence of abuse or fraud within claims.
One way that Northwood can help with this problem is by implementing a pre-authorization process for every single claim that your company works with. When a claimant is prescribed a medicine or a medical service, Northwood’s team members take a look at the prescription first. All physician prescribed services are reviewed to be sure they are directly related to the claimant’s injuries and that they are appropriate for the situation. Once these facts are reviewed, Northwood then authorizes the medicine or service for the claimant.
As an added bonus, Northwood also offers a network of quality providers for claimants to work with. Because each physician prescribed service is pre-authorized by Northwood, the providers can work directly with the client to coordinate the medicine or service. And there is no out-of-pocket cost to your claimant, which adds convenience.
Another way that Northwood helps reduce claim abuse is through its invoicing processes. When providers invoice insurance companies, they use the Healthcare Common Procedure Coding System (HCPCS). This system is rather intricate, containing multitudes of codes. Some providers will use not otherwise classified codes (NOCs), which can drive up the cost of a claim.
Other providers may practice something called unbundling, which also increases the cost of claims. Unbundling generally means that a provider is billing for individual components of one thing in order to receive a higher payment from the insurance company. Wheelchairs are a common example of unbundling since they may come with individual components like footplates and armrests.
Northwood reviews each invoice to ensure that the proper HCPCS codes are used and that all physician prescribed services are bundled when appropriate. This review process, combined with Northwood’s pre-authorization process, can significantly bring down unnecessarily high costs within your claims. In addition, Northwood offers other ways to help reduce fraud and abuse within claims while also helping to hold down the cost of administering claims.