Automobile no-fault claims present many challenges to insurance companies and their claimants. The continually increasing cost of claims, changes in claimant satisfaction levels and more all factor in to the administration of each auto no-fault claim. Northwood who has over 20 years of experience as a third-party administrator (TPA) of these types of claims and can offer tremendous help to an automobile insurance company in several ways.
One way that Northwood can assist insurance companies with cost savings pertains to the Healthcare Common Procedure Coding System (HCPCS). Most auto no-fault claims involving injuries will require HCPCS procedure codes and this can be challenging for adjusters to navigate in certain situations. Medical providers will often use multiple procedure codes for the same piece of durable medical equipment (DME) like a wheelchair. Other times the providers may use a not-otherwise-classified (NOC) procedure code for this same wheelchair.
These inconsistencies make it difficult for an insurance company to analyze opportunities for cost savings within their auto no-fault claims and also unnecessarily increase administrative time spent on claims adjudication. Northwood provides a solution by implementing transparency in medical billing processes. Northwood’s practice is to use accurate HCPCS procedure code identification for each claim. This consistent approach also reduces the need to use not-otherwise-classified (NOC) procedure codes and ultimately drives down the cost of claims and the average claim adjudication time for insurance companies.
Many times, when a claimant’s equipment is billed to an insurance company, the provider might “unbundle” services that are included in the core product. Northwood’s unique prior authorization process encompasses a Medical Management approach. The comprehensive nature of Northwood’s prior authorization process (“highly-managed”) promotes a successful cost/benefit outcome. Northwood’s prior authorization process includes HCPCS procedure code identification. Proper HCPCS procedure codes are identified in order to prevent “unbundling” of services. In most instances, supplies used in conjunction with rental equipment are included (not paid separately; re-bundled under the appropriate HCPCS procedure code) in the rental fee until capped or purchased. This process reduces the overall claims cost to the insurance company over time by also ensuring a higher degree of accuracy and efficiency within the claim.
It may be necessary for adjusters to work with multiple providers for one claimant. In this situation, multiple provider requests may come through for one claim and it can be challenging for an adjuster to review each request for auto relatedness. Northwood implements a proactive review process on each auto no-fault claim to assure the auto relatedness of all provider requests. This pre-authorization process reduces claims costs for insurance companies by eliminating unnecessary payments for medications and DME that are not directly related to the claimant’s injuries. Furthermore, it also ensures high levels of claimant satisfaction by eradicating out of pocket costs for claimants. Claimants will appreciate this simplified claims process which could precipitate a claimant to discuss their exceptional experience with their claim and more likely to renew their insurance with their automobile insurance company and to tell others.
In addition, Northwood’s prior authorization process includes determination of quantity limitations. In instances where quantities exceed standard practices, Northwood obtains medical necessity and injury relatedness for final determination and authorization by the adjusters.
Northwood provides numerous avenues of assistance to insurance companies administering automobile no-fault claims and has representatives available to offer more information. If you have questions about how Northwood will assist your insurance company, please contact Rosanne Brugnoni at 586-755-3830 ext. 3771 at your convenience.Leave a reply →