Insurance carriers in the auto no-fault and workers’ compensation claims industry deal with a multitude of responsibilities and regulations when it comes to their injured claimants. One of the top priorities for adjusters/examiners on any auto no-fault and workers’ compensation claim involves indemnifying the claimant. Simultaneously, adjusters/examiners are involved in and generally responsible for managing the outcome of the claim as well as holding claim costs down. When auto no-fault and workers’ compensation claims involve pharmaceutical services, an insurance carrier can realize significant benefits through a partnership with a Pharmacy Benefit Manager (PBM).
In the most basic and generalized overview, a PBM brings cost savings to both an insurance carrier and its auto no-fault and workers’ compensation claimants. When the proper systems are in place within an experienced Pharmacy Benefit Manager, insurance carriers and adjusters/examiners are empowered with proven tools and processes that increase claim processing efficiency which then correlates to increased claimant satisfaction throughout the auto no-fault and workers’ compensation claims process.
Insurance carriers will realize these benefits of partnering with an experienced PBM in a variety of ways. When partnering with a PBM, adjusters/examiners will have access to a credentialed network of pharmaceutical providers. Adjusters/examiners will save time on the claims administration process by utilizing the providers that the PBM has built trusted business relationships with; this network allows adjusters/examiners to eliminate the time typically spent researching provider quality and history because this network has already been thoroughly researched and tested by the PBM.
Additionally, the PBM will take over the performance of utilization reviews for the adjusters/examiners tasked with administering auto no-fault and workers’ compensation claims. As a neutral third party, the PBM will provide the perspective that is necessary for an objective analysis on prescribed pharmaceutical services. An experienced PBM will review a claimant’s prescriptions to determine whether the prescriptions are appropriate, necessary and accurate. By performing these utilization reviews, the PBM will ensure the insurance carrier is not paying higher prices for their claimants’ pharmaceutical services and prescriptions. Over time, these utilization reviews will ultimately result in reduced auto no-fault and workers’ compensation claims costs for the insurance carrier.
As a leading PBM, Northwood has developed proven procedures and systems that result in cost savings for auto no-fault and workers’ compensation insurance carriers it partners with. Northwood has built an expansive network of credentialed providers and allows adjusters/examiners and claimants access to this network upon its partnership with the insurance carrier. Northwood performs utilization reviews on auto no-fault and workers’ compensation claims in order to assist adjusters/examiners with determining injury relatedness of the prescribed pharmaceuticals. In addition, Northwood has specially trained representatives with an exclusive focus on auto no-fault and workers’ compensation claims that provides coordination for an insurance carrier’s claimant’s home health care products and service. Northwood utilizes its extensive PBM experience and its proven practices to administer auto no-fault and workers’ compensation claims and save insurance carriers and claimants’ money and time.
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