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    The cost of many things seems to be on the rise as of late. Prescription costs are no exception. In fact, IQVIA’s The Use of Medicines in the U.S. (published May 27, 2021) report highlighted that 6.3 billion prescriptions were given out in 2020. Furthermore, the amount spent on medicine in the United States increased to a total of about 359 billion dollars.

    With prescription costs rising, it is important that your insurance company takes proactive measures to ensure you are holding down costs within your automobile no-fault and workers’ compensation claims. There are a few ways your company can do this.

    First, be sure that you are reviewing each invoice received from a medical provider for every claim. Medical providers use the Healthcare Common Procedure Coding System (HCPCS) for these invoices to code the appropriate physician prescribed services. However, the HCPCS is incredibly complicated, containing numerous codes for various medications and services.

    Reviewing these invoices for the correct procedure codes can help ensure your company isn’t overpaying. Errors can happen as providers enter these codes, for instance. In addition, some providers may use not otherwise classified (NOC) codes on invoices. This can drive up the cost of claims because there is almost always an exact HCPCS procedure code to be used for every prescription.

    Second, your company can proactively implement processes that are designed to streamline claims. As an example, you may choose to pre-authorize all prescription medications for each claim. Doing so will help your adjusters and examiners determine that a medication is injury related before it gets approved for your claimant. This cuts back on unnecessary spending and helps ensure the safety of your claimants.

    Implementing this pre-authorization process and gaining access to a credentialed, trusted network of medical providers brings even more benefits for your claimants and your company. With these two approaches in place, your claimants will be able to pick up their prescription medications or physician prescribed services without having to pay anything out of their own pocket.

    While this certainly adds convenience for claimants, it also eliminates frustration points for them. Not only do they simply pick up their prescription and have it billed directly to the insurance company, but they won’t have to complete reimbursement paperwork. Claimants will be satisfied, driving up claimant satisfaction scores and retention rates. Yet your adjusters and examiners won’t have to spend their administrative time on reimbursement papers, either, saving them time and streamlining your claims adjudication process.

    There are plenty of other ways to proactively hold down costs as prescription medication prices continue to rise. For a customized look at ways Northwood can help your company hold down costs, schedule a call with Rosanne Brugnoni at 586-755-3830 ext. 3771.

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