Managing the adjudication of workers’ compensation and automobile no-fault claims can be challenging given the multitude of priorities and tasks involved within each claim. It is always critical to indemnify your claimants, of course. But managing profitability for your insurance company is another critical priority which may not always get the attention it deserves.
Partnering with a durable medical equipment, prosthetics, orthotics and medical supplies (DMEPOS), pharmacy and ancillary service provider is a wise way to ensure your company addresses all of your key priorities, including profitability.
Northwood is an experienced DMEPOS, pharmacy and ancillary service provider with over 30 years of experience administering auto no-fault and work comp claims. During its three decades of experience, Northwood has developed and implemented proven processes and procedures to elevate the priorities of its partners.
For insurance companies seeking to improve profitability, Northwood can help in many ways. One example is Northwood’s implementation of pre-authorization on all automobile no-fault and workers’ compensation claims. Pre-authorization means Northwood’s experienced team members review every physician prescribed service before it is approved for your claimant. Pre-authorization allows Northwood to ensure the physician prescribed service is directly related to your claimant’s injuries, which drives down unnecessary costs for your company.
Other providers often use a formulary instead of pre-authorization for claims involving prescription medications, which comes with several disadvantages. A formulary is essentially a list of medications that will be approved when they are included on a medical provider’s invoice. However, if a claimant was already on a prescription medication for pain such as Motrin, and that existing prescription was combined on an invoice with a new, injury-related prescription, a formulary would allow for approval of payment for both medications.
On the other hand, Northwood’s pre-authorization process would involve a review of the invoice that would flag the Motrin prescription as being unrelated to the claim. The prescription directly related to the claimant’s injuries would be approved but the Motrin would not be approved for payment. This process alone can potentially improve your company’s profitability through its elimination of unnecessary payments to medical providers.
Furthermore, your claimant still receives their prescription medication they need. And the pre-authorization process does not add significant time delays to the claims process. When claims are processed as quickly and efficiently as possible, claimants tend to rate their satisfaction with your company at a higher level. In turn, you will observe an increase in your retention rates which ultimately impacts your profitability.
Northwood has many additional methods to support your company’s profitability while ensuring your claimants have a good experience. Please schedule a review of how these methods can benefit your company by calling Rosanne Brugnoni at 586-755-3830 ext. 3771.
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