Workers’ compensation and automobile no-fault claims contain a multitude of differences. However, these two types of claims also share some similarities as well. This is especially true when it comes to claims that involve the usage of both prescription medicines as well as durable medical equipment, prosthetics, and orthotics (DMEPOS) and related services.
Claims that require prescription medications and DMEPOS to assist a claimant with recovery represent a wealth of potential complications and challenges for adjusters and examiners as well as the claimants themselves. No matter whether your company is focused primarily on workers’ compensation claims or auto no-fault claims, it pays to integrate medical and pharmacy benefits utilizing a single provider to achieve the best claimant experience possible.
One key detail that boosts the success rate of integrating medical and pharmacy benefits together hinges on the third-party administrator (TPA) your company chooses to partner with. It is essential to work with a TPA that not only acts as both a durable medical equipment benefits manager (DBM) and a pharmacy benefit manager (PBM), but it also has to have the knowledge and experience to administer these types of claims in a way that maximizes efficiency while taking care of your claimants.
A truly successful TPA will be able to smoothly and effortlessly take on the role of a DBM and PBM for your company. Your company will benefit from a TPA with experience in this regard because years of integrating medical and pharmacy benefits provides a solid foundation for a partnership between the TPA and your adjusters and examiners. This partnership ensures a seamless experience for your claimants as well, especially when the TPA offers a customer care call center.
As the partnership continues, the workload on your adjusters and examiners will be decreased because many tasks are shifted to the TPA. One significant example of this is the task of comparing pricing on prescription medications and DMEPOS that is normally assigned to adjusters and examiners. This single task can easily become something that takes up too much time, leaving adjusters and examiners scrambling to take care of their claimants while simultaneously doing their due diligence to find the lowest costs.
Integrating these benefits and working with a TPA acting as both your DBM and PBM as a single provider can drastically change how adjusters and examiners spend their time, allowing them to be able to efficiently administer claims while ensuring an excellent claimant experience. A partnership with a TPA that has built up a credentialed provider network and that has built streamlined processes to hold down costs and put claimants first is an essential component to ensuring your claimants are satisfied with your company.
Northwood is a TPA that will partner with your company to integrate pharmacy and medical benefits to help provide the best experience possible for your claimants. For a personalized look into how your claimants and your company can benefit from Northwood’s experience as a DBM and PBM, schedule a meeting with Rosanne Brugnoni at 586-755-3830 ext. 3771.Leave a reply →