While every carrier’s exact workflow and claim processing techniques are distinct, most claim professionals across the third party liability industry operate with the same goals in mind—settle claims accurately, efficiently and consistently. But sometimes, the complexity of third party claim processing can cloud these seemingly simple objectives.
Workers' compensation pharmacy is constantly evolving, from tackling the opioid crisis, to the rise of compounding pharmacies, to the pandemic. Amidst these changes, pharmacy benefit managers must constantly evolve to address an array of industry changes. In our final Enlytening Conversation our pharmacists discuss how changes within the industry as a whole including physician shortages, digital therapeutics, biopsychosocial approaches, new drug treatments, and much more are driving the need for constant planning and innovation to stay a step ahead in this ever-changing landscape.
Clients face numerous challenges in managing their workers' compensation pharmacy programs including capturing all pharmacy utilization and costs as well as addressing abuse by price opportunists. In this Enlytening Conversation we’ll dig deeper into these issues and others to find proactive opportunities to address pharmacy challenges through identification, regulation, and continually reevaluating outcomes and analytics to better understand how the right pharmacy partner can positively impact overall spend and claims outcomes.
Seizing opportunity within the complexities of workers’ comp prescription utilization requires a holistic approach that manages all transactions to gain the full picture of medications being utilized. This Enlytening Conversation covers key factors for payers to consider that impact pharmacy utilization and cost, including legislative and regulatory challenges, physician dispensing, utilization controls, complex billing issues and cost management solutions that consider therapy as a whole.
PrecisionDirect allows auto carriers to improve payment accuracy for provider services. During claims settlements busy adjusters often have neither the time or experience to negotiate and pay providers directly on bodily injury claims. Today, Enlyte is working to streamline that process by launching PrecisionDirect, an integrated provider negotiations and networks solution designed to free up adjusters to focus on claim settlement while securing savings on these bills.
Let’s set the stage with some facts that every carrier can relate to: a desire to close claims quicker and with more accuracy. If a fair settlement can be reached early on, it becomes a win-win for all parties involved. This is clearer than ever in the current environment.
Explore key workers' comp provider industry trends, including consolidation, network adequacy, and strategies.