Claims

Our clients can save an average of 45 percent on Pharmacy Benefit Management (PBM) by leveraging our buying power. Our PBM also provides excellent clinical services to ensure proper utilization and conversion to generics. We utilize strategic partners to manage costs on the most complex cases, resulting in significant lifetime savings.

Our MSA certified Medical Management Consultants and Attorneys review vendor prepared MSAs to ensure they are consistent with medical records and comply with Medicare protocols. We identify cost mitigation opportunities to drive down the cost of the MSA, making settlement more cost-effective.

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Our Best-In-Class Excess Claims department includes a dedicated catastrophic claims unit. Our resources are available, free of charge to all policyholders and their TPAs, including: 24-hour CAT hotline for prompt claim reporting, assistance with the initial investigation for compensability and potential subrogation, evaluation by our Chief Medical Officer and CAT nurses, and hospital bill negotiation for acute care charges. Through partnership, we can secure the transfer of the injured worker to a medically appropriate Center of Excellence. These facilities have been evaluated by our medical professionals and have a proven track record of helping injured workers achieve better outcomes.

We partner with premier vendors to negotiate discounts on the significant cost drivers on large claims, including but not limited to hospital and surgical bills, attendant care rates, long-term facility rates, durable medical equipment, and prosthetics.

Injured workers often need a variety of interventions to help them cope with their injuries. We partner with Functional Restoration Centers of Excellence that specialize in treating and helping the most seriously disabled workers. Our experts can evaluate each case individually and recommend the best and most cost-effective long-term solution for each injured worker.