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Auto Casualty Article

In-Network and Out-of-Network Trends

4 MIN READ

This analysis provides a comprehensive examination of prescription utilization across both in-network and out-of-network channels including retail pharmacies, mail-order services, and paper-based medical bill submissions. This dual-lens approach captures the full prescription landscape that extends beyond traditional pharmacy benefit management reporting, revealing critical cost and utilization patterns across all jurisdictions. While in-network channels demonstrate the real-time effectiveness of integrated clinical controls and cost management strategies, out-of-network data, often representing acute treatment episodes captured through medical bill review, exposes significant cost management opportunities and pricing anomalies. Together, these perspectives illuminate where pharmacy dollars are spent, how prescriptions are managed, and where targeted interventions can drive the greatest impact on both clinical outcomes and costs.

Disability Article

Need-to-Know Tips for ADAAA Compliance
Disability Article

Need-to-Know Tips for ADAAA Compliance
Workers' Comp Case Study

Motoring Toward Recovery

Field Case Management Meet Cheri Ratzlow, RN, COHN-S, CCM Case managers will often tell you they “see miracles happen” in their line of work.
Workers' Comp Article

North Carolina Utilization Rules for Opioid and Other Pharmacological Pain Management Treatment

2 MIN READ

When do the new rules apply? The rules apply to all affected treatment in all affected claims on or after May 1, 2018.
Workers' Comp Article

North Carolina Utilization Rules for Opioid and Other Pharmacological Pain Management Treatment

When do the new rules apply? The rules apply to all affected treatment in all affected claims on or after May 1, 2018.
Workers' Comp Article

Care Management: Empowering Knowledge For Case Managers and Those They Serve

Explore how informed advocacy empowers case managers to deliver ethical, evidence-based care by understanding regulations, leveraging best practices, and guiding clients through complex health and disability systems.
Workers' Comp Case Study

Heart of Case Management Award Winning Case: Home Team Advantage

A 53-year-old male sustains a crush injury with shinbone fractures on both legs.
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