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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.

Workers' Comp Article

StateWatch: Summer 2018

Keep current with new legislation and its potential effect on your organization.
Workers' Comp Article

How to Stop Paying for Billing Mistakes: Use an Auditing Technology Platform

Medical billing mistakes are occurring at an alarming rate–external sources claim anywhere from 30 to 80 percent of medical bills could have some type of inaccuracy. Since many payors don’t have the most effective systems in place to identify billing issues, these errors are potentially costing them millions of dollars
Workers' Comp Case Study

Next Stop = Return to Work

catastrophic Case Management Meet Wendy Daney, BSN, RN, CCM Wendy Daney, BSN, RN, CCM, is a dedicated nurse case manager with more than 20 years’ ex
Workers' Comp Case Study

Walking Toward Function

Field Case Management Meet Rachel Boughter, RN, BSN, CCM   A case manager at Genex for 12 years, Rachel Boughter is known for her excellen
Workers' Comp Case Study

On the Right Track

Field Case Management Meet Mary Aydt, RN, MS, CRRN  With more than 30 years of experience as a Genex case manager, Mary Aydt, RN, MS, CRRN, is

Workers' Comp Blog

A Look at the Foundation of Work Comp Pharmacy Trends

We are excited to kick off this blogging effort by discussing the workers’ compensation trends we have identified in our 2017 annual Drug Trends Series and to dig into some of the key drivers behin
Workers' Comp Article

Sensors in Claims: How To Reduce Workplace Injuries

We live in world where almost anything can become or have associated with it a sensor that informs a broader system designed to make the world around us more intelligent, convenient, and very often safer. Consider the Fitbit: according to the company, more than 25 million people worldwide actively used their devices in 2017.
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