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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.

Risk Management Magazine Article

Improving Workers' Comp Through Data

Unmanaged medical costs have always been a potential sinkhole for workers compensation claims.
Risk Management Article

Risk Management: Improving Workers' Comp Through Data

Unmanaged medical costs have always been a potential sinkhole for workers compensation claims. As risk managers in charge of workers comp programs strive to optimize medical costs and improve outcomes for injured workers, they must formulate a medical management approach that will yield the best results for their unique set of injuries and work conditions.

Workers' Comp Article

Care Management: Cultural Competence and the Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) Patient

In this insightful article, Chikita Brown Mann, MSN, RN, CCM, explores the critical role of cultural competence in delivering equitable and ethical care to LGBTQ individuals.
Workers' Comp Article

10 Things You Need To Know About California SB 1160

SB 1160 will implement major reforms to the California workers' compensation (WC) system.
Workers' Comp Case Study

American Airlines: How Customization and Collaboration Resulted in Improved Return to Work and Significant Savings

"Genex held an important role in the workers’ compensation program creation and directly contributed to achieving our goals.
PDF Article

WC Magazine: The New Cost of Mistaken Identity

To obtain a deeper understanding of the issues and steps needed to minimize your risk exposure from the DOL initiatives download today.
Workers' Comp Article

Property Casualty 360: Establishing a quality IME process for your workers' comp claims

Complex case disputes can result in significant medical and indemnity costs despite efforts to fairly cover the injured worker's medical care and facilitate return to the job.
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