White Paper

3 Tips to Maintain Provider Appeals Rate Under 1% in Workers’ Compensation

Strong provider relationships and proactive issue resolution are the key to appeals mitigation.

White Paper Summary

In an increasingly competitive market, workers’ compensation insurers are dealing with a multitude of issues, including the COVID-19 pandemic of which long-term effects are still unfolding; as well as soaring inflation; and an evolving workforce (the “Great Resignation”), which has created additional work volume for case managers and adjusters in already busy claims departments.

A strong workers’ compensation PPO network can offset these burdens by proactively mitigating appeals/claim petition disputes, which can cost workers’ compensation insurers millions in administrative and legal fees to resolve.

While many appeals inquiries require quick and decisive issue resolution, some payment disputes may be altogether avoided through careful planning and consideration.

Newly appointed HCS Network Solutions President, Jacqueline Alonso, believes that strong, collaborative relationships are the key to success for workers’ compensation insurers aiming to keep provider appeal and claim petition rates low. A key advantage for HCS is that it leverages the sizable MedRisk Company market presence; and HCS providers are credentialed in accordance with National Committee for Quality Assurance (NCQA) guidelines.

Here are three tips for maintaining a low provider appeal and claim petition rate.


To learn more about HCS Network Solutions, A MedRisk Company, visit https://www.medrisknet.com/.

 

Horizon Casualty Services Inc., an affiliate of Horizon Blue Cross Blue Shield of New Jersey, in business since 1994, is a leading PPO in New Jersey workers' compensation and personal injury protection. The company's 100% direct-contracted provider network includes almost all New Jersey acute care hospitals, significant overall WC savings and, with its deep focus on precision, an extremely low WC appeals rate of 0.2%. Its PPO results, combined with its WC healthcare value and OFN strategy, enables insurers to be the best at delivering quality medical care to claimants at the right cost — clearly a win-win for all.

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