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 Horizon Casualty Services (HCS) 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 Horizon Blue Cross Blue Shield of New Jersey 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 Horizon Casualty Services, Inc., visit https://www.horizonblue.com/horizoncasualty/.

 

Horizon Casualty Services, Inc., a subsidiary of Horizon Blue Cross Blue Shield of New Jersey, in business since 1994, is the #1 workers’ compensation (WC) and personal injury protection (PIP) PPO in New Jersey. The company’s 100 percent direct contracted provider network includes 99% of New Jersey acute care hospitals, WC savings 62 percent below UCR and with its deep focus on precision; an extremely low WC provider appeals rate of 0.2%. Its PPO results coupled with its WC health care value Outcomes Focused Network strategy enables insurers to be best at delivering quality medical care to claimants at the right cost — clearly a win-win for all stakeholders involved in WC claims.

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