9 Critical Capabilities for a Modern PBM Claims Management System
White Paper Summary
Managing workers’ compensation claims can often be overwhelming. Claims representatives already have notoriously heavy workloads, and the lack of sophistication and reliability of many tools available to them certainly doesn’t help.
One of the many complex aspects of managing a claim is the pharmacy component. Determining the appropriateness of a claimant’s prescription and monitoring its ongoing usage, as the injured worker rehabilitates, is key to both controlling costs and ensuring optimal clinical outcomes. Pharmacy benefit managers, therefore, are crucial partners in the claim management process.
Most PBMs offer an online portal where their clients can access prescription information and centrally manage their claims. However, those portals largely haven’t kept up with advances in technology. More often than not, they are difficult to navigate, require many unnecessary steps, don’t contain comprehensive clinical information, and in general are not very helpful beyond basic authorization capabilities.
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