Overcoming Overpayment Risk With FairPay Flex

Problem

A top-ten workers’ compensation carrier needed detailed insights and clarity into their specialty bill review workflow. This challenge was driven by a desire for enhanced efficiency and transparency for adjusters handling complex claims in certain jurisdictions, particularly in states without a fee schedule where resource-draining legal disputes are common.

Solution

Enlyte experts and the client worked together to implement a two-fold strategy to boost the client’s knowledge and understanding of specialty bill review. First, Enlyte educated the client’s team on the methodology used to determine fair and reasonable rates, as well as the workflow of a bill impacted by FairPay Flex. Then Enlyte used the client’s specific bill examples to illustrate how to ensure savings opportunities were not missed. The second part of the strategy focused on reducing resources spent resolving disputes. Specifically, ensuring the client had peace of mind knowing disputes would be resolved on their behalf by the dedicated FairPay Flex team of experts.

Outcome

By closely partnering and tailoring needed support, Enlyte’s experts helped the client transform their specialty bill review workflow. The transformation shined a light on the performance of specialty bill review delivering 53% savings overall and 66% in non-fee schedule states. Adjusters also gained confidence in anticipating and managing disputes, particularly in challenging jurisdictions where legal disputes are frequent. Newly streamlined processes allowed adjusters to focus their energy on core claim handling responsibilities. Additionally, the client benefited from improved collaboration, fostering greater trust and reliability.