Virtual Connections
As the telemedicine industry continues to boom we’re seeing new forms of telehealth emerge in the marketplace. Variations including tele-rehab, remote patient monitoring, and even “avatar-like” nurses being utilized by hospital systems and providers.
What is an MCO?
3 MIN READ
More often than not clients will ask the question: What is an MCO? Well isn’t that a loaded question? If we take it at face value, a Managed Care Organization (MCO) is an organization that manages care. Like Coventry, who manages all types of “care” injured workers seek to get on the road to recovery. However, usually the question has more to do with State Certified Managed Care Programs, commonly referred to as MCOs. From there it gets clear as mud. While the general category of state certified programs may be commonly referred to as MCOs, when you get into the state specifics you won’t find it to be that easy.
How Long is a Filled Prescription Good For? Does the Medication Ever Go Bad?
2 MIN READ
The expiration date indicates the time period the prescription drug can be expected to meet the claims of the Pharmacopeial monograph (information sheet provided with a medication), that it conforms to the recommended storage conditions. These dates are usually found on the manufacturer’s container and may be included on the prescription bottle label, depending on various state requirements.
10 REASONS TO INCLUDE A PHARMACY NURSE IN YOUR WORKERS' COMPENSATION PROGRAM
1 MIN READ
A recent survey of public health experts predicted 650,000 people could die from opioid misuse within the next 10 years.¹ Public health spending is falling short, medication-assisted treatment is too rare, and the worst drug overdose epidemic in U.S. history is culling our labor force. Rising medical costs and the opioid epidemic aren’t new trends to our industry, and while there are many beneficial tools being implemented to address these issues there is also one you may be less familiar with – a pharmacy nurse.
Defining Formularies & Step Therapy Medications
2 MIN READ
HealthCare.gov defines a formulary as, a list of prescription drugs covered by a prescription drug plan offering prescription drug benefits. Typically, a “prior authorization” for coverage is needed when a medication is not listed on the formulary or requires step therapy. Management of the formulary is often maintained by a pharmacy benefit manager (PBM), such as First Script. Meaning, when a medication is not on a formulary, First Script would start the prior authorization process to get approval for payment of the medication.
How Managing Provider Data Can Make a Positive Impact on the Claims Process
As we’ve established in the first two articles in this series, provider data quality is an issue in the Property and Casualty industry that can be challenging to manage and maintain. Though it can be difficult, provider data management is a worthwhile project, since accurate provider data helps facilitate data-driven decision making, which can in-turn lead to improved efficiencies and outcomes for claims organizations.
Five Guidelines for Provider Data Management
The majority of healthcare provider data today is fraught with inaccurate or duplicate information, causing a multitude of issues for claims organizations, notably workflow inefficiencies and suboptimal outcomes. An accurate provider database can help to improve efficiencies, but managing provider information is more difficult than it may seem on the surface.