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Auto Casualty Article

In-Network and Out-of-Network Trends

4 MIN READ

This analysis provides a comprehensive examination of prescription utilization across both in-network and out-of-network channels including retail pharmacies, mail-order services, and paper-based medical bill submissions. This dual-lens approach captures the full prescription landscape that extends beyond traditional pharmacy benefit management reporting, revealing critical cost and utilization patterns across all jurisdictions. While in-network channels demonstrate the real-time effectiveness of integrated clinical controls and cost management strategies, out-of-network data, often representing acute treatment episodes captured through medical bill review, exposes significant cost management opportunities and pricing anomalies. Together, these perspectives illuminate where pharmacy dollars are spent, how prescriptions are managed, and where targeted interventions can drive the greatest impact on both clinical outcomes and costs.

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Mitchell Article

Silver Linings in 2020 [Video]

Watch Alex share some silver linings from 2020, with recommendations on how to leverage this year’s positive trends to help you find greater success.
Workers' Comp Case Study

Phoenix Rising: Changing Course After Tragedy

After a devastating crash, flight paramedic Derek Boehm faced a long road to recovery. Watch how expert case management helped him reclaim his life.
Workers' Comp Blog

Clinical Cannabis Considerations

It seems there is always something new to say when it comes to the hot topic of medical marijuana or “cannabis,” as it’s commonly referred to in clinical literature.
Workers' Comp Blog

Keys to Building Relationships

As Case Management Week comes to a close, we want to recognize all of our Coventry Case Managers for their dedication and commitment to helping injured workers return to work, to play, to life.
Auto Casualty Article

Success Story: New AI Model Helps CCMSI Seal the Cracks in the Claims Cycle

Download a PDF Version of this Article CCMSI, a large boutique third party administrator (TPA), has been providing innovative risk management solutions to thousands of companies for more than 40 years. As artificial intelligence (AI) began emerging, CCMSI was early to adopt, and over the last several years, they developed an AI-driven intervention model that has been implemented with tremendous success. This new model had a simple goal: Use AI to flag at-risk claims for adjusters and ensure nothing falls through the cracks throughout the claims process.
Workers' Comp Blog

Unlocking the Benefits Behind Custom Networks

In this era of rapid changes to health care, networks are becoming more important than ever.

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