Tampa, FL – PMSI, one of the nation’s largest and most experienced companies focused on workers’ compensation, recently announced the launch of SettlementComplete™, a comprehensive program that integrates the company’s expertise in pharmacy, clinical, and Medicare Secondary Payer (MSP) compliance services to drive reasonable Medicare Set-Aside (MSA) allocations, allowing for settlement of more cases. SettlementComplete applies proactive and real-time cost containment strategies through various programs along the claim lifecycle to contain costs, simplify claim administration, ensure compliance, and expedite settlement.
SettlementComplete encompasses a suite of programs that manage the claim along the lifecycle, such as:
- Part D Candidate List: By creating specific profiles from pharmacy and claim data, payers can identify potential MSA issues, such as prescription drug contraindications or high utilization, long before settlement negotiations begin.
- Part D Predictor: An estimate of the proposed Part D prescription exposure allows the adjuster to proactively determine if clinical interventions are necessary to meet settlement expectations.
- Clinical Cost Containment Review (CCCR): Performed by an independent clinical pharmacist and nurse, CCCR can identify treatment that may not be medically necessary, is not causally related, and/or is being utilized excessively. Medication Analysis can be employed to target prescription drug utilization.
- Peer Outreach: A specialty matched physician reviews with the treating physician(s) the treatment plan, potential consequences, and any modifications that might be reasonable for the safety of the injured worker, with the treating physician, positively impacting the lifetime exposure to the payer.
- Clinical Monitoring: A PMSI nurse assures that treatment modifications are followed, monitoring for implementation and successful outcomes.
- MSA Self-Administration assistance: Provides claimants from settled claims with access to PMSI’s pharmacy network to secure medications at a price lower than typical retail prices.
“PMSI’s SettlementComplete program draws on PMSI’s pharmacy expertise to drive aggressive cost containment and highly accurate MSA allocations throughout the claim lifecycle,” stated Jeffrey Gurtcheff, PMSI’s Vice President and General Manager of Settlement Solutions. “Our comprehensive approach for MSAs begins with a detailed review of the medical history and treatment modalities. It then concludes with the final submission and approval process, with the ultimate goal of settlement of the claim.”
Source: PMSI