New Braunfels, TX – Independent clinical review provider Nexus recently announced that it has earned URAC reaccreditation in Workers’ Compensation Utilization Management. URAC is the independent leader in promoting healthcare quality through accreditation, certification and measurement. By achieving this status, Nexus has demonstrated a comprehensive commitment to quality care, improved processes and better patient outcomes.… [Read more]
Claims, Legal, & Compliance News
Mitchell and Genex Services Finalize Merger
San Diego, CA – Mitchell International recently announced it has finalized its merger with Genex Services. Now operating as a division of Mitchell, Genex Services will consolidate and deliver the company’s clinical solutions, including case management, utilization review, independent medical reviews, and disability management. Genex joins and strategically complements Mitchell’s existing divisions: Auto Physical Damage,… [Read more]
Phase II Charges Filed on Four CA Chiropractors & Capper in Workers’ Comp Referral Scheme
Santa Ana, CA – Four chiropractors and a capper were recently charged with insurance fraud in a massive multi-million dollar workers’ compensation insurance referral scheme that exploited persons in predominantly Spanish-speaking communities. Last year, 10 attorneys and six cappers were charged as part of the same investigation. This is the second phase of filing resulting… [Read more]
MEMIC Replaces Legacy Claims System with Insurity Platform
Hartford, CT – Insurity, Inc. recently announced that The MEMIC Group will adopt the company’s ClaimsXPress solution. MEMIC, which wrote over $380M in Direct Written Premium in 2017, is a workers’ compensation insurer with $1.3 billion in assets that serves over 21,000 employers in every state across the country. The integrated platform will overhaul core… [Read more]
NCCI Report Examines Medical Services and How They Contribute to the Cost of WC Claims
Boca Raton, FL – NCCI recently released a new Insights research brief that updates previous research and explores the difficult process of trying to understand and predict medical cost trends, which are influenced by several different factors. Not all workers compensation claims are equal when it comes to medical treatment. You don’t usually see the… [Read more]
NY Workers’ Comp Board Launches Virtual Hearings Option
Albany, NY – New York State Workers’ Compensation Board Chair Clarissa M. Rodriguez recently announced the Board has launched a first-in-the-nation initiative that allows injured workers and other participants to attend workers’ compensation hearings right from their homes or offices. The Board’s virtual hearings provide injured workers a way to move the claim process forward… [Read more]
OSHA Launches Program to Target High Injury and Illness Rates
Washington, DC – The U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) is initiating the Site-Specific Targeting 2016 (SST-16) Program using injury and illness information electronically submitted by employers for calendar year (CY) 2016. The program will target high injury rate establishments in both the manufacturing and non-manufacturing sectors for inspection. Under this… [Read more]
CA WCIRB Releases Study on Medical Fraud Enforcement
Oakland, CA – The California WCIRB recently released a new study in which its researchers examine the impact that increased efforts to identify and prosecute provider fraud may be having on the California workers’ compensation system. The Impact of Medical Fraud Enforcement on California Workers’ Compensation study uses data from the WCIRB’s medical transaction database… [Read more]
RegQuest Announces New Workers’ Compensation Utilization Management Module
Annapolis, MD – RegQuest™, a national online regulatory compliance resource focused on health insurance functions including medical management and appeals, recently announced the launch of its fourth and newest module: Workers’ Compensation Utilization Management, which reviews state workers’ compensation utilization management laws and regulations. The module offers subscribers regularly updated regulatory information broken down by… [Read more]
NCCI Releases Research Brief on Changes in Monday Claims
Boca Raton, FL – NCCI recently released a new research brief that examines changes in Monday claims, noting that sometimes, workers compensation (WC) pays claims for injuries that are reported as work related but are not, or are only partially, work related. It is hypothesized that such claims are more likely to have a Monday… [Read more]