 Shine Some Light on Your Vendors
We’ve provided a checklist of questions to ask your various vendors in order to get a better understanding of their capabilities, including but not limited to, the following: MCO How and when do they inform you of the claim and claim number? Are average medical costs below or above BWC fee schedule? What is the turnaround time on the payment of medical bills? What is the percentage of return to work success?
Third Party Administration How closely can they work with your MCO? How is reserve accuracy measured? Are claims payments made in a timely and accurate fashion, and without duplication? Can the services be unbundled? How does the TPA’s pricing structure relate to expected outcomes?
Substance Abuse Can services be delivered on a mobile basis? What is the turnaround time on positive results? Can they assist in establishing corporate policy?
Case Management What triggers telephone contact? What triggers on-site visits or a coordinator? Who reviews medical treatment plans? How is ongoing contact with you and with injured employees and the physicians accomplished? Do they make sensible use of vocational rehabilitation?
Systems What reports are available on-line? Is file information viewed simultaneously or by more than one party? Who owns the information?
All Vendors Are they “at risk” for earning their fees? Do they have proper incentives for reducing the cost and number of claims? Do they provide an appropriate return for your service fee investment? In what ways do they support the use of substance abuse programs?
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