Crowe Paradis Services Corporation (CPSC) and PRIUM have formed a strategic alliance to help the property/casualty insurance industry improve claims outcomes and reduce Medicare liability through prescription cost containment and strategic settlement initiatives.
These unique offerings use medical and legal advocacy to reduce the use of inappropriate prescription drugs.
Pharmaceutical costs play a significant role in future medical expenses, according to Michael Gavin, PRIUM’s chief strategy officer. “Pharmacy represents 19 percent of medical costs in workers compensation claims, and 34 percent of those medications are narcotics,” said Gavin. “A systematic and proactive approach to addressing those statistics is what brought our organizations together.”
The CPSC/PRIUM service offerings are targeted to help treating physicians wean claimants off opioids and other inappropriate drugs before Medicare Set-Aside arrangements (MSAs) are submitted to The Centers for Medicare and Medicaid Services (CMS).
“You can’t simply submit a drug utilization review and recommendation to CMS and expect a successful result,” said Robert Lewis, president of CPSC. “Any changes to drug therapy must be evidenced before seeking CMS approval of a Medicare Set-Aside. Our service ensures those changes are in place. By getting involved early in the claim, we’re able to address conditional payment and medical issues before settlement negotiations begin. That creates favorable outcomes at the time of settlement.”
Insurers, third-party administrators, and other payers are benefitting from the claim oversight tools and evidence-based medicine methodologies that the CPSC/PRIUM alliance has to offer.
Both CPSC and PRIUM will be exhibiting at RIMS in April and are available to discuss their services. To arrange a meeting, please contact Carrie Barr at 412-420-9005 or firstname.lastname@example.org.
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