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Rising medical costs continue to challenge workers'
compensation. Choose a partner that can help your business
more effectively manage these expenses – without
compromising quality.
PMA has integrated industry-leading managed care
capabilities to ensure seamless delivery of services to
our clients. Our Managed Care Program combines our risk
management and medical expertise, technology systems, and
third-party relationships. This approach enables us to
more effectively assess and manage cases with the goal of
maximizing outcomes while minimizing costs.
Better Service. Better Results.
At PMA, we're serious about delivering tangible value to
your business. To that end, our Managed Care Program
follows a simple yet compelling philosophy. We believe in
delivering services with a laser-like focus on:
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Excellence. PMA Companies is committed to maintaining a program that merits "best practice" status in the insurance industry.
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Efficiency. We work hard to reduce the cost of services, allowing us to impact expenses. We are extremely responsible, and manage every dollar spent as if it were our own. By reducing the cost of services, we have a positive impact on your insurance expenses – and your company's bottom-line results.
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Service. Our service-driven culture translates into exceptional client support and satisfaction. As your trusted advisor and partner, we work diligently to meet your needs and exceed your expectations.
We have developed our Managed Care Program around two core
components: Medical Bill Review and Medical
Case Management.
Medical Bill Review
Our Medical Bill Review Program enables us to make
informed, legally mandated, and equitable decisions about
payments to medical providers. It is designed to achieve
the best possible outcomes while reducing costs. To help
ensure appropriate medical billing, we follow a
step-by-step state-of-the-art approach:
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Initial Review. Our sophisticated imaging and workflow software performs an initial review of all medical bills – flagging waste and abuse.
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Complex Bill Review. For a second line of review, we maintain a team of coding specialists and Registered Nurses who perform in-depth reviews of questionable bills.
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PPOs and Specialty Networks. Following the
two-part review process, our electronic data
interchange system submits bills to our network
partners, where providers' bills are reduced to
contracted levels. We have more than 450,000 network
providers and access to physical therapy and
occupational specialty networks to further manage
both cost and utilization.
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Out-of-Network Billing. For bills from out-of-network providers, we utilize defensible, reasonable, and customary repricing and negotiated payments to provide savings.
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Pharmacy Benefits Management (PBM) Program. PMA partners with one of the largest workers' compensation PBM programs to yield savings for clients through retail and mail-order services, clinical management, and formularies, as well as online resources for reporting and education.
Medical Case Management
We have a formalized approach for addressing appropriate
utilization of medical services and providers to achieve
the best possible outcomes for patients while optimizing
costs for clients.
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Case Management. Working with individuals via phone or in
person, our Registered Nurses, where assigned, assess each
case, develop an action plan, and implement that plan in
accordance with applicable rules and guidelines. Our RNs
continually assess medical treatments against
evidence-based benchmarks, helping to assure optimal
outcomes. For workers' compensation cases, they also
support stay-at-work and return-to-work strategies by
facilitating communication among all involved parties.
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Utilization Review. Our formal utilization review programs
address the medical necessity of diagnostic and treatment
procedures before, during, or after services have been
performed.
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Peer Review. We offer peer review as part of a utilization
review or as a stand alone service. A provider who is
Board-certified in the same specialty as the treating
provider reviews the file and documents his or her opinion
about medical treatment recommendations.
Read more about our services...
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