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Extra-territorial Medical Provider Claims

Workers' Compensation

FACTS Five workers employed in the State of New York suffered work-related injuries in NY while working for a NY employer. They were treated in a NJ hospital that obtained assignments for medical costs from the patients against the workers’ compensation carrier of the NY employer. Hudson Regional Hospital v.

Medical 52
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Employer Reporting on Prescription Drug Pricing Due By 12/27

Griffin Benefits

Among the various transparency rules contained within the Consolidated Appropriations Act is a requirement for employers to provide certain plan information about prescription drugs. Finally, short-term limited duration insurance (which is typically an individual market product) is also exempt.

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NH Case Remanded: Was MRSA Infection “Direct and Natural Result” of Work-Related Injury?

The Workcomp Writer

In October, the claimant collapsed and went into a coma and was hospitalized at Dartmouth Hitchcock Hospital for about a month. Workers’ Compensation Claim The Academy’s insurance carrier denied the claim. Thereafter, despite treatment, the claimant’s condition worsened. Was MRSA Direct and Natural Result of Injury?

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Best practices to avoid receipt requests

Benefit Resource Inc.

Confirm enrollment in a health plan To receive automatic approval for co-pays, certain co-insurance, and deductible expenses, make sure your employer has reported you as enrolled in the company health plan. Co-pays for office visits, specialists, and hospital stays are typically approved automatically.

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Dear Valued Participant, we’re here for you

Benefit Resource Inc.

Lately, we’ve seen an uptick in questions around the roles of responsibilities of your company’s broker, your TPA (that’s us), and your health insurance provider. And where does your health insurance carrier play into this? What is a health insurance carrier? Let’s break it down.

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Narrow Networks, Tiered Plans May Reduce Costs

InterWest Insurance Services

The key for employers grappling with these higher costs is how they can reduce their impact by switching up plan offerings and choosing plans that do a good job of managing specialty drug costs, which have been spiraling over the last decade. Compare insurance plans and providers. Other cost-saving measures. The takeaway.

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New Health Plan Prescription Drug Reporting Mandate

AssuredPartners

For fully insured plans, health insurance carriers will be responsible for making the necessary reporting from a legal standpoint. Employers who sponsor self-funded health plans should coordinate with their self-funded TPA and pharmacy benefit manager (PBM) to ensure timely reporting of the required data.