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PA Appellate Court Nixes Use of “Red Book” in Setting Reimbursement for Drug Costs in Comp Cases

The Workcomp Writer

The appellate court agreed with the petitioning workers’ compensation insurance carrier that that the Red Book values did not reflect AWP as required by the Act. (Bureau of Workers’ Comp. Hearing Off.*), 2024 Pa. LEXIS 1 (Jan. Workers’ Compensation Appeal Board (Derry Area School District)*, 639 Pa. 645, 161 A.3d

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How Clinical Informatics Can Uncover Major Saving Opportunities in Healthcare Plans

Griffin Benefits

CLINICAL INFORMATICS FOR ALL Clinical informatics was once limited to large healthcare plans, which could access analytics and informatics through their insurance brokers. However, changes to federal law now means small and middle-market employers are entitled to their benefits data by law , including pharmaceutical use and cost data.

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Want to Save on Insurance? Be a Smarter Healthcare Consumer

Stratus.HR

While you think you’re only paying $15 or $25 for an office visit, the final cost is picked up by your health insurance carrier – and that cost eventually makes its way back to you by way of premiums in your plan renewal. Accident Plan Insurance 101 Should you stay with your small group insurance plan?

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Innovation is Necessary to Meet the Challenge of COVID in 2022

Workers' Compensation

Employers and insurance carriers should actively encourage adopting and implementing new innovative testing and treatment avenues to limit their risk exposure. Merrell Dow Pharmaceuticals, Inc., Dueling “experts” will leave workers’ compensation hearing officials with conflicting evidence to establish adjudicate claims.

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New Transparency Requirements for Health Plans

AssuredPartners

This rule, entitled Transparency in Coverage, requires group health insurance carriers and self-insured plans to disclose rates and cost-sharing information for all covered items and services.

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Adjusted Community Rating and Its Role in Health Care Costs

Insperity

Examples of these taxes and fees include: Transitional reinsurance fee – designed to help stabilize premiums in the individual health insurance market for those with pre-existing conditions. Insurer excise tax – this tax on health insurance carriers is expected to total $8 billion in 2014. Strength in numbers.