Prompted by the pandemic and driven by necessity, pharmacy benefit managers (PBMs) are amid a new era of pharmacy adjudication. An era that takes the primary role of the PBM − to make sure a patient or injured worker receives the medications they need, when they need them, at the lowest cost – and combines that with advances in technology to automate and streamline pharmacy management.
In this WorkCompWire Leaders Speak article, Cliff Belliveau, MyMatrixx by Evernorth® Chief Innovation Officer, describes how implementing advanced analytics and Artificial Intelligence (AI) to automate workers’ comp processes can reduce time and labor and deliver the clinical data pharmacy claims adjusters need to make informed decisions to help:
- Lessen fraud, waste, and abuse
- Eliminate emergency room visits
- Control runaway/legacy claims
- Eliminate unnecessary surgeries
- Close claims more effectively
- Manage Medicare Set-Aside amounts
Automated Claims Management Isn’t Just About Working Faster
In an industry that is facing high turnover rates and a shrinking workforce, you’ll learn how tools such as automated medication authorization, recommendation engines, and optimized formularies can help employers manage workers' compensation claims more efficiently while still providing appropriate clinical care.