BOSTON, April 18, 2013 — 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 RX 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.
Based in Duluth, Ga., PRIUM is a URAC-accredited utilization review and medical cost management company providing prospective, concurrent and retrospective medical and pharmaceutical reviews to the workers’ compensation industry. Among its services is a comprehensive complex claims control program, with an emphasis on opioid control that is rooted in the core principles of peer-to-peer discussion, enforcement through pharmacy benefit management and oversight via PRIUM’s clinical oversight team. To reach PRIUM, call 888-588-4964. For insight and commentary on medical management issues in workers’ compensation, please visit PRIUM’s blog at http://prium-evidencebased.blogspot.com.
About Crowe Paradis Services Corporation
Crowe Paradis Services Corporation (CPSC) is a leading Medicare compliance firm and a member of the Verisk Insurance Solutions group at Verisk Analytics (Nasdaq:VRSK). By leveraging legal, clinical, and technological expertise, CPSC provides insurers, third-party administrators, and employers with a suite of solutions to meet their Medicare compliance needs. CPSC is headquartered in North Reading, Mass., and has offices throughout North America. For more information, visit www.cpscmsa.com or call 1-866-630-2772.