var i = (window.location.host == "www.verisk.com") ? 'GTM-NKWPGK' : 'GTM-NR9MLKH'; (function (w, d, s, l, i) { w[l] = w[l] || []; w[l].push({ 'gtm.start': new Date().getTime(), event: 'gtm.js' }); var f = d.getElementsByTagName(s)[0], j = d.createElement(s), dl = l != 'dataLayer' ? '&l=' + l : ''; j.async = true; j.src = 'https://www.googletagmanager.com/gtm.js?id=' + i + dl; f.parentNode.insertBefore(j, f); })(window, document, 'script', 'dataLayer', i); </script>  <script> // Holding Experimentation events until user opt in window["optimizely"] = window["optimizely"] || []; window["optimizely"].push({ "type": "holdEvents" }); </script> <script type="text/plain" class="optanon-category-C0004"> window.addEventListener("load", function() { window.optimizely.push({type: "sendEvents"}); }); </script> <script src="https://cdn.optimizely.com/js/22793102135.js"></script>  " height="0" width="0" style="display: none; visibility: hidden" ></ iframe >

Kendra Phillips

Kendra Phillips is director of quality assurance, Casualty Solutions at Verisk. You can contact Kendra at kphillips@verisk.com.

Ani Kolleshi 684082 Unsplash

7/29/2015 - 3 min read

Impact of utilization review on Medicare Set-Asides

Although Utilization Reviews (URs) and Independent Medical Reviews (IMRs) have been used in state jurisdictions for years, insurers have only recently focused on how the Centers for Medicare and Medicaid Services (CMS) treats URs and IMRs when evaluating Medicare Set-Asides (MSAs).

Joshua Coleman 623117 Unsplash

3/25/2015 - 1 min read

Medicare set-aside update: Generic Nexium and its impact on MSAs

On January 26, 2015, the FDA approved esomeprazole, the generic form of Nexium. Claims payers and the Medicare Set-Aside (MSA) industry take notice any time a widely prescribed brand-name drug becomes available as a generic. The impact of generic availability, if not immediate, can eventually prove to be dramatic.