Experience the Progressive Medical Advantage
An out-of-network situation could be the result of the injured party not having their prescription card with them at the pharmacy or an instance where a primary care physician wrote a prescription for an anti-inflammatory for a sprained ankle prior to the employee reporting an incident to their employer.
Injured parties going out-of-network to fill their prescriptions, especially medications, is a major pain point for payors in workers' compensation. This can arguably be the biggest challenge when it comes to controlling prescription drug costs.
By utilizing Progressive Medical's NetworkAssistTM program, a client can minimize out-of-network leakage. Progressive Medical provides recommendations for payment on out-of-network invoices by running them through medication plans and reducing them to appropriate rates.
Two program solutions are available; electronic or paper. The electronic solution allows out-of-network bills to be electronically adjudicated to Progressive Medical for review and payment of the invoice in real time.
Progressive Medical's paper solution applies if an injured party fills a prescription out-of-network or pays out-of-pocket for a prescription. In this case, the bill has not received any edits. The NetworkAssist program reduces the bill to appropriate rates in addition to applying DUR edits and business rules. This also achieves getting the injured party into the network for future DUR and reporting.
The NetworkAssist program not only saves our client money, it is efficient as well. Recommendation for the amount of payment our client should make to the pharmacy is confirmed within five days of receipt of the original invoice.
Learn more about how you, too, can experience a 78% reduction in the number of out-of-network bills and only pay for authorized medications.