Page 30 - Walden Security
P. 30
Complex Large Claims
Management and Stop Loss
Dedicated Clinical Claims Unit — core value
Lockton’s clinical claims team is CLINICAL COST CONTAINMENT PATHWAY
made up of dedicated physicians,
nurses, billing and coding experts,
etc., as well as a strategic partnership
with the Mayo Clinic. Our clinical
review and management approach Stop loss carrier
is complementary to processes
currently utilized by your carriers and
administrators. Below are examples of
our approach: YES, INFORM
• Focus on the small minority (<1%) CLAIMANT ACTIONABLE TPA/ASO RECOMMENDED TEAM/ IMPLEMENTATION
of cases that drive the greatest IDENTIFICATION STRATEGY
costs OPPORTUNITY CLIENT
• Depth of review and length of time
spent working cases that require
a highly resource-intensive model CCU
not feasible for many insurers
• Dedicated medical director with Complex Claims Clinical
deep expertise in provider quality Consulting Unit
management and cost containment
• Independent relationships with
numerous providers and ability to CLAIMS MANAGEMENT CLINICAL DASHBOARD COST CONTAINMENT
negotiate with both in- and out-of- • Ongoing claims tracking • Over 9,000 large claimants • Verify site of care
network providers • Monthly report monitoring identiied using available data • Review pharmacy utilization
• “Concurrent” specialty case review, • 85% identiication resources • Alternative treatment methods
if desired • Track large claimants and group
• Access to specialty contracts • Timely claim reimbursement trends • Cost eficiency and alignment
(e.g., transplant, ESRD, oncology, • Year-end claim reconciliation • Current and future claim
pharmacy) • Team of physicians, nurses, billing projections
and coding experts, etc. • Condition and treatment education
• Laser validation and reference
Walden Security — Lockton Employee Beneits Practice Overview 30 Lockton Companies
Management and Stop Loss
Dedicated Clinical Claims Unit — core value
Lockton’s clinical claims team is CLINICAL COST CONTAINMENT PATHWAY
made up of dedicated physicians,
nurses, billing and coding experts,
etc., as well as a strategic partnership
with the Mayo Clinic. Our clinical
review and management approach Stop loss carrier
is complementary to processes
currently utilized by your carriers and
administrators. Below are examples of
our approach: YES, INFORM
• Focus on the small minority (<1%) CLAIMANT ACTIONABLE TPA/ASO RECOMMENDED TEAM/ IMPLEMENTATION
of cases that drive the greatest IDENTIFICATION STRATEGY
costs OPPORTUNITY CLIENT
• Depth of review and length of time
spent working cases that require
a highly resource-intensive model CCU
not feasible for many insurers
• Dedicated medical director with Complex Claims Clinical
deep expertise in provider quality Consulting Unit
management and cost containment
• Independent relationships with
numerous providers and ability to CLAIMS MANAGEMENT CLINICAL DASHBOARD COST CONTAINMENT
negotiate with both in- and out-of- • Ongoing claims tracking • Over 9,000 large claimants • Verify site of care
network providers • Monthly report monitoring identiied using available data • Review pharmacy utilization
• “Concurrent” specialty case review, • 85% identiication resources • Alternative treatment methods
if desired • Track large claimants and group
• Access to specialty contracts • Timely claim reimbursement trends • Cost eficiency and alignment
(e.g., transplant, ESRD, oncology, • Year-end claim reconciliation • Current and future claim
pharmacy) • Team of physicians, nurses, billing projections
and coding experts, etc. • Condition and treatment education
• Laser validation and reference
Walden Security — Lockton Employee Beneits Practice Overview 30 Lockton Companies
