Page 11 - Lockton Total Rewards Practice
P. 11
Optimize
Optimize: Review cost-saving possibilities
Lockton’s clinical claims team is made up of dedicated physicians, nurses, billing and coding experts, etc., as well as a strategic Below are examples of our
partnership with the Mayo Clinic. Our clinical review and management approach is complementary to processes currently utilized approach
by your carriers and administrators.
• Focus on the small minority
(<1%) of cases that drive the
CLINICAL COST CONTAINMENT greatest costs
PATHWAY • Depth of review and length
Stop-loss carrier of time spent working cases
that require a highly resource-
intensive model not feasible
for many insurers
• Dedicated medical director
YES, INFORM with deep expertise in provider
CLAIMANT ACTIONABLE TPA/ASO RECOMMENDED TEAM/ IMPLEMENTATION quality management and cost
IDENTIFICATION STRATEGY containment
OPPORTUNITY CLIENT
• Independent relationships with
numerous providers and ability
CCU to negotiate with both in- and
out-of-network providers
Complex Claims Clinical • “Concurrent” specialty case
Consulting Unit review, if desired
• Access to specialty contracts
CLAIMS MANAGEMENT CLINICAL DASHBOARD COST CONTAINMENT (e.g., transplant, ESRD,
• Ongoing claims tracking • Over 9,000 large claimants identiied • Verify site of care oncology, pharmacy)
• Monthly report monitoring using available data resources • Review pharmacy utilization
• Track large claimants and group trends
• 85% identiication • Alternative treatment methods
• Timely claim reimbursement • Current and future claim projections • Cost eficiency and alignment
• Condition and treatment education
• Year-end claim reconciliation • Domestic steerage
• Team of physicians, nurses, billing and • Laser validation and reference
coding experts, etc.
Overview — Lockton Total Rewards Practice 11 Lockton Companies
Optimize: Review cost-saving possibilities
Lockton’s clinical claims team is made up of dedicated physicians, nurses, billing and coding experts, etc., as well as a strategic Below are examples of our
partnership with the Mayo Clinic. Our clinical review and management approach is complementary to processes currently utilized approach
by your carriers and administrators.
• Focus on the small minority
(<1%) of cases that drive the
CLINICAL COST CONTAINMENT greatest costs
PATHWAY • Depth of review and length
Stop-loss carrier of time spent working cases
that require a highly resource-
intensive model not feasible
for many insurers
• Dedicated medical director
YES, INFORM with deep expertise in provider
CLAIMANT ACTIONABLE TPA/ASO RECOMMENDED TEAM/ IMPLEMENTATION quality management and cost
IDENTIFICATION STRATEGY containment
OPPORTUNITY CLIENT
• Independent relationships with
numerous providers and ability
CCU to negotiate with both in- and
out-of-network providers
Complex Claims Clinical • “Concurrent” specialty case
Consulting Unit review, if desired
• Access to specialty contracts
CLAIMS MANAGEMENT CLINICAL DASHBOARD COST CONTAINMENT (e.g., transplant, ESRD,
• Ongoing claims tracking • Over 9,000 large claimants identiied • Verify site of care oncology, pharmacy)
• Monthly report monitoring using available data resources • Review pharmacy utilization
• Track large claimants and group trends
• 85% identiication • Alternative treatment methods
• Timely claim reimbursement • Current and future claim projections • Cost eficiency and alignment
• Condition and treatment education
• Year-end claim reconciliation • Domestic steerage
• Team of physicians, nurses, billing and • Laser validation and reference
coding experts, etc.
Overview — Lockton Total Rewards Practice 11 Lockton Companies
