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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 CLAIMS MANAGEMENT CLINICAL DASHBOARD COST CONTAINMENT
numerous providers and ability to • Ongoing claims tracking • Over 9,000 large claimants identiied • Verify site of care
negotiate with both in- and out-of- • Monthly report monitoring using available data resources • Review pharmacy utilization
network providers • 85% identiication • Track large claimants and group trends • Alternative treatment methods
• “Concurrent” specialty case review, • Timely claim reimbursement • Current and future claim projections • Cost eficiency and alignment
if desired • Year-end claim reconciliation • Condition and treatment education
• Access to specialty contracts • Laser validation and reference
(e.g., transplant, ESRD, oncology, • Team of physicians, nurses, billing and
coding experts, etc.
pharmacy)
HealthStream — Lockton Total Rewards Practice overview 26 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 CLAIMS MANAGEMENT CLINICAL DASHBOARD COST CONTAINMENT
numerous providers and ability to • Ongoing claims tracking • Over 9,000 large claimants identiied • Verify site of care
negotiate with both in- and out-of- • Monthly report monitoring using available data resources • Review pharmacy utilization
network providers • 85% identiication • Track large claimants and group trends • Alternative treatment methods
• “Concurrent” specialty case review, • Timely claim reimbursement • Current and future claim projections • Cost eficiency and alignment
if desired • Year-end claim reconciliation • Condition and treatment education
• Access to specialty contracts • Laser validation and reference
(e.g., transplant, ESRD, oncology, • Team of physicians, nurses, billing and
coding experts, etc.
pharmacy)
HealthStream — Lockton Total Rewards Practice overview 26 Lockton Companies
