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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. We also recognize that
being a provider yourself, the reviews
and recommendations may vary as we CLAIMANT YES, RECOMMENDED INFORM
stress the use of domestic resources IDENTIFICATION ACTIONABLE TPA/ASO STRATEGY TEAM/ IMPLEMENTATION
and services. Below are examples of our OPPORTUNITY CLIENT
approach:
• Focus on the small minority (<1%)
of cases that drive the greatest CCU
costs
• Depth of review and length of time Complex Claims Clinical
spent working cases that require Consulting Unit
a highly resource-intensive model
not feasible for many insurers
• Dedicated medical director with CLAIMS MANAGEMENT CLINICAL DASHBOARD COST CONTAINMENT
deep expertise in provider quality • Ongoing claims tracking • Over 9,000 large claimants • Verify site of care
management and cost containment • Monthly report monitoring identiied using available data • Review pharmacy utilization
• Independent relationships with resources
numerous providers and ability to • 85% identiication • Track large claimants and group • Alternative treatment methods
negotiate with both in- and out-of- • Timely claim reimbursement trends • Cost eficiency and alignment
network providers • Year-end claim reconciliation • Current and future claim • Domestic steerage
• “Concurrent” specialty case review, • Team of physicians, nurses, billing projections • Custom managed care rates
if desired and coding experts, etc. • Condition and treatment education
• Access to specialty contracts • Lower domestic steerage
reimbursement
(e.g., transplant, ESRD, oncology, • Laser validation and reference
pharmacy)
Western Wisconsin Health — Lockton Total Rewards Practice overview 33 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. We also recognize that
being a provider yourself, the reviews
and recommendations may vary as we CLAIMANT YES, RECOMMENDED INFORM
stress the use of domestic resources IDENTIFICATION ACTIONABLE TPA/ASO STRATEGY TEAM/ IMPLEMENTATION
and services. Below are examples of our OPPORTUNITY CLIENT
approach:
• Focus on the small minority (<1%)
of cases that drive the greatest CCU
costs
• Depth of review and length of time Complex Claims Clinical
spent working cases that require Consulting Unit
a highly resource-intensive model
not feasible for many insurers
• Dedicated medical director with CLAIMS MANAGEMENT CLINICAL DASHBOARD COST CONTAINMENT
deep expertise in provider quality • Ongoing claims tracking • Over 9,000 large claimants • Verify site of care
management and cost containment • Monthly report monitoring identiied using available data • Review pharmacy utilization
• Independent relationships with resources
numerous providers and ability to • 85% identiication • Track large claimants and group • Alternative treatment methods
negotiate with both in- and out-of- • Timely claim reimbursement trends • Cost eficiency and alignment
network providers • Year-end claim reconciliation • Current and future claim • Domestic steerage
• “Concurrent” specialty case review, • Team of physicians, nurses, billing projections • Custom managed care rates
if desired and coding experts, etc. • Condition and treatment education
• Access to specialty contracts • Lower domestic steerage
reimbursement
(e.g., transplant, ESRD, oncology, • Laser validation and reference
pharmacy)
Western Wisconsin Health — Lockton Total Rewards Practice overview 33 Lockton Companies
