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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 OPPORTUNITY CLIENT
our 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 CLAIMS MANAGEMENT CLINICAL DASHBOARD COST CONTAINMENT
• Dedicated medical director with • Ongoing claims tracking • Over 9,000 large claimants identiied • Verify site of care
deep expertise in provider quality • Monthly report monitoring using available data resources • Review pharmacy utilization
management and cost containment • Track large claimants and group trends
• Independent relationships with • 85% identiication • Current and future claim projections • Alternative treatment methods
numerous providers and ability to • Timely claim reimbursement • Cost eficiency and alignment
negotiate with both in- and out-of- • Year-end claim reconciliation • Condition and treatment education • Domestic steerage
network providers • Team of physicians, nurses, billing and • Laser validation and reference • Custom managed care rates
• “Concurrent” specialty case review, coding experts, etc. • Lower domestic steerage reimbursement
if desired • Steer to domestic pharmacies (specialty,
• Access to specialty contracts 340B, maintenance drugs, etc.)
(e.g., transplant, ESRD, oncology, • Leverage domestic infusion clinics and
pharmacy) drug access
ThedaCare — Lockton Total Rewards Practice overview 17 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 OPPORTUNITY CLIENT
our 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 CLAIMS MANAGEMENT CLINICAL DASHBOARD COST CONTAINMENT
• Dedicated medical director with • Ongoing claims tracking • Over 9,000 large claimants identiied • Verify site of care
deep expertise in provider quality • Monthly report monitoring using available data resources • Review pharmacy utilization
management and cost containment • Track large claimants and group trends
• Independent relationships with • 85% identiication • Current and future claim projections • Alternative treatment methods
numerous providers and ability to • Timely claim reimbursement • Cost eficiency and alignment
negotiate with both in- and out-of- • Year-end claim reconciliation • Condition and treatment education • Domestic steerage
network providers • Team of physicians, nurses, billing and • Laser validation and reference • Custom managed care rates
• “Concurrent” specialty case review, coding experts, etc. • Lower domestic steerage reimbursement
if desired • Steer to domestic pharmacies (specialty,
• Access to specialty contracts 340B, maintenance drugs, etc.)
(e.g., transplant, ESRD, oncology, • Leverage domestic infusion clinics and
pharmacy) drug access
ThedaCare — Lockton Total Rewards Practice overview 17 Lockton Companies
