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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 in the healthcare industry, the
reviews and recommendations may CLAIMANT YES, RECOMMENDED INFORM
vary as we stress the use of potential IDENTIFICATION ACTIONABLE TPA/ASO STRATEGY TEAM/ IMPLEMENTATION
healthcare partners resources and OPPORTUNITY CLIENT
services. Below are examples of our
approach:
• Focus on the small minority (<1%) CCU
of cases that drive the greatest
costs Complex Claims Clinical
• Depth of review and length of time Consulting Unit
spent working cases that require
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 • Verify site of care
deep expertise in provider quality identiied using available data
management and cost containment • Monthly report monitoring resources • Review pharmacy utilization
• Independent relationships with • 85% identiication • Track large claimants and group • Alternative treatment methods
numerous providers and ability to • Timely claim reimbursement trends • Cost eficiency and alignment
negotiate with both in- and out-of- • Year-end claim reconciliation
network providers • Current and future claim
projections
• “Concurrent” specialty case review, • Team of physicians, nurses, billing
and coding experts, etc.
if desired • Condition and treatment education
• Access to specialty contracts • Laser validation and reference
(e.g., transplant, ESRD, oncology,
pharmacy)
Change Healthcare — Lockton Total Rewards Practice overview 19 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 in the healthcare industry, the
reviews and recommendations may CLAIMANT YES, RECOMMENDED INFORM
vary as we stress the use of potential IDENTIFICATION ACTIONABLE TPA/ASO STRATEGY TEAM/ IMPLEMENTATION
healthcare partners resources and OPPORTUNITY CLIENT
services. Below are examples of our
approach:
• Focus on the small minority (<1%) CCU
of cases that drive the greatest
costs Complex Claims Clinical
• Depth of review and length of time Consulting Unit
spent working cases that require
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 • Verify site of care
deep expertise in provider quality identiied using available data
management and cost containment • Monthly report monitoring resources • Review pharmacy utilization
• Independent relationships with • 85% identiication • Track large claimants and group • Alternative treatment methods
numerous providers and ability to • Timely claim reimbursement trends • Cost eficiency and alignment
negotiate with both in- and out-of- • Year-end claim reconciliation
network providers • Current and future claim
projections
• “Concurrent” specialty case review, • Team of physicians, nurses, billing
and coding experts, etc.
if desired • Condition and treatment education
• Access to specialty contracts • Laser validation and reference
(e.g., transplant, ESRD, oncology,
pharmacy)
Change Healthcare — Lockton Total Rewards Practice overview 19 Lockton Companies
