In today’s challenging insurance environment, providing superior claims management often leaves valuable ancillary services overlooked. At NARS, the following services are part of our claims administration model. At the request of clients, we can unbundle these services to help other organizations optimize their claims operations.
Our Pharmacy Solutions Program focuses on the mitigation of drug costs and, most importantly, the safety of the injured employee. We deliver effective prescription benefit plans and bring uncompromising customer service. The NARSRx program includes a dedicated team of clinical and claims management experts who work closely with a nationwide physician advisor network. Together we help our clients and injured employees achieve the best possible outcome.
NARSRx understands the importance and is proud to focus on the injured workers’ care and treatment outcome. We strive to ensure employee safety, advocacy and protection by providing consistent oversight into each injured employee’s treatment plan. Our claims experts are notified immediately, for intervention, when the relatedness of a drug to the compensable injury is questionable. When a pharmacy alert is received, our team takes immediate and aggressive steps to confirm the appropriateness of the medication for the injury. We work with our clinical team to facilitate education to the medical providers and injured employee. Together we collaborate, until the pharmacy components of the claim are appropriately managed.
The NARSRx Pharmacy Solutions Program delivers strategic prevention of opioid abuse, management of medically unnecessary prescriptions, control of unnecessary compound prescriptions, reduction of fraud, control of drug overutilization and physician dispensing, appropriate generic-vs-brand prescribing and removal of duplicate treatments and therapies.
- Real-time claims portal
- Pharmacy locator
- Highly competitive discounted pricing
- A unique and aggressive no risk first fill program
- Mail order
- Customized formularies
- Streamlined prior authorization process
- Prospective and real-time review
- Retrospective review
- Comprehensive predictive analytics and cost savings reports
- Drug information and regimen reports
- Adverse trend reports
- Provider portal
At NARS, we consider it a moral imperative to prevent, detect, report and fight fraud. The main objectives of our Special Investigations Unit (SIU) are to effectively identify and investigate suspected fraudulent activities, while educating and training claims handlers to do the same. Primary duties include:
- Screening all SIU referrals
- Conducting investigations including background checks, social media checks, clinic/hospital searches, etc.
- Monitoring field SIU investigations
- Providing Fraud Awareness Training
- Ensuring compliance with state regulations for the reporting of suspected insurance fraud
Through training and investigation, our experienced claims professionals recognize the latest schemes and take steps to actively prevent fraud. Algorithms within our claims management system detect suspicious activity and alert adjusters and the SIU team, thus providing our clients with additional protection.
System limitations and lack of expertise have caused insurers to collectively lose millions of dollars in recovery potential. The NARS Recovery Unit is wholly devoted to handling subrogation, salvage, second injury fund and deductible collection across all lines of business. Our workflows are geared toward the prompt identification of potential recoveries, allowing our experienced recovery specialists to get involved early in the claims cycle. They focus on their role in resolving the claim until recovery is achieved or completely ruled out. Removing this function from adjusters ensures better results. Our databases help us identify, locate, and track companies, insurers or persons that are responsible for damages so we can recoup money wherever they are. Every effort to maximize recoveries and offset payout is made. We also offer subrogation audits to identify missed recovery opportunities on closed claims.
Through a NARS-designed quality control system, Statistical Claim Opportunity Report (SCORE!), we conduct claim audits identifying trends and providing analysis of areas where there is room for improvement. Trends are analyzed at the adjuster, manager, director or program levels. While tailored to specific issues associated with different lines of business, it can be modified to capture client-focused issues.
SCORE! provides objective measures of quality in key areas including: coverage analysis, reserving, documentation, reserving, file handling, customer service, evaluation, negotiation, settlement, client reporting, vendor management, litigation handling and subrogation. Audits accomplish the following:
- Provide a basis for technical scores in Performance Evaluations
- Identify adjuster strengths and weaknesses to target areas for training
- Recognize overall trends that require correction
Through our work with a variety of customers and evaluating programs and risks that differ in line of business, size and scope, NARS has a broad range of experience addressing loss control. Our practical, results-oriented approach will provide valuable information to help drive important underwriting and risk management decisions. In line with our claims management philosophy, we offer a custom approach whenever possible. We can accommodate nationwide assignments across all lines of business and a variety of industries.
Our team is multi-disciplined and highly credentialed, with an average of 20 years of experience. With an intimate view of accident causes, consistent damages, jurisdictional issues etc., we conduct an in-depth trend analysis that can identify what areas need further evaluation. In the spirit of true partnership, NARS serves as a complete resource for its customers. We value the team-oriented approach where we work together to create viable solutions. The combination of data, expert observations and recommendations will give you greater insight on what can be done to mitigate your risk and, in turn, help control costs and increase your bottom line.
- Loss Control Evaluations
- Loss Control Consultative Service
- Loss Control Industrial Hygiene Evaluations
- Loss Control Telephone Surveys
- Ergonomic Assessments
- HPR Service
- Insurance to Value Surveys
- Unique Form Development