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.
NARSRx - Pharmacy Solutions Program
Our Pharmacy Solutions Program focuses on the mitigation of drug costs and, most importantly, the safety of the injured employee. NARSRx operates under a philosophy that prioritizes an injured worker’s care and treatment outcome. We strive to ensure employee safety, advocacy and protection by providing consistent oversight of their treatment plan. NARSRx offers a dedicated team of clinical and claims management experts who work closely with a nationwide physician advisor network to review treatment plans. Together, we help our clients and injured workers achieve the best possible outcome.
Our claims experts are notified immediately when the relatedness of a drug to a compensable injury is questionable. When a pharmacy “alert” is received, they take immediate and aggressive steps to confirm the appropriateness of the medication for the injury. We work with our clinical team to educate both medical providers and injured employees. Our measures allow for the strategic prevention of opioid abuse, control of medically unnecessary and compounded prescriptions and the reduction of fraud. Together, we collaborate until the pharmacy components of the claim are appropriately managed.
Filling a prescription at a NARSRx pharmacy is simple. Participants take their NARSRx ID card and prescriptions to a pharmacy in our network. Unless otherwise specified by the treating physician, prescriptions will be filled with generic medications. They meet strict FDA requirements and are as safe, efficient and effective as brand name drugs. The NARSRx Pharmacy Network includes nearly every major chain and independent pharmacy. To confirm if a pharmacy accepts NARSRx or to find a pharmacy partner, injured workers can contact our customer service department at (844) 700-5376 or click here to use our Pharmacy Locator.
NARSRx remains involved post settlement by ensuring the injured worker feels confident and comfortable managing their prescriptions on their own. They use the same prescription card, experience the same savings and have access to the same level of customer service. Additional program features include:
- Real-time claims portal
- Pharmacy locator
- Highly competitive discounted pricing
- Unique, aggressive, no risk first fill program
- Mail order prescriptions
- Customized formularies
- Streamlined prior authorization process
- Prospective, retrospective and real-time reviews
- Comprehensive predictive analytics
- Cost savings and adverse trend reports
- Drug information and regimen reports
- Provider portal
Special Investigation Unit (SIU)
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