Vendor Profile

PMSI

PMSI

175 Kelsey Lane Tampa, Florida, United States 33619

Phone: 877.ASK.PMSI

Fax: 813.664.0774

website: www.PMSIonline.com

e-mail: send an e-mail

Overview

Categories: » Claims Management (45)
»» Adjusters (5)
» Workers’ Comp & Disability (37)
»» Claims Management (17)
»» Cost Containment (15)
»» Medical Bill Review (9)
»» Pharmacy Benefits Management (11)

PMSI is a leader in developing solutions to control the growth of medical costs in workers’ compensation. As one of the nation’s largest, most experienced companies focused on workers’ compensation, we deliver proven solutions for cost containment.

Service or Product Description

PHARMACY
The value of a pharmacy program is linked to its ability to contain costs and minimize out-of-network spend. PMSI addresses the major pharmacy cost drivers—rising unit cost prices, increasing utilization and long-term use—with solutions that increase network penetration and manage utilization. Our Pharmacy Benefit Management (PBM) solution includes a Retail Network of nearly 65,000 pharmacy locations nationwide and a Mail Order Pharmacy partnership with one of the largest national pharmacy chains. The structure of our PBM program is based on a foundation of traditional programs, including First Fill, Pharmacy Cards, and Generic and Mail Order conversion that promote network penetration and ultimately drive down costs.

PharmaComplete is our proprietary, comprehensive solution to drive cost containment and network penetration by addressing high-cost, out-of-network bills through Specialty Network Arrangements, Automated Re-Indexing programs and Out-of-Network Conversion strategies. The sooner a prescription enters the network, the sooner we can ensure cost savings and recruit, capture and convert out-of-network transactions to increase network penetration. By developing innovative programs that comprehensively address all potential network leakage points, PMSI masters cost containment for pharmacy benefit management.

CRITICAL CARE
Specialized products and services, timely information and customer service are required for our clients to meet their business objectives. PMSI offers one of the most extensive networks of over 6,000 high-quality providers in Durable Medical Equipment (DME), Specialty Services and Critical Care that we contract with directly and credential to meet our high standards.

By combining our proprietary network with our workers’ compensation experience, equipment and services guidelines, comprehensive coordination of care, and evidence-based clinical best practices, we deliver the appropriate cost-effective therapy, service or item for the proper duration. Leveraging our informatics expertise, we tier network providers based on cost effectiveness, service and clinical program compliance. The benefits of single-source simplicity, high-touch, 24/7 customer service, built-in technology efficiencies, and competitive pricing and programs to increase network penetration all work together to drive cost containment. Included in this offering is a completely new approach to Home Health Care Services, an all-inclusive solution with utilization controls to contain costs relating to this difficult-to-manage service line.

PMSI’s Home Health Care program takes a holistic approach to care delivery through a proprietary process that applies evidence-based medical guidelines to ensure appropriate high-quality care. The focus is on providing continuous communication, increasing network penetration, utilizing only the best home health agencies, and streamlining administrative processes. These activities are tracked through insightful reports to claims professionals, which support effective collaboration and decision making. Our approach has delivered meaningful cost reduction for even the most complex workers’ compensation claims.

SETTLEMENT SOLUTIONS
PMSI Settlement Solutions provides guidance to drive appropriate and compliant settlements for workers’ compensation and liability claims. Through an integrated medical, pharmacy, claims and legal approach, our best-in-class services and technology solutions help clients navigate the shifting settlement landscape.

PMSI Settlement Solutions is a premier provider of Medicare Set-Aside (MSA) allocations and a leader in Medicare Secondary Payer (MSP) compliance education, preparation and programs. We have created an end-to-end total claims management solution, designed to assist with settling claims quickly and fairly. Investments in automated processes in many key areas, such as medical cost projections, drug allocations and Mandatory Insurer Reporting (MIR), provide flawless workflow management and effective reporting mechanisms that drive excellence in customer service.

Our team has been at the forefront of MIR compliance, as required by Section 111 of the Medicare, Medicaid and SCHIP Extension Act (MMSEA) of 2007. By integrating our core competencies in MSAs, client connectivity, state reporting and information technology, PMSI has created a comprehensive solution for MMSEA111 reporting—MedicareConnect. This innovative platform leverages established, stable reporting systems with flexible and efficient data management capabilities critical to your business to ensure compliance with MIR requirements. MedicareConnect is the proven solution for Mandatory Insurer Reporting, delivering a 99.9% acceptance rate on submissions to CMS.

Conferences

RIMS Annual Conference & Exhibition

04/27/2014 - 04/30/2014


Booth Number: 1931

PRIMA 2014 Annual Conference

06/08/2014 - 06/11/2014


White Paper

Legislative Update: Important Legislative and Regulatory Changes

Published in 10/29/2013 in Workers’ Comp & Disability category by PMSI

PMSI's Government Affairs team has compiled a very informative summary of the issues that are making news across the country. This legislative update details specific regulations from around the country and how they impact you.


The Impact of Medicare Part D Exposure on MSA

Published in 10/29/2013 in Workers’ Comp & Disability category by PMSI

This perspective discusses the issue of prescription drug costs and its role in settling claims, and includes a PMSI case study showing our program outcomes.


AWP Settlement: Market Impact and Payor Considerations

Published in 10/16/2012 in Workers’ Comp & Disability category by PMSI

The Settlement of Average Wholesale Price (AWP) has caused confusion in the workers' compensation industry.


Morphine Equivalency Dosing: A Tool for Opioid Management

Published in 10/16/2012 in Workers’ Comp & Disability category by PMSI

Morphine Equivalency Dosing can be used to compare the relative opioid potency when treating a patient with different narcotic pain relievers.


A Combined Focus on Unit Cost and Utilization Control for More Effective Cost Containment with DME

Published in 08/02/2012 in Workers’ Comp & Disability category by PMSI

Durable medical equipment (DME) and supplies, although a smaller percentage of spend, contribute significantly to overall spend and it is here that payors are now taking a closer look at these costs and seeing opportunities for cost savings.


Resolving Out of Network Pharmacy Spend

Published in 08/02/2012 in Workers’ Comp & Disability category by PMSI

For those who pay workers' compensation pharmacy bills, the phrase "out-of-network" is not only an unpleasant thing to hear, but can be a costly one as well.


The Use of Marijuana in Medical Treatment

Published in 06/01/2012 in Workers’ Comp & Disability category by PMSI

A debate has arisen in the medical community regarding the appropriateness of medical marijuana in treating pain.


An Initial Assessment of Texas Closed Formulary

Published in 03/01/2012 in Workers’ Comp & Disability category by PMSI

PMSI announced initial findings demonstrating the positive impact of the recent implementation of the Closed Formulary in Texas, which took effect for claims with a date of injury after September 1, 2011.


Ensuring Payer Compliance with Mandatory Insurer Reporting

Published in 11/01/2011 in Workers’ Comp & Disability category by PMSI

The Mandatory Insurer Reporting (MIR) process is complex and affects multiple data sources and processes within the claims management process. The risk and cost of achieving compliance with MIR requirements is a serious concern for decision makers.


Examining the Use of Physician Dispensing

Published in 10/01/2011 in Workers’ Comp & Disability category by PMSI

Physician dispensing in workers' compensation is cause for concern for many payors because it is hard to control utilization, oversight and cost.


Medication Review Case Study_Perspective

Published in 05/02/2011 in Workers’ Comp & Disability category by PMSI

PMSI’s Medication Review with Peer-to-Peer Outreach provides an opportunity to evaluate current medication therapy and conduct peer physician outreach to the prescriber where appropriate. Learn how PMSI addresses high-risk medication-related issues.


Medicare Update Understanding Payer Responsibilities and Requirements

Published in 05/02/2011 in Workers’ Comp & Disability category by PMSI

Over the past three years, the Centers for Medicare and Medicaid Services (CMS) issued substantial changes and established stricter guidelines as part of their ongoing effort to preserve the Medicare trust fund.


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