These products and services protect and extend the financial benefits allocated for Medicare Set-Aside (MSA) in a Workers’ Compensation claim. Understanding the jurisdictional and regulatory requirements, and then managing costs to slow the withdrawals from the trust fund, will enable the benefits to last longer and be more effective for the injured worker’s overall health.

 

Some of the unique values that PRIUM provides are:

Network depth - Over 64,000 pharmacies nationwide

Access – Immediate access to prescriptions via Retail or Mail Order

Discounts – Negotiated discounts to ensure the best possible price

Limited Out-of-Pocket – Removes the need for injured worker payments

Negotiation – Pre-negotiated costs on expensive procedures

No Risk – No savings, no cost

Other applications – Available as a standalone service outside of this claim

Focused - Strategic and tactical focus on Workers' Compensation

Integrated Utilization Review - Monitoring opportunities for pain management optimization

Clinical oversight - Physicians (nationwide, multi-discipline, active-practice) involved in the UR process

Actionable sentinel - Proactive identification of outlier claims (by trends and Evidence Based Medicine) to create management action plans

TEC – Embedded Therapeutic Equivalent Conversion program

POP – Provider Outreach Program, proactive TEC

Compliance – Ensures proper paperwork and best practices are maintained for the trust fund

Quality - PRIUM has been accredited by URAC since 1997