Priority Care Solutions (PCS), a division of Genex Services, is a leading specialty managed care services and network provider for the Workers' Compensation Industry. Drawing on the cumulative experience of an executive leadership team with an average of 20 years in all areas of workers' compensation, PCS has created unique, proactive solutions to mitigate risk, create operational efficiencies and reduce costs while providing compassionate, exceptional, and timely care to the injured worker.
Our comprehensive set of solutions address the most demanding situations and are developed to tackle the challenges faced by the industry today. The results are faster, more efficient, and cost-effective claim resolution and an injured worker who receives the critical care needed.
Priority Care Solutions, LLC, is a privately held specialty managed care services and network provider for the workers’ compensation industry. Based in Tampa, Florida, it meets the needs of a client base comprised of 95 carriers, third-party administrators, self-insured employers, government agencies and managed care organizations.
Meeting the Industry's Challenges
PCS' innovative, cost-effective solutions are continually evolving in order to address the changing realities challenging the workers' compensation industry. By designing programs and products in partnership with each client, PCS offers the flexible solutions that work:
PCS does not rely on post-accident engagement to establish catastrophic claim handling units with vendors. Instead, program managers work with clients to develop pre-accident strategies that address medically complex conditions while effectively controlling catastrophic losses and driving the best possible outcomes for the injured worker.
A Central Role of Nurse Case Managers
PCS' innovative business model dedicates a local Catastrophic Nurse Case Manager (NCM) to each case. The NCM promptly conducts an assessment and recommends a plan of action to the payer. All recommendations are presented to the client/payer for authorization prior to execution of services through the PCS care coordination team. This consultative and pro-active approach provides the optimum strategy for all parties involved, ensures timely intervention and cost management of high dollar exposure losses, and applies a best-practice approach for excess and reinsurance claim management.
- All services are preauthorized with transparency in price quotes
- Services are national in scope using regional providers with local knowledge and expertise
- Service offering includes integration of eight supporting products to execute plan of action using a single platform
- Catastrophic NCM is supported internally by a care coordination team to execute the plan of action
- Skill set is aligned and services are rendered sequentially without fragmentation
- Integration of services using a single platform provides a comprehensive view of costs and savings
These examples show just a few ways that PCS is uniquely providing better service. By always focusing on the worker, PCS has developed practical solutions with the client as a full partner to drive the best possible outcome for the injured worker.
PCS continues to prove that one company can provide for the physical health of workers while protecting the financial health of their companies.