Capabilities

Capabilities

Priority Care solutions is dedicated to the workers' compensation market, providing proven solutions and processes to enhance services integration, ease administrative burden and compress medical costs. Our programs coordinate care throughout the duration of the recovery process to ensure workers receive the best care as quickly as possible. Our experience in the industry has provided invaluable benefits to our clients:

  • Utilization of buying power to negotiate preferred rate structures
  • Improved underwriting profit and loss ratios through cost containment
  • Opportunity to access or gain market share through proven results
  • Market distinction for potential clients seeking value added services
Comprehensive Solutions Platform

Our fully integrated service offerings ease the administrative burdens and fragmentation of care coordination in the continuum of care. Services encompass diagnostics, home and complex care management, transportation and language services, durable medical equipment, home and vehicle modification and pharmacy benefit management.

Application of Data Analytics to Claims Management

Priority Care Solutions has developed a three tiered loss mitigation approach to the claims management process. Leveraging sophisticated data analytics and our platform of integrated services we proactively assess risk, decision to underwrite and pricing, and develop intervention strategies and predictive model to flag high risk cases. Finally by integrating custom algorithm within the Payor workflow and application of utilization and referral requirements are applied to develop a custom claims management process.

PCS Loss Mitigation Model results in cost reduction and dramatically improves client retention:

  • Improved Underwriting profit & loss rations
  • Higher client satisfaction & retention rates
  • Opportunity to access or gain market share through proven results
  • Market distinction for potential clients seeking value added services
Innovative Business Model

Our innovative business model dedicates a local Catastrophic Nurse Case Manager (NCM) to each case to conduct an assessment and recommend a plan of action to the Payor. All recommendations are presented to the client/Payor for authorization prior to execution of services through our 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-practices approach for excess and reinsurance claim management.

Strong Network of Providers

Our nationwide provider network are consistently monitored to provide high quality care. This approach provides strong oversight throughout the workers' compensation life-cycle to help minimize costs, time and provider care quality. We use credentialed, proven providers and match the injured worker with the right provider through our sophisticated platform. PCS' internal coordinators ensure timely and accurate transmittal of critical data and reports to ensure claims are managed correctly and payments are made on time.