The Texas Department of Workers' Compensation is hearing about some troubling, albeit isolated, incidents of adjusters denying medication therapy for legacy claims (i.e., claims with dates of injury prior to 9/1/11). These claims are still subject to the "open formulary" - and even when the "closed formulary" kicks in on 9/1/13, these medications still must run through the established preauthorization process (unless, alternatively, the applicability of the closed formulary has been documented between the carrier/employer and the prescriber prior to 9/1/13).
We spend a lot of time here at PRIUM thinking about, traveling to, and conducting business in Texas. I am still uncomfortably surprised at how little is understood about the new closed formulary rules. Granted, carriers, employers, and providers routinely express that they've heard about the rules and loosely understand them... but too often, they go on to completely and totally misinterpret the timeline, process, and rules associated with the closed formulary.
I try very hard to ensure this blog isn't used as a direct marketing tool and I'm not going to start now.
Whether you use PRIUM as your preferred URA or not, give us a call. We'll deliver our certified continuing education unit to you, your team, your office, your company, etc. and we won't try to sell you anything (unless, of course, you ask). We've worked hard to develop a deep understanding of the necessary approach to addressing the legacy claims and we're happy to help in any way we can - even if it's a simple webinar to walk through the rules and the associated process steps.
If you don't take appropriate action now, legacy claim management is going to get tough come next September. Let us know if we can help.
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