Workers' Compensation

Pacific now has the fastest (48 hour vs 5 day turnaround), most reliable (3.5% re-evaluation rate), highest rated (97% client satisfaction) and most accurate (99%) medical bill review platform in the US.

Workers' Compensation

Pacific's partners have launched some of the biggest technical revolutions in the industry and represent over 24 years of client-tested experience that has culminated in a Workers' Compensation platform that is widely recognized as the industry leader. Pacific's accuracy is greater than 99%. This equates to the following tangible benefits: maximum dollar savings, the industry's lowest reconsiderations and faster payments. This of course solidifies relationships with providers as well.

Pacific's clients always come first. Our experience shows that if we serve them well, our own success will follow. We are dedicated to sound project management and set the bar for industry best practices. Dedicated customer service and technical support teams serve our long-term, unbroken relationships with our clients. As a testament to our performance track record, Pacific and its partners have never lost a client.

At the end of the day, Pacific's software and bill review expertise will lower our client's costs and increase their return-on-investment. Pacific is about cash-flow management and present value dollars by driving savings dollars to our clients bottom-line as fast as possible, consistently, over extended periods of time.

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National Medical Bill Review Services

As clients increasingly examine methods to help contain their workers' compensation costs, the Pacific team provides cutting-edge recommendations to help clients achieve breakthrough results. We understand that software and service solutions are multi-faceted and demand a level of commitment from Pacific, technologically, administratively, functionally and financially, to achieve the desired outcome. Our results speak for themselves.

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Relationship Management

Our industry-leading experience in the medical bill review industry ensures Pacific's clients receive best-of-class service and attention. That is why Pacific's senior management mandates that our client representatives provide a level of knowledge and experience unsurpassed in the industry.

Customer Service

Pacific is dedicated to providing its clients with world-class service and support. 100 percent client satisfaction is a company-wide rule. We institute this attitude through proactive account management, problem solving and quick resolutions. Services include comprehensive technical support and immediate personal responses to questions about recommendations, analysis or specific issues regarding their bill review system. Pacific's case tracking system helps the client representative, in coordination with technical support, product development and project management proactively resolve questions that may arise.

Implementation

Pacific's client account representatives, in coordination with our technical support and client installation personnel, provide a smooth implementation process. Clients find our transition seemless and as simple as possible by utilizing a fully integrated approach to mitigate any client risk. This transition can seem difficult, but we consistently avoid major issues through intense preparation and up-front due diligence. Our comprehensive transition plans cover every potential issue that over 24 years in the industry have brought to light.

Client Interface

Our client interface checklist is the starting point for developing the comprehensive implementation plan and critical path management outline. Pacific's client representative and technical services teams work in conjunction with our client's personnel to produce a detailed critical path timeline and implementation plan specifically designed for their project.

Pacific's implementation plan includes business, technical and interface reviews. The resulting critical path includes functions, tasks, start and end dates, financial resources, duties, responsibilities and accountabilities. Every party knows up front, what is going to be completed, when and by whom. No surprises. No hidden agenda.

Lastly, based on our level of experience, the development of a comprehensive implementation plan requires a minimal amount of the client's time. Scheduling of client interviews will be completed to minimize impact to the client. This allows the client to concentrate on its core business while Pacific executes on the comprehensive implementation plan.

Project Management

Pacific customizes its project management services including due diligence analysis, integrations consulting, workflow development, critical path management, risk management, reporting and system interface configuration. Pacific sets the bar with state-of-the-art project management processes and techniques. Timing and accuracy are important drivers that ensure Pacific exceeds our client's expectations.

Comprehensive State Reporting

Pacific's state reporting capability provides nationwide state reporting and compliance management services. Our system meets or exceeds all regulatory compliance requirements. Our state reports are generated seamlessly from existing data sources without time consuming processes.

Pacific's compliance management services ensure that all state reporting is comprehensively and automatically updated as states modify existing reporting requirements. Our clients are assured that their medical reporting practices are squarely within each state's rules and regulations.

National Provider Network

Pacific provides access to one of the nation's largest, multi-specialty preferred provider networks. Our network includes more than 540,000 individual practitioners, 97,000 ancillary facilities and approximately 5,500 acute care hospitals. Contracted providers offer Pacific's clients significant discounts on services rendered to beneficiaries.

Pacific's network access is committed to creating innovative, custom-designed products, superior customer service and specialty niche services. We offer a quality provider network to our clients to reduce their medical expenditures, to reduce out-of-pocket expenses for medical services for covered persons and to offer providers the opportunity for increased utilization, prompt payment of claims, simplified administrative procedures and a competitive reimbursement arrangement. By understanding the needs of both clients and providers, Pacific continues to deliver "best in class" network solutions. We are committed to consistent growth and excellence through

  • expansion of the provider networks
  • formation of strategic partnerships
  • delivering incomparable savings
  • cutting-edge technology
  • unsurpassed client/provider relations

In addition, because Pacific is constantly forming strategic partnerships in local, regional and national areas, Pacific is able to provide and effectively administer any PPO network chosen by our clients, including a client's own PPO network. We can apply a client's predetermined PPO structure or work with them to customize PPO coverage. This maximizes PPO penetration and client savings. We also provide a number of support services including PPO analysis, system outcome studies and MPN creation and administration.

As an independent company, Pacific has no ownership affiliation with its PPO partners and can provide objective analysis of network coverage.

Utilization Review

Pacific has crafted a unique program to ensure a successful UR solution, focused on appropriate and consistent direction of care for the injured worker. Our team carefully examines each case, evaluating whether the recommended treatment complies with regulations, evidence-based guidelines and URAC. The significant efforts of our superior management and clinical team ensure that injured employees receive best-practice care. The goal is simple: The right number of treatments for the right diagnosis.

The success of our utilization review program is initiated with effective and efficient communications. Pacific integrates fax, online, e-mail, telephonic and person-to-person reporting systems in our UR solution and our web-based service is available on a 24/7 basis. Organizations using our innovative solution have experienced significant annual return-on-investment.

Comprehensive Solution

Pacific understands that everything we do must add convenience, cost control and value for our clients. That is why business excellence is a hallmark of our organization. Below are a few of the features of Pacific's utilization review solution and the benefits your organization will receive.

Explanation of Reviews

Explanation of Reviews for both the treating provider, claims administrator, injured worker and any legal representative within two business days. This provides labor code compliance and valuable information to the claims staff that will reduce potential litigation and provider dissatisfaction.

Written Correspondence

Utilization of a series of written correspondences to the provider and claims adjuster. This will provide prompt and effective patient care, reduce litigation rates and control medical cost due to provider compliance.

Real-Time Communication

Voice activated fax back technology and voice response communication system which makes available real time status of reviews. This service (implemented at the request of the client) will reduce the amount of time spent on physician management by the claims staff and thereby provide personnel with increased time allocated to additional claims activities.

Oversight Letters

Multiple time-controlled oversight letters are sent to the treating providers. This action will improve compliance and reduce potentially deceptive actions of the provider resulting in subsequent reduction in medical costs.

Time-Sensitive Red Flag Protocols

Time-sensitive red flag protocols linked to immediate administrative action of claims. These will identify overutilization/underutilization of treatment and potential fraud.

Peer Oversight

Peer oversight to ensure compliance and appropriateness of care. Provider supervision improves treatment outcomes, reduces litigation and potential fraud.

Signed Documentation

Request of providers to sign documentation ensuring verification of receipt of completed utilization review decisions. This step creates discoverable written confirmation of provider treatment plan.

Office Assistance

Assists the offices of less savvy practitioners in dealing with workers' compensation procedures. This administrative action reduces provider difficulties in management of workers' compensation procedures while reducing represented claims and inconsistent treatment.

Monthly customized ROI analysis

Objective metrics will improve financial documentation and identify future saving opportunities.

URAC Quality Assurance

Pacific's utilization review partner is fully accredited and certified by URAC. URAC is an independent, nonprofit organization, well-known as a leader in promoting health care quality through its accreditation and certification programs.

It offers a wide range of quality benchmarking programs and services that keep pace with the rapid changes in the health care system. URAC provides a symbol of excellence for organizations to validate their commitment to quality and accountability.

Through its broad-based structure, URAC ensures that all stakeholders are represented in establishing meaningful quality measures for the entire health care industry.

For further information about URAC please contact them at: www.urac.org.

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Multi-Level Evidenced-Based Guidelines

Pacific's utilization review capabilities are simply the fastest (48 hour turnaround time: industry average = 5 days), most effective (3.5% re-evaluation rate) and carry the highest customer satisfaction rating (95%) in the industry. Pacific's tracking system is widely recognized as best-in-class: it tracks individual reviews from receipt through final disposition and provides a detailed quality control and assurance report in record speed.

What drives this powerful engine is an unprecedented 9-level, clinically supported, evidence-based guideline platform. Please review this proprietary structure and learn how Pacific can reduce overall medical management costs across all areas of the workers' compensation value chain.

Level 1: American College of Occupational and Environmental Medicine (ACOEM) Guidelines
Level 2: American Physical Therapy Association Practice Guideline
Level 3: Agency for Health Care Research and Quality
Level 4: Official Disability Guidelines
Level 5: Cochrane Collaboration
Level 6: Mercy Conference Guidelines
Level 7: Clinical examination of peer-reviewed literature, biomedical compendia, and other medical literature that meet the criteria of the National Institute of Health's Library of Medicine for indexing in Index Medicus, Excerpta Medica, MANTIS, Medline and MEDLARS database Health Services Technology Assessment Research.
Level 8: Clinical examination of medical journals recognized by the Secretary of Health and Human Services or the following standard reference compendia: The American Dental Association Accepted Dental Therapeutics and the United States Pharmacopoeia-Drug Information.
Level 9: Clinical examination of amine studies or research conducted by or under the auspices of federal government agencies and nationally recognized federal research institutes including the National Academy of Sciences, Health Care Financing Administration, Congressional Office of Technology Assessment and any board recognized by the National Institutes of Health for the purpose of evaluating the medical value of health services.

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9 Pools of Money

Because the healthcare industry is so complex and many of the players have poured literally millions of dollars into keeping the true costs hidden, most companies do not know the total costs involved with managing the workers' compensation bill review process. There are many other pools of money involved besides cost per bill, average bill review savings or an incorrectly calculated return-on-investment metric.

Needless to say, it is imperative to understand all of the pools of money that have a bearing on a company's bottom-line. Pacific can help you uncover all the important pools of money and highlight their impact to your company's bill review process. Additional downstream expenses must be identified and quantified before a true return-on-investment can be calculated.

When investigating bill review software and service options, a thorough analysis may produce some surprising results. Taking this step could help prevent making an incorrect decision regarding a bill review system that appears to be cost-effective, only to realize later that there are no real savings at all.

The 9 Pools of Money

  1. Bill review accuracy
  2. National capability
  3. Owned v leased software
  4. Volume of reconsiderations
  5. Number of re-evaluations
  6. Efficiency of claims adjuster: average time per issue
  7. Impact of too frequent and prolonged provider complaints
  8. Poor provider relations
  9. Electronic capability = quantifiable time and money

Pacific can help you answer these questions through a comprehensive analysis of your current system.

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Industry Resources

Our industry resources provide links to state and local resources as well as national associations.

State & Local Resources:

Alabama

Alaska

Arizona

Arkansas

California

Colorado

Connecticut

District of Columbia

Delaware

Florida

Georgia

Hawaii

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota

Ohio

Oklahoma

Oregon

Pennsylvania

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

Vermont

Virginia

Washington

West Virginia

Wisconsin

Wyoming

Industry Resources:

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