An aggressive and effective medical cost management program should be an essential part of your business plan.

Preferred Provider Networks

Employers Alliance participates in two provider networks focused on quality, coverage and medical discounts.

The First Health PPO network is comprised of preferred providers selected for their quality, range of services and geographical location. Providers within the network charge below the Pennsylvania Fee Schedule, resulting in reduced medical bills and claim costs. The SmartComp provider network offers statewide coverage for physical therapy and MRI services, with reimbursement rates up to 50% less than other outpatient physical therapy networks. Together, these provider networks offer you a unique combination of medical providers focused on occupational injuries, while providing automatic cost savings opportunities.

Medical Case Management

A knowledgeable and proactive claims staff yields impressive results. By teaming with Employers Alliance, you will benefit from our proven results in the areas of early return to work and reduced claim costs. You will also experience the value of bringing focused medical expertise to manage the medical care provided on certain complex or serious claims.

We work in close partnership with a network of the region’s most experienced providers of injury management services. We coordinate flexible, cost-effective telephonic and on-site services. We work closely with you to select the providers best equipped to meet your needs - from the special medical expertise of their staff to their geographic location. Employers Alliance will help ensure the best possible outcomes for you and your employees.

We will help you identify those claims that would benefit from the joint efforts of a claims professional and a medical case manager. We will direct the provider’s activities and hold them accountable for the quality and cost-effectiveness of their work, never losing sight of the fact that we are ultimately accountable to you for the outcomes we achieve on your behalf.

Medical Bill Review Services

Are medical bill review and repricing services cost-effective? Our clients have saved an average of 39% of billed charges by taking advantage of our in-house Medical Cost Management capabilities. This automated process provides a thorough and reliable analysis of all aspects of your submitted medical charges, including:

• Patterns Utilization Review
• Prescription Drug Repricing
• Fee Schedule Review
• Disability Duration Review
• Managed Care Screening
• Employee Medical History
• Payment and Explanation of Reimbursement

Employers Alliance will provide you with various management reports to help you analyze any and all medical costs, from the smallest individual bill to a thorough summary of your entire medical cost management program.

Pharmacy Card Program

With a combination of significant prescription savings, increased utilization review, and improved efficiencies, Employers Alliance’s Pharmacy Card Program provides your injured employees with a better method of obtaining the medicine they need, while decreasing a very significant component of claims costs.

Within 24 hours of reporting a claim to Employers Alliance, your injured employee will be mailed a pharmacy card to obtain prescriptions from any participating pharmacy (50,000 nationwide). No pharmacy phone calls are necessary to confirm coverage or authorize medicine and injured workers don’t have out-of-pocket expenses. The most common workers' compensation drugs, such as anti-inflammatory and pain medications, are included in the formulary. All pharmacy bills are processed through one provider, rates are very competitive and below fee schedule, individual pharmacy activity can be monitored and their parameters adjusted in real-time, enabling Employers Alliance to employ a pro-active, not re-active approach toward medication.

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