WorkingRx’s suit against the Workers Comp Fund of Utah will likely shed some light on Working’s billing practices, methodology, and legal strategy. Working is a third party biller; a company that buys WC scripts from retail pharmacies and tries to get insurers to pay for them.
While that’s fine, and is a time-honored business practice in many retail and other industries with large receiveables, Working’s approach tends to be a bit more combative.
Working submits bills for reimbursement after applying their version of usual and customary, and then demands payment. Sources indicate that the WCF’s position is they have paid for the scripts already, and that Working’s demands are unreasonable. If Working’s other legal and collection actions are any indication, WCF may have a good point.
The issue is this; Working gets the bill from the retail pharmacy, and then reprices it using their own “usual and customary” methodology and/or adds an administrative fee. This last was shot down pretty abruptly in the WorkingRx-ScripNet legal battle, and WorkingRx’s U&C methodology is, well, unique.
One of the factors driving WorkingRx’s aggressive posturing and actions may well be the incentives of their legal team. Sources indicate that Working’s legal folk are, at least in part, financially rewarded for success in getting payers to cough up additional payments.
Apr
14
It would seem to me a pretty risk undertaking to challenge a payer’s usual and customary protocol with your own U & C protocol. But perhaps the Fund has a seriously flawed protocol…?