Here’s a few brief items from the world of workers comp managed care.
Steve Rodriguez, the ex-CNA insurance executive who was brought in to Coventry Workers’ Comp, has moved on, with his responsibilities apparently assumed by former Concentra network boss David Young. Rodriguez, who by all reports was well-respected within Coventry, reportedly has a six-month non-compet Rodriguez was COO of the WC unit at Coventry.
Third party biller WorkingRx (now wholly owned by Third Party Solutions) has filed over 160 separate suits against employers in Utah. The suits are apparently an effort by WRx to collect on the difference between what WRx was reimbursed by the payers and what WRx believes they are owed. Interestingly, the specific pharmacies that filled the scripts are named in the suits. What is even more interesting is the suits, for the first time, will likely reveal WRx’s margins – the difference between what WRx pays the pharmacies and what they bill the payers.
The difference may prove to be enlightening to regulators, infuriating to payers, and embarrassing to the pharmacies.
Whhy is WRx doing this? My guess (and it is only a guess) is that the terms of the deal with TPS include some provisions related to accounts receivable. WRx’ previous owners get paid more if more of the outstanding A/R is collected. This, combined with WRx’ well-documented eagerness to litigate, likely led to this action.
Jan
14
