Network Coverage with a Different Perspective

Making a Positive Impact on the Workers Compensation Industry

In This Issue

• Making a Positive Impact

• NovaWorx Goes Direct in

East Tennessee

• Which Network is Right

for you?

• Upcoming Events

NovaWorx continues to expand rapidly in Tennessee, Georgia, Alabama and Northern Florida. NovaWorx is an excellent solution to the current problems in the market related to workers’ compensation networks and their strained relationships with clients and providers.

NovaWorx’s relationships with providers and clients have made a positive impact on its ability to identify and contract with experienced workers’ compensation providers. Many highly qualified providers would like to be involved with workers’ compensation business but decline because of negative experiences they have had in the past with other networks. Often times the negative experience revolves around a simple billing dispute. These disputes are compounded by the problems other networks have created with contracts and discounts that are not

specifically directed at workers' compensation. They are usually intensified by the lack of customer support as well. The payor/client is often caught in the middle.

Cost containment is not limited to the physical treatment and back-to-work status of a claimant. A claim dispute can take on a life of its own and drain resources from providers and clients. In dealing with these issues, both the provider and the client rely on the network as an integral part of the resolution process. It is the network's responsibility to have clear contractual agreements with all parties. A network is unable to achieve this if they are working from a contract or discount that is not representative of the state fee schedule. A contract is inefective if it does not clearly indicate the provider's participation in the workers' compensation network and the discount associated with

that participation.

NovaWorx provides excellent customer support and provider relations to help resolve issues in a quick and efficient manner. NovaWorx's provider contracts are structured in a way that providers are clear that they are signing up for the workers' compensation network. Its contractual discounts are clear discounts off of the state fee schedule, so repricing after bill review is simple. The data that NovaWorx clients receive is closely maintained for accuracy. NovaWorx also provides a network concierge service that assists in identifying which providers are right for a client’s panel or specific needs. NovaWorx is constantly striving to provide a better alternative to the problems industry professionals face every day with other networks.

NovaWorx Replaces PHP WORxS in East Tennessee

NovaNet is pleased to announce that it now provides direct network access to East Tennessee.

As you may already know, because of Humana's acquisition of PHP, PHP WORxS no longer exists as a Workers’ Compensation network solution in East Tennessee. NovaWorx has a long standing affiliate relationship with PHP, but is now excited to offer the directly contracted NovaWorx network both for current business and for clients who now need a new network solution in East Tennessee.

With this additional contracting, NovaWorx now provides direct workers’ compensation network coverage throughout the state of Tennesse.

NovaWorx’s expansion of its direct workers’ compensation network into East Tennessee brings with it many advantages for clients. Providers have been contracted with agreements that are targeted to workers' compensation and include state mandated language and requirements. In addition, all (yes

that is right…ALL) NovaWorx agreements are based on discounts off of the state fee schedule. NovaWorx’s provider agreements are clear and concise so that both the client and provider understand their obligations and discount. The provider agreement ensures that the client is getting a true discount off of the state fee schedule and improves client /provider relationships by reducing the amount of confusion and frustration often involved in properly processing a claim.

What Type of Network is Right for You?

In the past issues of this newsletter we have discussed choosing the right workers’ compensation network and the factors that contribute to that decision. Construction of the network is always important and is the foundation for all other factors. Most importantly, why was the network built? If the network was built generically for various lines of business, chances are that not much attention was paid to aligning the agreement with state regulations

and the flow of workers' compensation business as it is today. In addition, discounts were probably not based on the state fee schedule. In the last few months we have spoken with a lot of providers whose discounts through other networks are a percentage off of billed charges or a CPT-based schedule. This type of arrangement may sound like a good deal until you compare them to the state fee schedule reimbursement amount and realize there is really no

discount at all. To complicate matters, the network may send the client data indicating a discount off of the state fee schedule when in reality no such discount exists. This type of situation can create a difficult issue between payor and provider. Therefore it is important to find a network with true discounts off of the state fee schedule.

Factor #3Providers

A network is only as good as the experience and expertise of its providers, and in the workers' compensation world, a network should be able to identify the best providers so that clients can utilize their expertise. Some networks are made up of thousands of providers that are not skilled or versed in workers' compensation. These networks will tout their large numbers of providers and depth of coverage as an asset, but in fact their data may actually show the weakness of their network. Some states, like Florida for example, require a physician to be certified in workers' compensation, while most states in the Southeast do not. Therefore, it is up to the network to be selective in their contracting methods. The last thing a client wants to do is send a

claimant off to an “in-network” provider only to be refused because the provider does not accept workers’ compensation business.

There is a place for almost all types of providers in the network, but clients should specifically focus on the selection of core workers' compensation specialties (the ones claimants will be using most often). Look for the Urgent Care, Emergency, Occupational Medicine, Pain Management, Physical Therapy and Orthopedic specialties. Identify the true type of discounts the network has with them and the number of providers in these specialities that the network has in specific geographic areas. Because these types of specialties see more workers' compensation business, their

discount is likely to be more representative of what clients will really get from the network.

NovaWorx targets core workers' compensation physician specialties with its contracting efforts to ensure that the providers its clients use will be experts not only in their specialty but also in workers' compensation. NovaWorx collects data from providers during the credentialing process that gives a real indication of their level of expertise. This data is available to NovaWorx clients through its workers’ compensation concierge service. Employers can contact NovaWorx and work directly with a contracting professional to identify high level providers in their area.

Upcoming EventsGeorgia Self Insurers' Association

(GSIA) Spring ConferenceSavannah, GA May 19- 21st, 2010

Southern Association of Workers' Compenation Administrators

(SAWCA) 61st Annual Convention

Savannah, GA July 19th- 23rd, 2010

Tennessee Self Insurers' Association (TNSIA) Annual Conference

Nashville, TN September 16th, 2010

Alabama Self Insurers Association Destin, FL August 15th-17th, 2010

Tennessee Workers Compensation- Dept of Labor

Nashville, TN June 15th- 16th, 2010

NovaWorx 3500 Parkway Lane Suite 700 Norcross, GA 30092Phone: 800-513-7177Fax: 770-729-1992 Contact Person: Lisa Nickell E-mail: lnickell@novanetppo.com Phone: 800-513-7177, ext. 221

NovaWorx Management Richard F. Morgan, President and CEO Lisa Nickell, Vice President of Network OperationsJohn Folks, Vice President of Client DevelopmentGreg McNair, Vice President of Business DevelopmentJordan Morgan, Director of Business DevelopmentMelissa Howard, Director of Network ServicesRobert Loew, Network Development SpecialistApril Goforth, Network RelationsMichelle Schwei, Provider Contracting CoordinatorAnela Zukanovic, Claims Department SupervisorMelody Alexander, Information Services DirectorMandy Gillis, Information Systems Coordinator

We're On The Web!www.novanetppo.com

For more information on NovaWorx or to submit your

comments, please emailRobert Loew at

rloew@novanetppo.com