Program Management and Enforcement

Ongoing Optimization of your Managed Care Program:

• Medical Bill Review
• PPO
• Case Management
• UR
• Pharmacy Benefits Management
• Medical Provider Network

After restructuring your existing workers' compensation managed care program or implementing a new service provider, DDC performs ongoing audit and enforcement by identifying and correcting program underperformance, implementing improvements, and overseeing changes to program structure. Program enforcement includes ongoing program analysis and reporting that summarizes program trends, highlights areas of concern, and identifies the best options for program enhancement.

DDC typically enforces tasks such as: executing transitions between managed care service providers; enforcement of contract/performance terms; identification and correction of reporting errors; recapture of fee overcharges and overpayments to medical providers; calculation of performance-based fee incentives; early identification of program performance issues; and providing representation at client board and committee meetings and service provider negotiations. Through this process, DDC reduces its clients medical spend an average of $1.35 million a year beyond what they were saving.

For a complimentary analysis with specific recommendations for financial and operational improvement of your workers' compensation managed care program (medical bill review, PPO, case management and UR services), please click here