MCIT
Spotlight on MCIT Workers’ Compensation Claims Division
MCIT workers’ compensation claims division continues to evolve to meet new and emerging challenges in claims handling. The team is currently comprised of:
- The workers’ compensation claims manager, Andrew Essling: He is responsible for developing and implementing the workers’ compensation program.
- The nurse case manager, Mimi Lynn: She works with employees and claims representatives to assess, coordinate and plan medical care.
- Six indemnity claim representatives (Kim Barnes, Amanda Goiffon, Rick Henning, David Hoffman, Rhonda Nilssen and Iona Shepherd): They predominately handle claims resulting in days away from work and medical treatment.
- The medical only claims representative, Sam Hudachek: He manages claims requiring medical treatment but that do not result in time away from work for employees.
All claim representatives work the claim in partnership with the employer (member), employee and health care provider to provide swift and appropriate care to gain the optimum recovery for the employee.
Recent Challenges for Team
COVID claims: Claims submitted as the result of COVID-19 infection were a challenge for the workers’ compensation team during the past few years, fueled in part by the presumption of a workplace exposure for certain employees, notably law enforcement and public health workers.
That presumption sunset in January 2023, but during the course of the pandemic, MCIT’s claims team handled 1,374 COVID indemnity claims and 105 COVID medical-only claims.*
Post-traumatic stress disorder claims increase: Effective Jan. 1, 2019, the Minnesota Legislature expanded the workers’ compensation law to include a presumption of compensability for PTSD claims for certain first responders.
From 2003 through 2018, MCIT had a total of six PTSD claims reported (by date of injury). Since the presumption was enacted, the number has steadily risen: eight claims in 2020, 14 in 2021 and 19 in 2022.
Continued Stewardship of Funds
New medical bill review partner: Beginning Aug. 1, 2022, MCIT has partnered with Rising Medical Solutions to ensure charges are appropriate under Minnesota’s fee schedule and to realize additional savings based on pricing available through preferred provider organizations. Rising Medical Solutions’ work has led to improved claims representative efficiencies, more clearly understandable explanations for changes to charges (for both health care providers and employees) and a more seamless, expedited process.
Since the partnership launched, MCIT has seen an average reduction per bill of 56.3 percent.
MCIT’s pharmacy benefit manager ensures accuracy in medication pricing: MCIT partners with AWPRx for accurate pricing of medications prescribed for injured employees. In 2021, MCIT paid $224,142 on pharmacy benefits, a total of 1,601 transactions, roughly $140 paid per transaction. In 2022, the total paid was $205,174 for 1,470 transactions, an average of $138 per transaction. The average savings over the previous provider resulted in a 25% reduction in pharmacy costs.