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The workers’ compensation marketplace is faced with unique and complex challenges when it comes to claim processing. Keeping up with regulatory requirements, CPT codes, and changing fee schedules can cause even the most experienced claim adjuster to become overwhelmed.

To further complicate matters, the workers’ comp arena is no stranger to consolidation. In recent years, the marketplace has seen many mergers, including Coventry’s acquisitions of Focus and First Health. Mergers, combined with rising medical costs, have led to an increased interest in specialty managed care companies. This creates mosaic-like workflows with multiple PPOs, specialty networks, and managed care companies each handling a piece of the workers’ comp puzzle. For claim adjusters, this means increasingly complex vendor management responsibilities on top of existing challenges.

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