Services, Inc. (iiSi) Endorses RxResults
have seen a spike in the cost of specialty drugs, which represent 1% of the
all prescription drugs dispensed, however they account for 35%+ of all drug
costs. It is anticipated that specialty drug costs will reach 50% of
all drug expenditures. In an effort to stem the high cost of
specialty drug use, iiSi has endorsed a
pre-certification program provided by RxResults.
RxResults is an evidence-based pharmacy risk management company
that provides an independent pre-authorization service for specialty drug
dispensing. RxResults finds that through
their pre-certification process that 68% of the prescriptions are approved,
12% are withdrawn and 20% are denied. This process eliminates 30%+ of
the specialty drug prescriptions. One of their notable observations is only
36% of the hep C prescriptions are approved being
many are denied as not meeting the drug’s clinical criteria. RxResults is seeing savings anywhere from 12% to 45%
with their Specialty Drug Management program.
benefits of this program are:
the utilization of specialty
the conflict of interest with PBMs providing their own
prior-authorization, which is advantageous to the PBM’s bottom-line
along with the distributor receiving incentives and
Plan costs by recommending lower cost alternatives
drug analytics leading to evidenced-base determination of prescribed
the frequency of lasers and increases in aggregate attachment point
is a first step in helping to address rising specialty drug expenses. For
more information contact L.G. Hanzel, Principal
& VP of RxResults at (817) 296-8147 or visit
the RxResults’ website at www.rxresults.com.
New ICD-10 Trigger
iiSi has revised our claim disclosure
form to reference the new ICD-10 clinical cataloging system that goes in
effect October 1, 2015. The new ICD-10 diagnosis listing has been expanded
to reference the more detailed coding classifications and replaces the
previous ICD-9 code listing. The new attached claim disclosure form should
be used for future submission. During the transition period, both previous
(ICD-9) and new (ICD-10) claim disclosure forms will be accepted. Contact
your underwriter or marketing representative should you have any questions.
ICD-10 Claim Disclosure Form (187Kb PDF)
Insurance Services, Inc. (iiSi)
Celebrates 30 Years as Medical Stop Loss Underwriting Organization
iiSi, headquartered in San Francisco,
CA, announced that it is celebrating its 30th year as a medical stop loss
underwriting organization. Founded in 1983, iiSi
has become one of the leading stop loss underwriters in the country by
providing effective risk management solutions and comprehensive managed
care resources to the self-funded community. As a full-service
organization, iiSi has worked closely with its
carriers, producers, third party administrators and policy holders to
provide products that meet the needs of the self-funded marketplace.
"We are very proud of our heritage of being one of the longest
standing medical stop loss managers in the U.S. today", said
Christopher Hutton, President. "We can attribute our success to the
professionalism and enthusiasm of our employees, and the loyalty and
support of our business partners and clients. We are very appreciative of
everyone that has helped make this possible and contributed to our success.
We look forward to many more successful and enjoyable years, confident that
the experience and expertise gained over the last 30 years will enable us
to meet the challenges and uncertainties that the future will undoubtedly
New Addition to the
iiSi Underwriting Team
We are please to announce the addition of Matt Robinson to our
staff. Matt comes to us with 14 years of employer medical stop loss
experience having worked in both the carrier and MGU environments. That
together with a degree in actuarial sciences makes him a uniquely qualified
addition to our highly professional underwriting team.
Matt will be working from a satellite office located Kingston Springs, TN.
***** NEW IRO
EXTENSION AMENDMENT *****
iiSi is pleased to announce that all of
our stop loss carriers have confirmed that they will extend coverage for
Independent Review Organization (IRO) decisions pertaining to previously
denied medical claims. This policy enhancement provides protection for an
employer who is required under the new Patient Protection and Affordable
Care Act (PPACA) to cover IRO decisions on overturned denials of previously
This extended coverage is applicable for groups written or renewing on or
after January 1, 2012. This coverage is provided without any additional
premium surcharge. The “denied” date of the initial claim will be
considered the “paid” date for policy tracking purposes. Complete details
are stated in the actual policy amendment.
We are pleased that our carriers have added this coverage to their policies
as a means to alleviate potential gaps in employer self-funded medical
contact your iiSi Marketing Representative should
you need more details.
Emergency Services Program
Insurance Services, Inc. is pleased to announce that effective October 1,
2011, all of its Companion Life Stop Loss clients now have access to global
emergency services through Assist America. Assist America
s vast array of resources covers individuals whenever they travel 100 miles
or more from home or while in another country. This value added
benefit will be included in all Companion Life stop loss contracts at no
additional cost to clients.
emergency services include:
- Medical Consultation &
- Hospital Admission
- Emergency Medical
- Compassionate Visit
pays for all of the assistance services it provides with no caps, limits or
charge-backs to anyone, and with no exclusions for pre-existing conditions,
adventure sports, geographic risk or alcohol-related incidents.
information or to see a brochure click on the Assist America tab on the iiSi website www.iisinet.com . You can also contact your iiSi Marketing Representative.