Medical Cost Containment - OneBeacon Insurance Group
Management of the medical expense portion of a claim is critical. Medical claim costs can escalate quickly, so OneBeacon works with key partners to deploy a full array of cost containment programs. These programs begin immediately after an injury occurs and will continue as long as treatment is medically necessary. Our cost containment programs include:
Preferred provider organizations:
Genex Provider Pathways is utilized for CO, CT, GA, MA, MN, NJ, NY, PA, and VA
- Accessing the Genex Provider Pathways Channeling Site:
- Go to: www.genexservices.com.
- Click Find a Provider/Genex Provider Pathway (top right)
- Login with Username: One and Password: Beacon
- Search for Network Providers by address, name and region
- Create Work Site Posters
If you have any problems accessing Genex Provider Pathway:
- To search for providers, please visit: www.coventrywcs.com.
- Select “Client Login & Tools” in the top right center of the homepage.
- Enter Client ID: BEA and submit
- Select channeling tools
- Allows you to search for a Network Provider by address, name and region
- Allows you to create Work Site Posters
- The requirements for CA employers can be found in the publication: Atlantic Specialty Insurance Company-Select MPN or Rhode Island Employers with California locations.
- The MPN provides MPN Medical Access Assistants within the United States who are available Monday – Saturday, 7:00 a.m. to 8:00 p.m. Pacific Time to provide employee assistance with access to medical care under the MPN.
Coventry’s First Health is utilized for all other States which are handled by Gallagher Bassett:
KY, LA & TX have specific requirements regarding the use of a PPO to direct care. If you print a posting notice from the Coventry website for any State it will be in compliance with the States jurisdictional rules.
Pharmacy First Fill Program
- First Fill Program – A prescription drug card program designed to ensure that the injured worker receives their initial medication as soon as possible after sustaining an injury, even before the claim is accepted as compensable. This program provides access to our national network of over 60,000 pharmacies with NO out-of-pocket costs for the injured worker. There is an $85 cost limit and a 10 day supply limit and the temporary card expires 30 days after the injury.
- Once a claim is accepted as compensable, generally within 7-14 days, a personalized prescription card will be mailed directly to eligible claimants allowing full refills of covered prescriptions.
- Our PBM’s will absorb the cost of the first fill prescription if the claim is later denied or the medications are unrelated to the injury. OneBeacon covers the costs of the first fill prescriptions for injury related medications that are medically necessary on claims that are ultimately accepted as compensable.
- For CA, CO, CT, GA, MA, MN, NJ, NY, PA & VA, our Pharmacy Benefit Manager is TMESYS, a nationwide pharmacy network for Optum. To locate participating pharmacies, please visit www.tmesys.com
- For all other States, the Pharmacy Benefit Manager is FirstScript. To locate participating pharmacies, please visit www.firstscript.com
- To locate a First Fill card, search for State-Specific Forms & Resources.