Product Portfolio

Third Party Administration

Technical expertise is important. Our clients rely on us for technical knowledge and experience but they also rely on the alliance we’re able to establish with them. That alliance is the first step in delivering excellent service. Many TPAs talk about “tailored” services, but do they really have the flexibility required to tailor services to individual clients? Qual-Lynx has that flexibility. An individualized program means that claim reporting is more efficient, communication is more effective, and there is real accountability in the risk management process. That’s where the alliance comes in. When the process runs according to expectations, claims are resolved more efficiently and more cost effectively.

Qual-Lynx provides third party administration for the following lines of business:

• Workers’ Compensation

• General Liability

• Automobile Liability

• Property

• Product Liability

• Public Officials Liability

• Employment Practices Liability

Managed Care Programs

In a Workers’ Compensation program, Qual-Lynx is experienced at providing seamless services designed to medically manage claims and control expenses. Managed care has been proven to be a very cost-effective component to Workers’ Compensation claim handling, and medical management features can be included in the program as “bundled” or “unbundled” services.

• 800 Reporting

• Telephonic Nurse Case Management

• Field Case Management

• Utilization Review

• Medical and Hospital bill audit and solid discounts

• Electronic Data Interface
  

Loss Control

Loss prevention and control must be aggressive from the onset of the program. Those clients requiring loss control services benefit from early site visits and subsequent recommendations on steps that can be taken to avoid Workers’ Compensation claims in the first place. Qual-Lynx loss prevention professionals have experience working with a large variety of both public entities and private businesses. They are available for safety training and committees and make valid recommendations on how to improve your loss experience through the reduction of claims.

Specialized Programs

Return-to-Work Programs
A.D.A.P.T. (Alternative Duty for A Positive Transition)
Alternative or modified duty programs are quickly leading the “cost containment pack” in terms of dollars saved. Employers who subscribe to a return-to-work program enjoy the benefit of increased production and employee morale, while lowering their costs. Qual-Lynx works with each insured to develop an effective return-to-work program, specifically set up to fit their individual needs. Once the insured’s A.D.A.P.T. Program is in place, our claims representatives work closely with the client, the medical provider and the claimant to fully utilize all opportunities for alternative duty.

Fraud Detection
Qual-Lynx is committed to fraud prevention. We have to be when $34 billion are paid out annually on fraudulent claims. This commitment to fraud detection helps us to substantially reduce costs on behalf of our clients. Aggressive investigation of potential fraud sends the message to employees that Workers’ Compensation is a benefit not to be abused. Our Special Investigation staff is experienced in identifying fraud indicators to isolate those claims that show potential for fraudulent activity, and following through to prosecution, if necessary.

G.O.T.C.H.A (Go Out To Check on Home Activities)
This investigative tool, offered only by Qual-Lynx, is invaluable in terms of cost containment. Investigators conduct unannounced, personal visits to each “lost time” claimant. The opportunity to interview injured workers in their homes provides us with detailed information to support telephonic investigation. These visits confirm or deny the existence of malingering or fraudulent activity, and often highlight other factors that may inhibit a claimant’s timely return to work.

Litigation Management
Qual-Lynx provides litigation management services focused on reducing litigation costs without sacrificing results. This can only be accomplished with the understanding that litigation management begins before a claim becomes a lawsuit. Our litigation management plans involve aggressive investigation, evaluation, direction and negotiation in concert with the assigned defense counsel. Regular review and management of expenses ensures that costs are consistent with the claims strategy and are reasonable, necessary and appropriate for the proper defense of each case.

S.C.O.R.E. (System-based Comprehensive Objective Rating Evaluation):
A regular system of internal audit satisfies three major issues for a TPA and their clients. First, it provides an objective tool for individual and overall performance evaluation. Second, it helps to identify and direct internal training initiatives. Third, it creates a basis for trend identification and benchmarking. In 1997, Qual-Lynx developed S.C.O.R.E. to accomplish these objectives. S.C.O.R.E. is a flexible program with rating features adapted to each individual client’s instructions on claim handling.