PMSI has been serving state and federal government clients for over 36 years. As the nation’s largest and most experienced company focused solely on workers’ compensation, PMSI has developed service offerings thoughtfully crafted to address the critical needs of the workers’ compensation industry, including state funds as well as state and federal government organizations. PMSI is uniquely qualified to provide government entities with the appropriate, high-quality care for injured workers that is compliant, delivers the appropriate cost for the treatment, and promotes rapid return to work.
We address organizations’ most critical business needs through comprehensive workers’ compensation programs. Through proactive investments in integrating clinical management, administrative efficiency, technology advancements, and insightful data, we enable our customers to meet the evolving state and federal regulatory requirements that drive compliance and high-quality care.
PMSI operates its workers’ compensation programs with the same standards as state and federal agencies, including DOL, OWCP and FECA:
- Prompt adjudication
- Prompt payment of medical bills
- Quality care management
- Prompt payment of compensation
- Assistance in returning to work
- HIPAA Compliant
PMSI Serves the Nation—From Big Cities to Small Towns
PMSI maintains a strong, active regulatory presence in all 50 states, Guam, Puerto Rico and the Virgin Islands. We stay current on state and federal legislation and issues, such as state reporting; closed pharmacy formularies; direction of care; eBilling; fraud, waste and abuse; physician dispensing; repackaged medications; compound medications; and average wholesale price (AWP), as it relates to State Fee Schedules and treatment guidelines.
National Presence, Local Service
PMSI’s programs are customer-centric, ensuring that claims examiners and claimants can receive products and services quickly and conveniently from workers’ compensation professionals who understand their needs. Not only do we have pharmacies and medical service providers located in major cities and small towns with professionals happy to assist claims examiners or claimants, we have a 24/7 Call Center staffed with PharmDs, clinical pharmacists, and medical specialists who can answer any questions.
Comprised of over 65,000 directly contracted pharmacy providers with access to all pharmacies that make up the Tmesys® network, including all major pharmacy chains, national clinics, compounding pharmacies and physician dispensers/repackagers. The density of this network ensures that claimants have access to quality pharmacy care from trusted and familiar pharmacies close to home or work.
Our Mail Order Pharmacy program provides convenience and is especially suited for claimants who are on long-term medications. PMSI ships approximately 400,000 prescriptions through the mail order program.
PMSI has direct contracts for durable medical equipment (DME) and specialty services with more than 8,000 best-of-breed providers nationwide. The breadth and depth of the network provides access to more than 35,000 items and services—in all 50 states.
PMSI delivers pharmacy, medical, legal and claims expertise to lower costs and improve settlement results quickly and fairly. Investments in automated processes for medical cost projections, drug allocations and Mandatory Insurer Reporting (MIR) allow PMSI to provide first-rate customer service, flawless workflow management and effective reporting mechanisms resulting in a compliant settlement for each case.
PMSI delivers a unique clinical approach to assess and manage appropriateness and utilization throughout the claim lifecycle through high-quality services and programs that reduce costs and improve outcomes. Utilization Control touches each prescription prospectively at the time of dispense, ensuring that each medication prescribed is compensable and appropriate; Targeted Intervention retrospectively looks across multiple transactions for high-risk or high-cost concerns; and Care Management handles complex and chronic claims with a holistic approach to retrospectively provide an in-depth review of prescriptions and medical services.
We Make It Easy for You
PMSI has created comprehensive workers’ compensation programs with easy-to-use tools for claims examiners and claimants.
PMSI’s Pharmacy Center provides tools to assist injured workers. Find a local Tmesys pharmacy, re-order mail order medication, or submit a drug information question to a PMSI clinical pharmacist.
Features up-to-date information for over 65,000 pharmacies within the Tmesys network and advanced search capabilities, making it easy for injured workers and claims professionals to find a participating pharmacy location. Search options include:
- Radius search, based on address or zip code
- Pharmacy Look-Up, to search by pharmacy name or phone number
- Region search, based on geographic selections including county, city and/or zip code
With just a simple registration, get access to useful information regarding the treatment of pain and other pain-related topics.
Our dedicated Government Affairs team is at the forefront of guiding policies that protect the interests of the workers’ compensation industry, our clients and injured workers. PMSI has cultivated long-term relationships with state and federal government agencies, regulatory officials and key legislators—allowing for recurring communication about pending regulation/legislation—and the opportunity to effect meaningful change for the industry.
Industry Reference
PMSI’s leadership position in the industry is based on the consistent development of informational tools to assist claims examiners and claimants.
ExpertInsights Video Series PMSI CEUniversity My ClaimsKit.com MedicareInsights.com