Advocacy & Compliance

Healthesystems’ Advocacy & Compliance experts are essential in the management of pharmacy and ancillary benefits for our clients. By tracking and influencing regulatory activity, our team stays ahead of evolving trends and identifies opportunities to advocate on behalf of our clients, their injured workers, and the broader industry.

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The Advocacy &  Compliance Team

Monitors and reports on proposed and pending regulatory changes that impact workers' comp, helping shape effective program strategies

Advocates for fair and balanced public policy through proactive engagement with regulators, customers, and other stakeholders throughout the rulemaking lifecycle

Supports operational compliance by providing guidance to internal stakeholders and external partners during the implementation of new regulatory changes

Regulatory Recap

A weekly e-newsletter informed by the Advocacy & Compliance team to help keep our clients and industry contacts in the know on the latest legislation and policy updates impacting workers’ comp.

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Technology

WCRI Publishes Overview of AI Promises and Challenges

The study is based on an exploration of literature and interviews with 34 leaders across workers’ comp.

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June 30, 2025

Access to Care

New York Clarifies When Injured Workers Can Use Out of Network Pharmacies

Effective July 11th, the updated rules apply to controverted claims and other dispute conditions.

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June 16, 2025

Cost Containment Treatment Guidelines

Nevada Enacts Formulary and Changes for Provider Panels

The DIR must adopt the ODG formulary by July 1, 2027.

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June 16, 2025

Advocacy Opportunity Cost Containment Treatment Guidelines

Arizona Commission Discusses Trends and Solutions for Topical Prescriptions

Fee schedule clarity and defined reimbursement caps were discussed as ways to reduce ambiguity and prevent payment disputes.

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June 16, 2025

Ancillary Services Cost Containment

CMS Publishes 2025 Q3 Updates to NCCI Edits

Medically unlikely edits were updated across DME, outpatient hospital services, and more.

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June 9, 2025

Advocacy Opportunity Cost Containment Treatment Guidelines

Arizona Seeks Stakeholder Input on Prescription Topicals

The meeting will take place on June 12th, aiming to explore current trends, challenges, and proposed solutions related to these drugs.

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June 9, 2025

Claim Costs Industry Data Worker Safety

CWCI Publishes Report on Long-COVID

Long COVID cases made up 4.7% of COVID claims, totaling 6,000 claims, yet medical payments for long COVID claims was $105 million.

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June 9, 2025

Access to Care

Colorado Injured Workers Can Now Choose Any Treating Provider

Injured workers may now choose any Level I or II accredited physician licensed under the Colorado Medical Practice Act.

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June 9, 2025

Technology Treatment Guidelines

Connecticut, Nebraska, Nevada, and Texas Introduce AI Regulation Bills

These different bills would prevent AI from denying, delaying, modifying, or making clinical decisions in healthcare.

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June 9, 2025

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Further resources you may be interested in

Additional articles and updates from Healthesystems related to policy shaping workers’ comp.

Physician Dispensing Concerns in Workers’ Compensation

Physician dispensing represents an ongoing challenge for today’s workers’ comp payers – not only from a cost perspective, but from clinical and safety perspectives.

Triple Threat: Healthcare Fraud, Waste and Abuse in Workers’ Comp

Identifying and combating a multifaceted problem, including proven and developing strategies.

WCRI Publishes 24th Edition of CompScope Benchmarks

A total of 14 different reports examine workers’ comp system performance across 17 states from 2017-2022.

DEA to Reschedule Marijuana

While bureaucratic wheels may take time, marijuana will become a Schedule III drug soon.

Triple Threat: Healthcare Fraud, Waste and Abuse in Workers' Comp

A current look at fraud, waste and abuse in workers’ comp pharmacy and medical services with strategies for management, including next-generation strategies involving AI.