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Sharing perspectives leads to greater understanding and fuels innovation. The ​Optum Insights ​blog is where we share our perspective and challenge preconceptions to clear a new path forward



  • 5 Tips to Prepare for the NY State Workers' Comp Formulary

    by
    • Policy Matters team
    | Dec 03, 2019
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    Workers' Compensation, formulary, New York
    The New York State Workers' Comp Formulary implementation starts December 5, 2019. These 5 tips will help you get ready.


  • California Insurance Guarantee Association is not a primary payer under Medicare

    by
    • Rafael Gonzalez Esq. President Optum Settlement Solutions
    | Nov 22, 2019
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    Medicare Insights, Medicare Set-Aside, MSA
    On October 10, 2019, the United States Court of Appeals for the Ninth Circuit published its opinion on California Insurance Guarantee Association v. Azar, concluding that CIGA is not a primary plan under the Medicare secondary payer provisions, but an insurer of last resort, therefore, is under no obligation to reimburse CMS for conditional payments made on behalf of workers’ compensation insureds.


  • CMS announces accessibility to Open Debt Reports

    by
    • Rafael Gonzalez
    | Nov 20, 2019
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    Medicare Set-Aside, MSA, Medicare Secondary Payer, MSPA Claims, CMS
    The Centers for Medicare and Medicaid Services (CMS) recently published Version 4.7 of the Medicare Secondary Payer Recovery Portal (MSPRP) User Guide. A notable update in this version is accessibility to Open Debt Reports for account managers. As stated in the user guide, the Open Debt Report page displays the status of open debts with account receivable balances greater than zero.


  • New medication approved for acute treatment of migraine ― Reyvow™ (lasmiditan) tablets

    by
    • Clinical Connection team
    | Nov 11, 2019
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    FDA, Migraine
    The U.S. Food and Drug Administration (FDA) approved a new medication to treat acute (active but short-term) migraine with or without aura (often described as a visual disturbance such as flashing lights) in adults.


  • New York Workers’ Compensation Board adopts emergency rule regarding drug formulary

    by
    • Policy Matters team
    | Nov 08, 2019
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    New York, formulary, Formularies, drug Formularies
    As expected, the New York Workers’ Compensation Board (WCB) adopted an emergency amendment to the existing Drug Formulary rule. The change, as discussed on the various training webinars sponsored by the WCB, adds a “special consideration #4” to the Drug Formulary list.


  • Lots of Changes in CMS’ Latest WCMSA Reference Guide

    by
    • Rafael Gonzalez
    | Nov 07, 2019
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    Side Effects, Medicare Insights, medicareinsights blog, CMS, WCMSA
    On October 10, 2019, the Centers for Medicare and Medicaid Services (CMS) published its latest Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide.


  • How comorbidity conditions of diabetes & obesity impact claims outcomes: Part five

    by
    • Clinical Connection team
    | Nov 07, 2019
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    Clinical Intervention, Comorbidities, comorbidity
    Common comorbid conditions that may be a contributing factor and/or a complication of an injury are diabetes and obesity. With over 30 million patients with diabetes (PWD) in the United States, diabetes presents a potential concern when it comes to injuries.



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