Benefits
The Challenge
Work Comp is an extraordinarily challenging environment with high-volume interactions occurring between the injured employee, Healthcare Providers/Practices, Employers, and Payers. The significant volume results from referrals to secondary physicians, specialists, hospitals, and/or clinics for a myriad of tests, labs, and procedures. Included in the mix are Case Managers, Third-Party Administrators, Medical Directors from large Self-Insureds, Claims Adjustors, and Lawyers.
Traditionally, the interactions between all these parties are labor and paper-intensive. Medical practices are only just beginning to realize the benefits of automation and Internet connectivity. Likewise, these transactions also require authorizations for referrals and two-way communications among multiple parties for both medical and administrative management of each case. Compounding the challenges are the strong demands for better medical and administrative outcomes; outcomes that result in cost savings with a high level of service and medical care at a low reimbursement rate. The inefficient business and record-keeping processes of multiple providers, practices and other stakeholders all combine to create an unnecessary level of friction and wasted resources.
- Fragmented, inefficient communications and data exchange
- Continually rising costs of Work Comp cases
- No common standards for documentation and processes
- Inherent problems with paper-based records
- Out of sync billing and payment processes
- Difficult to share patient data outside the enterprise
- Proprietary software applications using disparate data formats
- Unclear clinical protocols/transaction hierarchy
- Lack of incentive to change the current processes/systems
All resulting in:
- Sub-optimal Medical & Disability Outcomes
- Lost productivity
- Increased cost of care
- Increased cost for replacement wages
- Burdensome administration and documentation
- Higher litigation risk