When does maintaining an up-to-date library of workers’ compensation state forms become too great of a bureaucratic burden for your claims adjusters or administrative staff? The most straightforward response is this: The more states in which your organization handles workers’ comp claims, the greater the challenge of staying on top of form revisions and additions.
Time and resources could certainly be allocated to more important activities. In the International Risk Management Institute, Inc. (IRMI) article Workers Compensation Bureaucracy Drives Costs, Mark Walls and Kimberly George cite training and education as two such examples:
One of the goals of workers compensation regulations is to ensure that injured workers are paid benefits in a timely manner at the correct rate and that they have access to appropriate medical treatment,” write Walls and George. “There was a time when payers had offices located in most states with adjusters handling only that state. Now, with most payers utilizing multistate adjusters, payers must be constantly training and educating their adjusters to ensure that they understand all of the nuisances of the different states that they handle.
For organizations looking to reduce the bureaucratic burdens their adjusters face, Origami Compliance offers a secure, API-based solution that integrates with any claims management system to provide immediate access to a single-source, up-to-date library of state and federal workers’ comp claim forms. Without leaving the claims system, an adjuster can quickly find the right form based on state or category. And when that form is selected, form fields automatically populate with claim data and a PDF version is generated.
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Greater efficiency in handling workers’ compensation claims can contribute to a reduction in claim costs and improved claim outcomes. These gains are quickly undone when errors result in penalties for the violation of state-specific workers’ compensation laws.
According to the article Avoid Workers’ Comp Penalties and Other Pitfalls, two of the five most common errors that result in penalties occur when filing First Report of Injury (FROI) and making mandated benefits payments to claimants. The use of workers’ compensation technology solutions can reduce the likelihood of making these errors, in addition to streamlining the claims process.
1. Simplify the process of completing First Report of Injury (FROI) forms
As mentioned in Improving adjuster efficiency and accuracy with an integrated forms solution, the process of locating a workers’ comp form and then keying claim details into form fields for every claim can be tremendously inefficient. This administrative burden reduces the time available for staff to engage in other activities that can have a positive effect on claim outcomes. This approach to populating forms also has the potential to add costs, including fines for late filing, errors, or the need to correct and resubmit forms.
The article states: “A reliance on manual data entry increases the likelihood of error and exposes the organization to the costs of bad data. In most cases, the work is also duplicative, with claimant and accident details having already been keyed into the claim system.”
The submission of inaccurate or incomplete claim details in the FROI can have consequences beyond the potential for incurring penalties. In the article First Report of Injury Accuracy Critical for Workers Comp Success, Rebecca Shafer, an expert in the field of workers’ compensation, points out that multiple parties typically use the information in the FROI when setting up their workers’ compensation files. As a result, even minor errors on the reports can be copied, creating complications down the road. And while these errors can be fixed by re-submitting a corrected form, Shafer writes that doing so “is a waste of time for all the parties involved. Plus, when the First Report of Injury is inaccurate or incomplete, it can often be exploited by the employee’s attorney.”
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“Protecting Data in Motion”, a March 2018 Risk & Insurance article, points to the fact that during the first half of 2017 alone, at least 2200 breaches—totaling over 6 billion records—were publicly disclosed. And those were the numbers prior to the reporting of the Equifax data breach.
As claims organizations improve operational efficiencies by using technology designed to eliminate paper-intensive, inefficient, and error-prone processes, it’s critical that the vendors they work with monitor and address security vulnerabilities. … read more
TPAs continue to face increasing pressure to find more innovative ways to drive efficiency and do more with less. An article in Lexology states, “Automated claim processing is the future for insurance carriers, third-party administrators (TPA’s) and large employers, to improve efficiency and reduce the resources required to process claims.” Determining a strategy for automating claims handling can be challenging.
A recent post examined the ways top performers approached automation. One key benchmark study of differentiators recommended: “Employ claims decision support tools – such as workflow automation, advanced analytics, and predictive modeling – and use them more frequently throughout the claim lifecycle.” In fact, top performers are 4X more likely to use automation throughout the cycle than all others.
To achieve the results similar to those of top producers, a comprehensive approach to improvements through technology must be employed. … read more
To be sure that you’re selecting the right workers’ compensation claims compliance and reporting partner, a vendor’s track record is the closest thing to a “crystal ball” that exists.
“To stay competitive in today’s marketplace, companies need complex and multi-faceted digital capabilities,” writes Rashmi Dalia in The Economist. “However, no one company can easily possess all the resources needed to develop robust technology systems, and trying to do it alone can prove difficult and costly.”
For insurers and TPAs, choosing to work with a technology partner has increasingly become a critical strategic decision. 76% of respondents to a 2017 Accenture survey agree that “competitive advantage will not be determined by their organization alone, but by the strength of the partners and ecosystems they choose.”
Identifying gaps and areas in core systems where it makes the most sense to integrate third-party technology is one part of the challenge. Equally important to finding the right technology solution is having confidence in the people behind the technology. … read more
A major study by Accenture spanning 15 years of research compiled across more than 70,000 claims reached a troubling conclusion. Nearly half of an adjuster’s day is lost to low value, non-core administrative work. What makes up a large portion of that waste? In a word, paperwork.
Managing the completion and submission of required forms for each claim—from locating the latest version of a required document, to rekeying claim data into multiple forms and letters—is a key driver. To make matters worse, submitting the wrong forms (or omitting required data) can lead to substantial fines. These fines, however, are not the only costs created by relying on a manual claims reporting process.
The Hidden Costs of a Manual Process
There are three financial impacts from a manual process that are often overlooked:
- The cost of finding data
- The cost of bad data
- The cost of data silos
Together, these hidden costs can be a substantial hit on any claims operation. … read more
The Importance of Technology Partners
Choosing a technology partner is increasingly becoming a more critical strategic decision for TPAs. In Accenture’s Technology Vision for Insurance 2017, 76% of respondents agreethat “competitive advantage will not be determined by their organization alone, but by the strength of the partners and ecosystems they choose.” Identifying technology solutions that support the company mission and differentiate your organization from the competition is an important part of developing an effective business strategy. … read more