Property & casualty and health insurers overpay injured people an estimated $15 billion a year because each sector of the industry lacks information about claimants that only the other side has, according to Stephen Ambrose, CEO of ICEX, an insurance information-services company.
To plug that gap, ICEX has developed ClaimCatcher, a cross-claims data exchange designed to reduce overpayments for medical and injury claims.
“For the first time, P/C insurers will be able to tap into an injured claimant’s medical claims history from health insurers to verify preexisting injuries related to the current claim,” says Ambrose.
Separately, health insurers will be able to find out when their members have filed injury claims with p&c insurers. The health insurer can then subrogate against the member.
ClaimCatcher complies with HIPAA and NAIC model regulations and the most stringent state insurance laws on privacy, claims and data, according to Ambrose. The technology will be used by p&c carriers, health insurers, Medicaid, self-insured employers, and workers’ compensation carriers.
Between 0.5 percent and 1.0 percent of all paid medical claims result in subrogation recoveries, according to CIGNA. Relying on predictive analytics and form letters, Medicaid and commercial health plans recover less than $2 billion annually, perhaps only 25 percent of what’s available, Ambrose explains.
Because ClaimCatcher doesn’t rely on claimants to personally validate their involvement in a claim, widespread adoption of the technology could eventually boost recoveries to nearly $9 billion, Ambrose reports.
Almost 39 million injury claims are filed annually and payouts from all p&c insurers total nearly $180 billion a year, according to A.M. Best. Using ClaimCatcher’s process, p&c insurers can request and match up prior medical claims related to the claimant’s current injuries. Ambrose believes better identification of preexisting conditions can save P/C insurers $7 billion and slash overall claims costs by nearly 4.0 percent.
“Overpaying claims is unfair. It costs insurers, employers, taxpayers and insureds a fortune. Providing a new level of transparency will make claims management far more accurate and fair,” says Ambrose.
ClaimCatcher is expected to become available during the second quarter of 2013. ICEX is currently looking for a strategic partner to help deliver its proprietary technology to the insurance industry.