A surefire way for property and casualty carriers andthird-party administrators to manage costs on both Auto andWorkers' Compensation casualty claims is to take a closer look atoptions for optimizing claims processing.

Companies often use disparate software solutions that don'tfully utilize their chosen systems, leaving gaps in the claimsprocess.

There are a few key actions that can be taken to optimize claimsperformance. From integrating bill review and claims systems, tousing a rules engine to promote low-touch processing, improvingclaims performance across the board helps companies manage costsand improve outcomes.

Here are six solutions for companies to consider.

Read on…

By using integrated platforms, insurers can better solvechallenges and manage costs. (Photo: Shutterstock)

1.      Integrate disparate technology systems

Take a look at your claims process. This might sound all toofamiliar: your claims management system is over here, your billreview platform is over there and your nurse review recommendationsare coming in from a completely different system altogether. Thisis how many companies find themselves managing claims – separatesystems that lack integration. When technology systems don't worktogether in unison, companies often miss cost containmentopportunities.

By using platforms that are integrated, your company can solvemany challenges and better manage costs. For example, when a nursereview system integrates with the bill review platform, a companycan be more confident that the nurse's recommendations are appliedduring the bill review process. When these two aren't connected,it's easy for nurse recommendations to get lost during theprocess.

When choosing any system to assist in your claims handling, lookfor platforms that integrate the various software and services yourcompany uses during the process. Using consolidated, robustsoftware systems will streamline the claims handling process, notonly making your adjusters' lives easier, but also helping toensure the company is consistently paying the most accurate priceon bills.

Related: 5 tech upgrades carriers must makein 2016

 Work with companies that have the technology andexpertise to optimize your networks. (Photo: Shutterstock)

2.      Rely on strategic partners

An important step in optimizing claims performance is providingyour adjusters with expert resources to help them make expertdecisions. You can have a sophisticated technological platform, butif your team doesn't fully understand the platforms they'reutilizing, then these outside resources are not being used to theirfullest potential. Often, industry experts are able to leverage awide variety of cross-carrier experiences to make recommendationson software technology and service utilization. While adjusterswill always be more knowledgeable on individual claim handling,it's beneficial to have experts take a holistic look at your use oftechnology within your claims process. Leveraging these experts'knowledge will help fine tune and customize your company's claimsperformance, in addition to enabling your adjusters to make betterdecisions.

For example, strategic partnerships can help improve efficiencyaround Preferred Provider Organization networks. When a carrier orTPA is the administrator for its own network solutions, a greatdeal of extra work is added since the company now has toindividually negotiate and reconfigure providers in the stack.However, by choosing a strategic partner with the access andexpertise to optimize the networks, companies remove the need tomanage this otherwise tedious process. Now the partner will providethe appropriate recommendations while handling the administrativetasks surrounding networks, greatly increasing efficiency andeliminating internal pain points.

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A visual dashboard can help adjusters to see the differentparts of a claim. (Photo: Shutterstock)

 3. Utilize embedded analytics anddecision support

Embedded analytics refers to visual or logical representation ofdata analytic content within business process applications thatdetails necessary intelligence to assist users in making optimaldecisions. One helpful tool is a visual dashboard that allowsadjusters to easily see different parts of a claim. By reviewingthe entire history of treatments for a claim, an adjuster can makebetter-informed decisions.

Embedded analytics are also valuable to the claims process whenadjusters are approving provider payments. The best way to improveefficiency in this area is to use a system that leverages clinicaldata to automatically flag a bill for a listed procedure that isn'trelated to an injury or diagnosis. This simplifies the process foradjusters and allows them to focus their time on flagged treatmentsrather than sifting through them in their entirety to decide whichto approve and which to deny. Additionally, this helps to make sureadjusters aren't inadvertently approving unrelated treatments. Byusing a system that flags treatments based on data, adjusters canimprove their efficiency and spend more time focusing on their mostimportant tasks.

Allowing programs to automate certain functions can expeditethe claims process. (Photo: Shutterstock) 

 4.      Select technological platforms that facilitateautomation

Each bill that comes through the system is different, so inorder to improve claims performance, it's necessary to chooseprograms that allow decision makers to automate certain functionswithin the claims process. A common way to help facilitate thisautomation is to use a rules engine that allows for flexibility indeciding which bills adjusters need to pay close attention to. Forexample, with a capable rules engine, you will be able toautomatically approve hospital bills under $1,000, while stoppingother bills that contain higher amounts or rare or unrelatedprocedure codes.  

Not only is it important to choose a robust rules engine, butit's also important to customize it so you're using it to itsmaximum potential. Time needs to be spent writing rules that helpyour business improve efficiency and pay the fairest price onbills. A good business and/or a technology partner can assist youin optimizing your rules library.

Another way to automate more of your claims process is to employtechnology that automatically applies the industry standard medicaltreatment guidelines. Systems that enable this process to happenautomatically increase efficiency and eliminate a pain point foradjusters when they review bills that fall outside of therecommended treatment guidelines.

Adjusters have a great deal on their plate, so by usingtechnology that facilitates customized automation within the claimsprocess, it's much easier to make sure they are only spending theirtime on important tasks instead of tedious paperwork. Appropriatetechnology also makes it easier to ensure that bills are approvedusing the company and industry-approved standards, saving money andhelping to prevent litigation.

Related: 4 steps that foster a cultureof innovation

 There are many resources available to helpadjusters make critical decisions as part of a claim. (Photo:Shutterstock)

5.      Help adjusters make expert decisions

By utilizing the resources available to empower adjusters tomake the best decisions, the company will start to see the bestoutcomes on claims. For example, in third party auto claims, aneffective way to do this is to supply adjusters with a liabilityand injury assessment platform that allows the company toincorporate their best practices knowledge and rules. This makes iteasier for adjusters to make and explain key decisions in attorneynegotiations, which ultimately helps keep costs down.

Another way is to use technology to help adjusterselectronically refer claims to Independent Medical Examiners (IME),nurse reviewers, or other review services. Facilitating thisprocess with a platform that relies on industry data to makeintelligent recommendations allows adjusters to make the correctdecisions about if and when a claim needs to go through outsidesteps. This also saves companies time and money by not referringclaims too early or too late.

Read on…

Once the various company systems are integrated, it iseasier to track progress or rising costs. (Photo:Shutterstock)

6.      Seek new ways to improve consistency

Lastly, building expert knowledge into the company's claimsadjudication systems is a great way to achieve consistency acrossthe board, and a consistent operation is one step closer tofunctioning at the optimum level. There are a variety of ways to dothis, from using enterprise-grade rules engines to building aknowledgebase into your liability and injury assessment systems,all of which seamlessly integrate the claims process.

Both auto casualty and workers' compensation claims costs can begreatly reduced once businesses integrate otherwise disparatesystems, leverage partner expertise and solutions, and incorporateintelligence and analytics into their process and workflows. Thesesteps not only increase the businesses overall productivity, butthey may lead to higher profitability and to empowering betteroutcomes.

Shahin Hatamian is the vice president of product managementand strategy of Mitchell International's casualty solutionsgroup.