For more information, contact the company at 415-498-2400, www.claimiq.com.

Sedgwick Cuts Claims Processing Time

Based in Nashville, Tenn., Sedgwick CMS (Claims Management Services) is a third-party administrator handling workers' compensation, disability claims, and some general and auto liability claims. It has about 4,000 employees and 50-some offices, not counting the employees on site at customer offices.

Sedgwick wanted to create a paperless workers' compensation claims processing system that would improve efficiency, consistency, and quality. The company decided to do a pilot test with MedRisk's CLAIMExpert service in a small office it has in Des Moines, Iowa. The results were met with approval, and Sedgwick now plans to convert all its operations by the end of 2006.

Efficiency – Sedgwick has professional examiners who analyze and investigate claims, and their time was being eaten up by administrative, routine duties. The TPA wanted to take the administrative function off their professionals' backs and give them information when they needed it, but only the specific information they wanted. CLAIMExpert's automatic electronic routing accomplishes just this. In the past, a case manager might receive a document that only the adjuster needed, and had to spend time resending it to the correct person.

Sedgwick also wanted to increase claim processing speed, and eliminating paper was a major first step. In the past, people had to open envelopes, read documents, determine where they should go, and send them not only to internal personnel, but also to one or more vendor partners. Often, that involved making copies then mailing or using overnight services to send them to external vendor partners. Time delays are big problems in workers' comp where indemnity payments come into play because companies can be penalized for failing to act within a given time frame.

With CLAIMExpert, the electronic document moves through a series of questions. If information is missing, the system automatically returns the invoice to the provider and requests the missing data.

The service can automatically approve straight-forward invoices and weed out non-compensable invoices, too. If the document meets the business rules test, it can be processed without going through a human.

Consistency and Quality — The business rules built into CLAIMExpert always use the same criteria to evaluate an invoice or other documents unlike humans, who may judge similar claim situations differently.

One immediate time and cost-saver is taking the mail room and file room out of all the Sedgwick's offices. Paper (and electronic) mail goes to MedRisk, who handles the scanning, indexing, etc. (Eventually losing the mail and file rooms will mean leasing less space and reduce FTEs). Plus, they have to keep documents for 10-20 years sometimes and have a warehouse, but it would take a lot of time to retrieve a document. Now, any security-approved user can go online and look at documents in the claims processed through CLAIMExpert.