The squeeze on workers' compensation costs has been dramatic, with medical benefits on lost-time claims tripling since 2003, according to the National Council on Compensation Insurance (NCCI), a U.S. rating and data collection bureau.
Informed claims management can help ease the pressure. The use of data access and standards provides structure that enables payors to better manage costs while delivering improved service to injured workers and their employers.
With informed claims management, payors such as carriers, TPAs or self-insured companies, can tap into pooled information and databases that are widely available and easily shared. They also gain newfound access to data such as processed medical bills that many have gathered but had limited opportunities to use.
The advances are long overdue. Unlike group health claims processing, which has always had policy definitions and benefit caps, workers' comp has historically had few limitations. There has been little structure for treatment requests and care authorizations. Even worse, payors have had few systems for measuring how an injured worker's treatment is progressing against norms.
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