Claim Management Strategies
Our claim management strategies help manage costs by offering a comprehensive approach that ensures your injured employees have access to first-rate medical care while protecting your bottom line.
Specialized Medical Audit and Review Team (SMART)
Our Specialized Medical Audit and Review Team (SMART) provides a review of medical bills not always possible with automated medical payment systems. With this process, over 25% of medical bills submitted are reviewed by a SMART medical bill analyst who specializes in the workers compensation medical field.
The team also proactively identifies trends that have a negative impact on workers compensation costs, such as commonly made mistakes or medical fraud.
When a new trend emerges, we refine our automated system to incorporate it. We can also work with regulators to combat questionable billing practices and abuse.
Early Severity Predictor
Effective pain management presents a significant challenge for healthcare professionals and their patients. In America, more than 100 million are burdened with chronic pain – more than diabetes, heart disease and cancer combined.
Our Early Severity Predictor® model identifies an injured employee’s likelihood of experiencing chronic pain using weighted predictors at key points during the life of a claim. This provides opportunities for intervention on potentially high-risk and high-cost claims. This proactive claim management helps get the injured employee the treatment they need so that they can return to work as soon as medically appropriate and avoid potential opioid misuse.