Studies show that if workers' compensation claims are received early, that discipline alone can result in significant cost savings. Many organizations have tried to implement a strict policy of prompt reporting of injuries, but paper-based, manual processes slow down and disrupt the reporting process. A delay can negatively impact quality medical care, prompt investigation, claims payments and legal exposure.
Internet technology, such as a browser-based claims system, provides the infrastructure to make this process fast and easy. Employees and their supervisors submit claims information online--at anytime, from anywhere. As a result, claims are reported sooner and can be managed for optimal costs and care outcomes.
In a call-center scenario, organizations must maintain two systems--one for the call center and another for claims, which requires a complex interface to share information. However, by leveraging online reporting, organizations streamline into an efficient one-system approach.
With the advent of intelligent online claims forms, the use of Internet reporting is now dramatically increasing. These smart forms use drop-down lists, auto-populated fields and threads of logic to navigate users quickly through the electronic claims submission process. Due to their intuitive, user-friendly design, online forms are faster than a typical phone transaction.
Web-based transactions not only provide organizations with nimbleness, they also provide savings. Using a call center, the injury reporting process costs $16 per claim on average, but Web-based reporting costs about $3 per claim.
Another benefit is that online reporting enables organizations to initiate a truly paperless claims process. In this data-driven environment, information is entered once and made available to all parties via an enterprisewide electronic infrastructure. This paperless paradigm has expanded as organizations integrate optical character recognition, digital photos, videos and audio files.
On the back end, Internet technology--such as Web services--automatically retrieves and verifies data. For example, Web services can access personnel records in real time to verify employment status, automatically fill data fields and confirm coverage via the Internet.
Online reporting also assists with legislative compliance. For example, many states have EDI reporting requirements. Browser-based platforms allow organizations to transmit EDI-required information to respective state agencies.
In addition, many workers' compensation processes have mandated timelines. If deadlines are not met, organizations face stiff penalties. Integrated scheduling tools track the statutory time frames that begin once the claim is reported online and automatically alert adjusters when deadlines are approaching and when specific actions must be taken. As a result, adhering to statutes has becomes highly efficient, helping organizations eliminate fines.
Organizations don't have to worry about losing the "personal touch" in this electronic process. Online reporting actually triggers a host of automated business rules. These rules route incoming claims to the appropriate claims expert so claimants receive a high level of service.
For example, business rules alert nurse case managers so that they accompany employees to the initial medical visit and begin timely communication with the employee and physician about a treatment plan. Rules also engage the return-to-work coordinator to provide appropriate modified duty assignments to facilitate early RTW results.
Finally, online reporting captures the full range of workers' compensation data, so organizations can analyze losses and improve performance. Internet technology makes reports easy to access, customize and distribute. Using this intelligence, organizations have applied safety initiatives to injury-prone areas, thereby reducing claims. These data analysis capabilities have empowered some organizations to reduce claims costs by as much as 65 percent.
Many early adopters have achieved 100 percent same-day reporting and found that the Web-based reporting provides additional opportunities to improve efficiency and cost savings?all while building better relationships with claimants.
RANDY WHEELER is managing director of Aon eSolutions, and founder of Valley Oak Systems.
July 1, 2008
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