DataCare is proud to present its latest release for Adjusters and Claims Professionals: UR++ 1.4 WHAT'S NEW Adjusters/ Claims Professionals come across several Request for Authorizations (RFAs) each day, and some cases may require additional attention. For this reason, the latest version of UR++ enables clients to incorporate a best practices ruleset to make [...]
The Bill Review or BR process consists of several stages that require close monitoring to ensure repricing and payments meet the state mandated turnaround times. BR Specialists may keep track of when bills come into the system during the KFI or Key-for-Information stage, but the high volume of reviews can make it difficult for them to [...]
DataCare takes pride in being able to support many companies including Ascential Care in achieving an optimal day-to-day workflow for Case Management and Utilization Review. Ascential’s need for software first arose when they began operating in the managed care industry and manual data entry was an unnecessary evil they initially faced. The lack of a [...]
Companies involved in Workers’ Compensation will typically use Utilization Review, Case Management and Claims Management software independent of one another. The Ahshay core software platform achieves higher efficiency, savings, and detailed reporting by combining these modules under one platform. Within DataCare‘s core platform Ahshay, Utilization Review, Case Management, and the claim enhancing Medical Process [...]
Time after time, adjusting offices find themselves asking the same question: “Should we approve this request for physical therapy, or is it worth sending to UR? We usually just go ahead and approve these, but we have been seeing PT requests for this patient pop up an awful lot this past month… Let’s just [...]
In an effort to reduce the delays incurred during the treatment process for injured workers, the DWC has been continuing to update medical guidelines to align with the workers compensation drug formulary as required by Assembly Bill 1124. DIR Director Christine Baker mentioned that the drug formulary will serve as a guide for medical [...]
Source: WorkCompWire San Jose, CA – DataCare’s recently announced that its web-based workers’ compensation case management software is integrating the Reed Group® MDGuidelines. MDGuidelines offers: Real-world and physiological return-to-work duration Predictive modeling of return-to-work duration Medical monographs for clinician reference and patient education State treatment guidelines for workers’ compensation Leave of Absence Advisor™, a [...]
Top Factors Impacting Return to Work Some might think that determining when a disabled patient will return to work is a matter of luck. Fortunately, you don’t have to roll the dice to have an estimate on how long someone will be out of commission from a disability or injury. Through years or collecting [...]
$8 million loss… Where did it come from? As of March 10th , 2016, several third-party administrative agencies face over $8 million in fines for allegedly failing to provide necessary medical documentation in time for independent medical review (IMR). A great deal of risk is involved when managing a large database of medical records [...]
Workers comp administrators receive 200 to 300 bills a day which need to be directed to adjusters. However, the adjusters don't necessarily review the bill, even though numerous incidents occur when they are sent out for the wrong reason. Some of these reasons may include a bill for unnecessary treatments, fee schedules changing frequently, or even [...]