Here are some of the common myths of workers’ compensation.
|Bill review only pays for approved treatments.
We see overpayment of 10-14% of medical costs after bill review reduction when UR enforcement is not automated. Are you paying for unauthorized treatments? When was the last time you did a bill review audit?
|UR is too expensive. Don’t send anything to UR.
Approving all claims will over the long run drive your medical costs sky high. A balance is needed because if you don’t have a UR. Your medical costs are going to be too high. But, only about 20% of your claims should go to UR.
|My medical provider network (MPN) and pharmacy provider network (PPN) is following my business rules.
DataCare provides provider scorecards for MPN and PPN networks. We move the discussion from “This guy always is over the limit” to “84% of the time his treatments are over the limit.” If you knew another provider was over the limit 90% of the time, would you keep them in your network? DataCare provides the data that allows you to take action against the bad actors in your network.
|My claims are under control.
Our alarm bells go off when we hear everyone saying “My claims are under control. Those other guys are just not doing a good job”. Often this is based on a warm and fuzzy feeling rather than hard numbers and understanding how they compare with industry standards. Is your pharmacy cost 1-5% of your medical cost? We suggest doing a bill review and pharmacy audit every three years. When was the last time you did an audit? DataCare customers have the data and can run the reports frequently to continuously monitor for problems
|Every claim should go to UR.
There is a limit to how much you can lower your medical costs, so it does not make sense to spend more than necessary on UR. We provide the data to evaluate and Express Approve claims where a UR will not save you money at the adjuster or triage level. Do you know where your savings are coming from?
Care for the data?
We provide the actionable data. Claim demographics, faxes, emails, letters, reports, notes and medical records are all available for a single, unified view of claim demographics that allow supervisors to easily reconfigure workflows, quickly query information and analyze data.
DataCare’s Software Application Modules
- Case Management
- UR software
- UR Enforcer
- Express Approval
- Claims Assistant
- CA Lien modules