Addresses Financial Impact of Disconnect Between Utilization Review and Bill Review
DataCare Corporation, a leading developer of software for the workers’ compensation market, announced the release of UR Enforcer™ . This new application augments traditional bill review services and has documented savings of up to an additional 20% of medical expenses by verifying bills against the treatments authorized in utilization reviews. For a company spending $10 million on workers compensation claims, adding the UR Enforcer to regular bill review could save $2 million on unauthorized medical payments. These savings have no effect on those treatments authorized by utilization review and that ensure a speedy return to work.
A recent study by Navigant Consulting conducted for the California Department of Insurance confirms the magnitude of the opportunity. Navigant reviewed a random sample of 373 medical bills and found that 27.4 percent of the sample dollars were paid in error. Navigant’s “Workers’ Compensation Medical Payment Accuracy Study (June 17, 2008)” is available at a DataCare’s booth at the California Self Insurers’ Association Conference on March 29, 2010 or found athttp://www.dir.ca.gov/CHSWC/Reports/2009/Navigant_Medical_Payment_Report.pdf .
According to Catherine Sreckovich, Managing Director of Navigant Consulting, “UR Enforcer represents the type of creative use of computer technology which we discussed in our “Workers’ Compensation Payment Accuracy Study”. We are encouraged by the development of this type of tool which we believe industry participants will want to evaluate.”
DataCare developed UR Enforcer in close collaboration with a California Fortune 100 firm that self-insures and self-administers its workers’ compensation claims. The firm was motivated to add this verification process after an internal audit highlighted a disconnect between utilization review treatment authorizations and the current bill review process. DataCare’s UR Enforcer is the first product to address this disconnect with automation. Self-insured corporations, insurance companies and third party administrators serving the workers’ compensation market now have a tool that minimizes this gap and its related financial impact.
“Current bill review systems apply appropriate discounts to medical bills and weed out obvious overpayments. But verifying that the final bill is for a treatment authorized by a utilization review is a manual process and subject to interpretation. UR Enforcer automates the process and flags questionable bills for a higher level of scrutiny,” said Paulo Franca Ph. D, President and CTO of DataCare.
UR Enforcer is offered as Software-as-a-Service (SaaS). The web-based software is HIPAA and SAS-70 compliant. UR Enforcer is part of DataCare’s software solutions for utilization review and case management applications for the workers’ compensation market.
About DataCare Corporation
DataCare provides software solutions that help the workers’ compensation industry better manage medical treatment and billing. Our users streamline their workflow and report saving time and money with better visibility into status, quality, and workload issues. Our sister company, EK Health Services, provides a complete line of workers’ compensation healthcare management services.