Integration with DataCare’s UR/Case Management system creates a fully integrated system for applying evidence-based medicine to workers’ comp claims.

American All-Risk Loss Administrators (AARLA), a leading third party administrator and provider of claims services, has selected DataCare’s Express Approval software, part of DataCare’s Ahshay® platform, to facilitate workers’ compensation treatment authorizations made by their claims adjusters.

According to Steve Wigh, President of AARLA and its affiliated company, Total Managed Care, “The investment in Express Approval is part of an ongoing program to bring cutting edge technology solutions to our organization. This is essential to achieving our mission of helping clients get injured workers back on the job more quickly without unnecessary medical expense, and has provided me the operational and audit reports I need to track examiner approvals.”

With the addition of Express Approval at AARLA, both AARLA claims examiners and TMC nurses are now able to see a claim’s full treatment history in an easy to use dashboard when making treatment approval decisions. The benefits Express Approval has brought to AARLA include:

  • A pick list of treatments for claims examiners. Examiners do not need to know medical codes or answer complex medical questions.
  • Automatically applied client business rules and state specific mandates. Multiple business rule sets can be established to support organizations operating in multiple locations and/or jurisdictions.
  • A UR and Bill Review integrated treatment history dashboard containing:
    • Treatment request history including UR approvals, denials, and claims examiner express approvals.
    • Bill review history of what treatments were actually paid for.

AARLA’s affiliated company, Total Managed Care, implemented the DataCare utilization review and case management platform in 2011. According to Denise Glessner, Director of Managed Care at TMC, “The DataCare utilization review (UR) and case management platform has helped our nurses apply evidence based guidelines more consistently while increasing productivity. Express Approval is further enhancing TMC and AARLA’s ability to apply appropriate treatments quickly.”

DataCare’s Express Approval supports:

  • A quick UR referral option if the treatment request needs to be escalated to a nurse or physician.
  • Approval letters are automatically faxed, emailed, or queued up to be mailed to required contacts.

Treatment codes, quantities, and date ranges are captured in a structured database that can be used to develop robust audit, operational, and client facing reports. According to Dr. Paulo Franca, President and Chief Technology Officer of DataCare Corporation, “Our system offers decision support for human judgment of the complex treatment needs of workers comp claims.”