Between complying with the new regulations, mounting medical inflation and the need to find creative ways to manage cases, claims administrators everywhere have their hands full. As a result of added complexities in the claims world, the importance of increased organizational efficiency has never been as clear as it is today. When a company operates in an efficient manner, employees have more time to dedicate to customer service and the implementation of well thought-out strategies for managing their cases and getting solid results.
Businesses often rely on technology to automate processes and increase output. Making use of technology to support business efficiency is a hot concept but not a new one. The ability to store and retrieve data with the power of information at one’s fingertips is a reasonable expectation, but not one easily supported by most claims systems. This is only compounded by the prevalence of paper in our “paperless” world and a lack of communication between applications used to store all of the data. This reality leaves the claims professional responsible for manually tallying medical visits/expenses, comparing requested treatment with bills and trying to decipher bills and liens for a wide range of dates of service. All of this manual work can lead to overpayments, unnecessary litigation and a lack of strategic focus.
In keeping with one of our core values—innovation—EK Health Services®, Inc. (“EK Health”), in partnership with our sister company,DataCare Corporation, has worked to solve some of the common inefficiencies found in our industry. Claims professionals often find themselves spending time manually applying utilization review decisions to bill review recommendations to verify medical bills are paid correctly. This detailed process is an inefficient use of a claims professional’s time and is plagued with human error. Enter the UR Enforcer, DataCare’s proprietary technology solution that connects utilization review decisions with bills and automates this cumbersome process, while eliminating the possibility of human error. By utilizing advanced technology to support the UR/BR process, valuable time and effort is spared and savings are significantly increased.
The tedious task of manually comparing bills to UR decisions may be burdensome but it’s not the only aspect of workers’ compensation that could greatly benefit from a bit of technological efficiency. The process of reviewing liens against those same utilization review decisions, dates of service, and prior payments can be just as tasking. DataCare, once again, is at the head of the efficiency table with their technology-based solution for this time consuming work. The lien module captures all relevant paid information and matches those payments and dates of service to the presented lien information. The system then analyzes any existing utilization review decisions, statutory caps, and bill review allowances to make recommendations on how to proceed with the resolution of the lien disputes.
These are just a few examples of how EK Health and DataCare are continually working to resolve everyday problems with innovative, efficient and cost effective managed care solutions. We strive to be your first call when struggling with inefficient processes and/or workflow problems. We standby to partner with you and evaluate how our technology can bring efficient solutions that save you time by pairing expertise and technology while focusing on quality of care and bringing you the greatest cost savings.