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STRIMA 2007 Conference“Maine: Downeast and Different”
September 9 – 13, 2007Portland, Maine
Mon, Sept. 10
3:00 – 4:30 pm
Images, Ghosts and Picture: Document Management Solutions
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Your Guides
James Wedster Vice President of Product Development Valley Oak Systems, Inc.
Christopher Schaffer, EsquireVice President, National Sales CorVel Corporation
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Agenda
The Case for the Paperless Claim File Document Management (DM) in the Claims Process An Electronic Infrastructure for DM CIRMA Case Study: Integration for Improved Workflow City Case Study: DM Tools and WC Best Practices Developing Your Own Paperless Path Q & A Session
The Case for an Interactive
and Fully Electronic Claim
File
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Initial focus was on importing documents into claim file
Ongoing focus will be on fully automated claims systems that take advantage of current technologies and provide a single platform for communication by all stakeholders
Beyond Scanning & Imaging
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Operating efficiencies Advanced technologies
Artificial intelligence Rules based engines
Storage Security Enhanced reporting and information sharing Improved results and effectiveness
Why Change the Process?
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Map out your claims process Critically analyze each step
Why do I do this? Can I automate? What value is added?
How can each step be effectively and efficiently coordinated to reduce process time
Where to Start?
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Items to Consider Incorporating into Electronic
Claim File Process First Notice of Loss Nurse Case Management Medical Bill Review RX/DME Appraisals Recorded
Statements/VOIP ISO Indexing
Diagnostics EOB/Check Writing OSHA Reporting and
Tracking Payroll Systems Photographs Positive Pay/Check
Cashing Reserving Worksheets
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Project Implementation
A well-designed electronic claim file and document management system should enhance the process - Not add to the process
Implementation should be staged to avoid information overload
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Recognizing the Paradigm Shift in Claims Adjusting
In the past, the effectiveness of your claims administrator was results driven
Now, in addition to results, claims administrator is now responsible for data integrity, computer measured benchmarks, OSHA reporting, paying medicals within XX days, etc.
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Unfortunate Reaction
Adjusters have become box-checkers and data input clerks
Intense focus on objective automated measurements Three-point contact Compensability determined within XX days Average medical turnaround Closing ratio
Substantive, proactive claims adjusting has become secondary because results aren’t easily measured
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Implementing for the Future
Implement in a way that promotes focus on substantive claims handling while assisting adjuster in box-checking, data integrity and file documentation Use audit tools Rules-based auto routing Letter writers
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Invest in Technology to Support Process or It Will Not
Be Used
Dual monitors to reduce screen flipping Size of monitor – No zooming in Effective and common sense document
management Ability to insert notes or comments on
correspondence Speed of delivery Speed of system – Load time/storage capacity
Document Management
in the Claims Process
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Originally, a system used to track and store images of discreet paper documents
Evolved to a systematic approach for storing, accessing, and tracking information electronically
Key characteristics of document management (DM): Ability to manage information, collaborate when creating
information, distribute information, and allow secure access by relevant parties
Supports a wide spectrum of “less paper” to “paperless” work environments
What is Document Management?
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Inefficient workflow and business processes hamper productivity Time-consuming, labor-intensive tasks, e.g. repetitive data entry Inability to achieve end-to-end automation, straight-through
processing Difficulty in accessing and sharing data across the enterprise High operational costs (paper, copies, storage, and personnel) Lost documentation, due to physical transfer, storage and retrieval Inconsistent application of best practices in paper-based
environment Lag time in communication and collaboration among stakeholders Slow transactions impact customer service and satisfaction Inability to analyze and report on trends that affect costs
Traditional Claims Challenges
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30 years ago the term “paperless office” first appeared, based on belief technology would eliminate paper
Today, paper consumption at 100-million tons a year Associates may be at different stages of paperless
path, need to accommodate their paper processes Consumers are tech-savvy, demanding more
paperless, web-based transactions For now, total elimination of paper is unrealistic; but
moving closer to a paperless environment has many attainable benefits and reward
Paperless Claims: Realistic or Unattainable?
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Claims Management Policy Administration Underwriting Risk Management Incident Reporting / Event Management Billing
Delivering Value to Paper-based Processes
An Electronic
Infrastructure for
Document Management
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Types of Technology
Software as a Service (SaaS) / Browser-based
Technology
Software as a Service (SaaS) / Browser-based
Technology
Workflow Management
(Business Rules)
Workflow Management
(Business Rules)
Scanning, Document
Imaging, OCR, Digital Photos
& Video
Scanning, Document
Imaging, OCR, Digital Photos
& Video
EDI, XML, Web ServicesEDI, XML,
Web Services
Internet Tools: Email, Hyperlinks
Internet Tools: Email, Hyperlinks
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Yesterday’s Paper-based Processes
Claims
Bill Review
Policy
Imaging
Medical Mgmt
Accounting
Users
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Today’s Electronic, Internet-based Infrastructure
InternetCentral
Repository
Hub
•Claims•Bill Review•Imaging•Policy•Medical Mgmt•Accounting•HR
One-System
Users
Server
Business RuleWorkflow
Connecticut Interlocal Risk Management Agency
An Integrated Environment for Improved Workflow
Case Study
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CIRMA: Updating IT for Document Management
Success One of the largest, most sophisticated public-entity
risk management pools in the nation
Grew 600% since 2000, business environment became more complex
Legacy systems couldn’t keep pace in terms of functionality and capacity level
Integrated claims and policy administration system was key priority to achieve DM efficiency across enterprise
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With Exponential Growth, Increased Claims Capacity
Went from 12,000 to 22,000 claims a year
Needed to handle increased capacity without increasing human resources and without impacting quality and performance
Previous Claims System
Labor-intensive, paper-based business processes
No web-based capability (e.g. no online reporting of claims)
Policy Administration
Two disparate systems, multiple interfaces with claims system
Difficult to access, retrieve and update policy information
CIRMA Claims Challenges
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New System’s DM Tools Deliver Process Efficiencies
Truly web-based, integrated claims and policy system Enable integration and document management across core
business units
Flexibility to meet CIRMA’s unique document management requirements
Created an end-to-end electronic platform that integrates all relevant insurance processes
Established a centralized data repository, making it easy to access and share information
Business rules define and automatically manage workflow: right people receive the right information at the right time
Contemporary tools enable automation and paperless processing
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Before: Disparate Environment
LAP Underwriting
WC Underwriting
Finance(Great Plains) Claims
Two Underwriting Systems
First Notice of Loss
Managed Care
SIU Support
External Users(Members and Staff)
CITRIX
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After: Integrated Infrastructure
Finance(Great Plains)
First Notice of Loss
Managed Care Services
SIU System
External Users(Members and Staff)
EDI
Internet
EDI
Claims & Policy Hub
Internal Environment
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Enterprise Connectivity
Claims Adjusters
Admin Assistant
NurseCase
Manager
Risk Control
Under-Writing
Members
Finance
Business Analyst
View-Only ClaimsImproved connectivity and sharing of information among all stakeholders
Document Management
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Benefits & Savings
Claims Reporting Via Call Center CIRMA Online Process
Costs $16 / claim $3 / claim (anticipate 20% of 22,000 claims a year)
Admin Costs Industry Average CIRMA Benefit
Ratio 22 cents / premium $ 13.6 cents / premium $
Reports Paper Distribution Online Distribution
Distribution Takes 3 people 2 weeks to run quarterly reports, which stand 3 feet high
Automatic scheduling and distribution – save time, resources, paper & hassles
Integrating DM Tools for WC Best Practices
Case Study
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City Profile
7th largest City in the US, 11,076 employees Self-insured, self-administered WC program
$23.8 million in workers’ comp claims costs Expensive! Effective claims management best strategy to
control costs and losses
Needed DM tools to enable more efficiency and identify high-cost, high-risk areas for loss control
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“Before” Picture
Legacy System Paper and labor intensive Lack basic functionality Little automation of routine,
low-value tasks Inconsistent data collection
and reporting Band-aid approach in rapidly
escalating cost environment
Desired DM Best Practices Seamless claims reporting DM efficiency leads to
manageable caseloads Support for more automated
processes DM data collection will help
identify high-cost, high-loss claims areas
Results: Inability to report outcomes = Inability to influence outcomes =
high claim costs!
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Leveraging DM Tools
Document Management Tools: Avoid generation of paper in the first place: injuries reported
immediately to call center and interfaced into claims system Automated business rules drive best practices Auto-populated correspondence with claimants Diary-driven claims examiner workflows Electronic interfaces maximize efficiency and information flow
Enable Data Reporting and Effective Management: Accurate data collection through required fields Identify trends to target with safety and loss-control initiatives Monitor key performance measures to track success
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“After” Picture
Seamless alignment of technology and DM objectives Electronic import of new injury reports
Reduces injury reporting from 4 weeks to 24 hours Automation of bill review and payment
36,000 automated payments annually Bill review savings:$10.8 million in year after DM implementation
Maintain 1:1 open to close ratio Diary driven workflow increases efficiency and productivity Immediately closed 700 claims, reducing examiner caseload
Distribution of quarterly reports help agencies to control costs DM data collection helped reduce claims by +6% over four-year period Costs reduced by $2.4 million in year after DM implementation
Developing Your Own Paperless Path
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Document Management: Success Strategy Summary
Online data capture avoids generation of paper in the first place Leverage scanning, document-imaging and OCR capabilities Utilize digital files where possible (PDF, photo, video), attach them
to electronic claims file Embed DM capabilities within workflow management, ensures
right person gets the right information at the right time Create an enterprise-wide electronic infrastructure
Browser-based technology Centralized data repository
Utilize connectivity tools (EDI, Web services, the Internet) to further streamline business processes and the flow of information
Leverage data to improve decision-making and program performance
Questions & Answers
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Contact Information
James WedsterValley Oak Systems, [email protected]: 925-242-4600
Christopher Schaffer, EsquireCorVel [email protected]: 843-937-4900