How Your Carrier or TPA Should Process Claims Intake

It is pretty hard to be proactive on your injury claims if you struggle to get the claim to your carrier/TPA. Several Carriers now have a complete, customizable system to make this task easier on you the employer.

In the past, if an injury occurred you would pick up the phone, call the carrier or your agent, and give them the pertinent information over the phone. From there, those people would complete the injury report and the job would be complete. Nowadays, the need for information has become more and more prevalent.

Different Ways Carriers/TPAs Should Accept Claims:

1. Email the claim info to the intake center

We live in a world of electronic communication. This form is not only faster, but more efficient. Carriers give their insured’s forms to complete, and then they can scan and email them to the intake email address. This also gives the employer a copy of the information, so they can keep it on file. This is a fairly failsafe option, and very common in the insurance world. [WCx]

2. Fax an injury report to the carrier

If email is not your thing, most carriers will supply you with forms to complete and fax to your intake center. This is a fairly easy task, but it can lead to some problems. Because they can be written out by hand, faxing can make the print hard to read for the carrier employee to input into their system. Even worse is when the employer does not complete all of the necessary fields. This stalls the claim, because the carrier employee has to call the employer and confirm the information that they need for claim setup. Submitting claims via the fax machine is no longer the preferred option. Carriers make it an option, but rarely will they prefer fax over the other electronic forms of communication.

3. Call the injury details in to your carrier or agent

Even in today’s electronic world, calling in the claim is still a very popular option. Calling the claim in is a bit more labor intensive for the employer, but there is comfort in actually talking to someone. If requested, carriers will give you a dedicated phone line to call which goes right to their intake center. Top carriers/TPAs will offer adaptable call scripts to ensure questions specific to your business are answered every time..

4. Submit the injury report via the internet

Most carriers can provide the employer with a secure website in order for the employer to report the claim. This way the employer sees exactly with the intake employee would see from the carrier side, and if you do not have all of the information that the page needs you can always save your work and come back to it once you have the information that is needed. This eliminates a phone call, being placed on hold, and repeating information to the intake employee.

After you submit the claim you will receive a tracking number that is verification the claim was received and will be assigned to an adjuster. This has become a common form of injury claim reporting and it has proven to be efficient.

5. Submit the claim information using intake software

As popular as website reporting has become, the new wave is giving the employer the software needed to report the claim direct and right into the new claim system the carrier uses. Almost all carriers/TPAs use a type of claims software to handle their claims and intake process. To make themselves more integrated with their insureds they have allowed employers certain access to this software, including the ability to report a new claim. This process has many benefits It has decreased phone calls for both parties, and it allows the employer to see into the claim and some of the claim notes to find out whatever info the employer is looking for, be it wage information, injury reports, loss runs, reserves, and the like. The employer will not have access to the entire claim due to HIPPA privacy laws involving medical records, but they will have a lot of access for the most part. This is the current trend, and more and more carriers are marketing this as a way that can separate them from other carrier competition. [WCx]

6. Key points to remember when submitting a claim

No matter how you choose to report the claim, you have to be sure of a few things prior to reporting. Make sure you have all of the information the carrier needs, including date of birth, social security number, claimant address, injury details, wage history if applicable, the last day worked, the return to work date, if you have light duty work for this employee, the employer address and contact person, contact person information such as phone number and email address, type of injury, and so on. Without all of this information submitted with the claim, the adjuster will have to contact the employer to obtain it. No matter how insignificant the injury, these are all facts the adjuster will need in order to do a proper investigation into a claim. A lot of times the insignificant claims are the ones that can turn into more severe claims when conditions warrant.

7. Key points to look for from your Carrier / TPA

• 24 / 7 reporting
• Escalation Procedures for Critical Claims: Critical losses require immediate attention, ensure your carrier/TPA has established procedures for once the claim intake is complete.
• Immediate Distribution of Confirmation Letter: Necessary for you to confirm and acknowledge the information delivered during intake.
• Integration with the Claims Management Process: The intake process has to be integrated with the claims management process for the system to run on an optimal basis. Any breakdown in this structure will lead to less than perfect results.

Summary

Having a streamlined claims intake process is not only beneficial to the employer, but also to the carrier as well. By being able to have the information they need, the adjuster handling the claim can hit the ground running and work on ways to be proactive on the claim rather than being slowed down chasing information. The first days in a claim are often the most vital, and any steps you as the employer can take are the most important. You will see claim expense savings sooner by being thorough rather than by being complacent about the whole process.

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.

Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.

WORKERS COMP MANAGEMENT MANUAL: www.WCManual.com

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

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