Workers’ compensation insurance claim teams rely on many different service providers to perform various functions. While this provides efficiency to the process and reduces program costs, it can become daunting when finding the right partners. Now is the time to evaluate the processes involved in finding the right fit to ensure that the right service providers are in place. Failure to do so can result in program redundancies that only drive up program costs.
Roles of Services Providers for Claim Management Teams
Countless services claim management teams rely on in their day-to-day operations. Everyday needs of a claim management team include:
- Nurse case management services – a service provider that utilizes training nurses to be available 24/7/365 to triage work injuries and best direct medical care;
- Utilization review services – The review of medical care and prescription drug use is a key driver in costs. These service providers review medical best practices and make recommendations
- Private investigation services – this comes in the form of surveillance and background checks on injured employees to develop defenses to claims and sniff out potential fraud;
- Medicare Secondary Payer compliance services – Medicare Secondary Payer is a mainstay in all claims operations and is not going away. Services include Section 111 reporting, conditional payment investigation/resolution, and Medicare Set-aside allocation preparation/submission; and
- Defense attorney panels – the attorneys that defense the employer and insurer interests in workers’ compensation claims.
The list can be endless. It is time to re-evaluate how your team is spending money and if better service providers can be utilized.
Key Concepts to Keep in Mind
There are several concepts to keep in mind when selecting the right service providers for a claim team. Thinking about these concepts can force upper management to choose the right service providers.
- Efforts to Collaborate with Claims Team: The collective whole creates the best product ineffective claim management. The product is produced by input from people of diverse backgrounds and experiences.
- Motivation Through Incentives: It is basic human nature to be driven by the incentive to perform. This must include the need to be ethical and honest at all times. Failure to do so breeds contempt and bad faith exposure.
- Accountability: This is key in any relationship with a service provider.
- Use of Metrics to Measure Performance: Claims team needs to identify what they are attempting to fix, accomplish, or avoid when bringing on a service provider. Metrics should be established as part of the interview process with anyone brought in to provide a service.
- Communication: Issues that need to be determined beforehand include the method, frequency, and content of all communications. Establishing these criteria will drive better performance and assist in the evaluation of a service provider’s performance.
- Bundling of Services: All service providers should be open to building an al carte menu of services available. This avoids a “one size fits all” approach and allows claim teams not to duplicate services already being used.
Keeping these concepts in mind allows upper-level management of a claims team to locate the best service providers and reduce workers’ compensation program costs.
Finding the Right Partner
Finding the right partners for providing outside services should also include a review of several intangible factors. It is crucial to seek out this information in the interview process.
- Trust: It is important to ensure that the service provider you work with will conduct themselves ethically and honestly. Integrity is essential.
- Accessibility: Determine if the service provider has a point of contact. Set expectations as to when and how they will provide status reports.
- Consistency: Ensure the service provider can provide a consistent work product. The best way to determine this is via a pilot program.
- Stewardship meetings: Quarterly meetings regarding metrics is important. It is also a great way to see what values the provider has regarding providing high-quality products and services.
- Ongoing education and training: Every service provider should offer complimentary training on the claim team’s interest topics. It is also essential to review their delivery of these sessions when evaluating the value proposition and what they bring to the team.
Now is the time to implement and review these items when evaluating a new service provider or determining if current vendors add value to your claim team.
Service providers should add value to the workers’ compensation claim team. It is essential to understand their role within the claim resolution process so the right vendors can be added. When reviewing competing companies, it is important to look for flexible service providers, have integrity, and add value to the claims process. When this is done right, it can reduce workers’ compensation costs and promote settlements.
Author Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%. He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is the founder & lead trainer of Amaxx Workers’ Comp Training Center, which offers the Certified Master of Workers’ Compensation national designation.
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