The Official Disability Guidelines (ODG) established by the Work Loss Data Institute play an important role in every workers’ compensation case. ODG provides unbiased, evidence-based guidelines that support payers, providers, employers, and auto insurers as they guide injured workers back to health.

ODG provides the statistical data set and recommendations to support best-practice strategies in workers’ compensation claims management. 

Typically, the use of the ODG standards can be accomplished through direct interaction with the ODG website. This process requires professional medical or claims staff to manually review the guidelines, claim activity, and medical bill processes. Utilizing the ODG data in a manual workflow process is therefore quite time-consuming and doesn’t allow for the monitoring of all key aspects of the claim in real time.

That’s where Acrometis comes in.

The Acrometis CLAIMExpert platform translates the ODG statistical data set and distills the information into automated processes for each claim. The automated recommendations and real-time claim monitors are based on claim activity. Automated notifications are triggered when claims are identified as deviating from the expected ODG guideline. The same automation is applied to customized parameters established by the claim professionals.  

Evidence-based ODG guidelines are applied to claims based on ICD Codes and take a best-practice approach to claims management, assisting with reserve oversight. The tool automatically flags services that exceed recommendations or user-defined allowances, as well as claims that may be candidates for nurse-case management, etc., triggering a referral if necessary.

CLAIMExpert is a robust claims-processing solution offering unparalleled workflow management, with documents automatically routed by a configurable rules engine. Rule sets cross all three facets of the claim (Indemnity, Medical, and Expense) and include capabilities such as claim-assessment scoring, body-part-to-claim compensability matching, jurisdictional directives, relatedness scoring, and a host of other claim conditions. Using a proprietary set of workers’ comp processing rules, the Acrometis system is designed to reduce claim duration and all loss costs.

CLAIMExpert automatically processes up to 70 percent of incoming medical bills and non-medical documents with no user intervention. Documents requiring adjuster attention are flagged and sorted for easy review and straightforward decision making.

Acrometis is a leader in powerful workflow automation tools and MCG Health’s Official Disability Guidelines (ODG) are the most comprehensive treatment and return-to-work guidelines available. We take their expert capabilities beyond the database level and integrate them into our solutions via a powerful visual fashion that helps the adjuster track the claim against similar cases. Clients understand how their claims are progressing against benchmarks in real time and can take the necessary actions to keep them on track.

With Acrometis and ODG integration, you can expect to shorten treatment delays and reduce disability duration. Our system’s reserve-setting feature allows for more accurate reserves.

Real-time claims monitoring allows for early detection of potentially problematic claims. And our algorithms identify comorbidities and auto-adjust the guideline recommendations.

Don’t get left behind. Equip your adjusters with a cohesive platform and keep up with changing business environments, while enhancing your claims operations. To learn more about Acrometis and ODG integration, or to request a live demonstration, visit acrometis.com or call 1.855.282.1476.