According to the Self-Insurance Institute of America, more than 6,000 corporations and their subsidiaries across the United States operate self-insured workers’ compensation programs. They typically do so in order to control costs and ensure their injured employees get proper care in a timely manner.

But since workers’ compensation claims go through multiple steps in multiple systems, at each point of intersection there is a chance for inappropriate payments or leakage. Examining and verifying claims every step of the way is time-consuming and error-prone. To address these inefficiencies, Acrometis developed CLAIMExpert, our claims processing solution that offers unparalleled workflow management, with documents automatically routed by a configurable rules engine. Based around claim assessment scoring, body part to claim compensability matching, jurisdictional directives, relatedness and rarity scoring and a host of other claim elements, the Acrometis business rules are designed to reduce claim duration and costs.

To illustrate how CLAIMExpert can improve a business’s bottom line, let’s examine a real-world case study.

Our client is self-insured with more than 6,500 stores across 11 countries. This client’s manual processes were overwhelming their adjusters, who were being presented with 100% of their medical bills. Subsequently, bill-review costs were incurred on 100% of those medical bills. Bills were not being adequately screened for appropriateness.

They came to us looking for ways to automate existing manual processes that were slowing them down, reduce their reliance on bill review due to significant associated fees, and decrease their overall costs.

By implementing CLAIMExpert, we were able to auto-adjudicate 70% of all document types before bill review (leading to significant adjuster efficiency gains). Our solution’s proprietary business rules (including treatment-based rulesets) identified 26% of medical charges that were presented to adjusters for possible rejection. And 78% of system-identified, message-based rejected bills did not return for payment (leading to significant medical and bill review savings).

In the first year, our client experienced a 21.4% reduction in medical spend. In the second year, that reduction grew to 25.5%. And by year three, they enjoyed a whopping 26.6% reduction in medical spend.

The reduction in spend increased year-over-year due to modifications in business-rule sensitivity, our performance measures of vendors, and auto-approval of certain procedure sets and providers. Plus, the treatment-based rules we implemented now account for 42% of message-based rejections.

This company, like so many others, was utilizing resources on functions that could easily be automated. Instead of wasting time on routine tasks, their adjusters now have a huge part of their day back to focus on closing the problematic and complex claims. They enjoy cost savings on bill review as well, since our system is able to identify bills that should never have been submitted to bill review in the first place (and resulted in fees associated with the bill review process being errantly paid). Finally, they are seeing a significant reduction in medical spend – a number that continues to improve as we tailor our system to their growing and changing business needs.

CLAIMExpert can fix inefficiencies in your company’s claims process, while reducing medical spend, just like it did for the self-insured retailer cited in this case study. We can help you gain control over your provider networks and increase the power of your adjusters.

If you want results like this for your business, take the first step by calling 1-855-282-1476 today.