Incident reporting, absence management, and the claim intake associated with these processes can prove challenging for most larger businesses. Are claims falling through the cracks? Could these lead to unnecessary legal action against your company? Is your organization losing valuable time as a result of a lacking absence management program? To learn how these solutions can improve your bottom line, check out these popular blogs:
Author: Andrew
Catastrophe Reporting: Weathing the Storm
How can your business handle FNOL call volume in the event of a catastrophic incident? Outsourcing all specific-incident calls or general overflow to claim intake professionals will dramatically reduce the likelihood of long wait times, missed claims, and other volume-related issues. High bandwidth technology including fiber optics, VoIP switching, and cloud storage allow for greatly increased call handling efficacy. Further, custom scripts that capture critical information and automatically transfer to a central database for access and reporting will mean that your business is never in the dark. These are a few of the many attributes crucial to expert catastrophic incident reporting. To learn more, contact us.
Insight into the Incident Reporting Process
The companies providing full-cycle claim and incident reporting solutions help insurance carriers, self-insured companies, third party administrators and managed care organizations to improve their productivity and reduce costs. Cost-effective insurance
claim reporting management depends upon the efficiency of collecting accurate information for the first time, when the incident occurs. The incident reporting process includes the following steps:
- Analysis of the current process:
The company uses the best practices to make a complete and fully organized report providing various reporting channels such as telephone, e-mail, fax and even electronic file
submission. They respond quickly to critical incidents and prepare customized plans specifying data collected and formats of reports, detailed recipient notification and other vital details.
- Reporting of the incident:
The company’s specialists are available 24/7, 365 days a year for the first notice of loss to handle worker’s compensation, short-term and long-term disability claims. They develop a step-by-step documentation of all records to provide a complete audit trail for every type
of contract received.
- Converting claim reports into actionable information:
After intake of necessary information, the company helps close claims quickly by providing essential services. Some of these services include triage to ensure escalation of critical situations, performing medical coding, duplicate checking to flag matches, quality assurance reviews, follow-up completion of claims and many more. Claim number assignment is also done to track notices from the company according to your rules.
- Expediting completed reports to key recipients:
The incident reporting process does not end at a claim’s closing, but also includes expedition of completed reports to government agencies in formats like EDI, mail, text message, phone or e-mail. The insurance claim reporting services provider maintains all
current state FROI for worker’s compensation and performs all state filing procedures of FROI and subsequent reports of injury and medical bills.
- Managing risk effectively:
Complete and timely incident reporting results in reduced claims paid out, lower claim handling expenses, and decreased costs. A complete overview of your organization helps to identify and manage risks more effectively.
FNOL for Your Business
Different organizations require individualized FNOL solutions. Using a proprietary intake solution in house, we have fewer constraints than a software/ASP vendor, and can implement customizations quickly, as needed rather than on a rigid schedule. We have developed custom browser-based solutions for claim intake, and additional client- or customer-specific questions and instructional scripts can be set up, changed or deleted within minutes by the Account Manager.The many built-in capabilities are primarily profile driven to easily manage the needs of our diverse customer base.
First Report of Injury and the Importance of Timely Response
FROI, or first report of injury, is a critical component to compliance with workers comp guidelines. Whether or not an employer agrees with an employee, the FROI must be filed. Typically reports are required when an injury causes an employee to miss 5 or more paid workdays, and must be submitted within seven business days of the fifth missed day of work. Each state has its own FROI form, available online, which should be completed in quadruplicate. One copy must go to the state, one must go to the employee, one to the insurer, and it is recommended to keep one for business records.
If a doctor sees the employee, and the employee complains of work-related injury, he or she is also compelled to file a report. Neither report exists to comment on the veracity of the employee or employer, solely to begin a paper trail to ensure that dates, times, and places can be known to as great a specificity as possible when ascertaining the proper course of action. Like FNOL (first notice of loss), the more promptly and accurately FROI forms are completed, the more likely a positive outcome.
Top Absence Management and Claims Management Blogs
Absence management greatly reduces corporate loss through improved communications and tracking systems. Implementing these systems through a highly trained outsourcing provider allows all parties involved to focus on what they do best. Claims management plays a crucial role in succeeding through absence management. Without a custom-tailored claim intake and management process, salient details are likely to slip through the cracks, defeating the purpose of the program. Learn more about how these solutions play crucial roles in major corporations throughout the world:
The Importance and Utility of Outsourcing
If high ASA’s and abandonment rates are a concern, qualified call centers are first line of defense. As with most call centers, there are times when occupancy rates reach 90% – and no one is available to answer the phone.
You could return the call an hour later or the next day, but it may be too late, and they may have already contacted an attorney. This will increase the cost of your claims dramatically and will simultaneously reduce the effectiveness and level of customer service provided by your organization. This is why many of today’s contact centers employ outsourced call centers staffer with claims professionals to improve the customer experience.
By leveraging a contact center for overflow, nights, weekends and holidays, you will improve the efficiency in your organization by as much as 40% while greatly improving your customer experience. All of which impact the bottom line. Today, many high quality call centers outsource FNOL (First Notice of Loss) for overflow and non-peak times.
Insurers with longer than average cycle times of 14.8 days are rated in the bottom 50% in terms of customer satisfaction. – J.D. Power and Associates
At 80%+ call center occupancy your people are busy, turnover increases due to burnout, customer service is poor, and many calls go unanswered. At 50% occupancy your people have some down time, customer service levels are relatively good, and most calls are answered. At 20% occupancy, almost every call is answered, ASA times are short, customer service is superb; however efficiency is low and the cost per claim is astronomical.
Finding the right outsourced call FNOL solution can allow your call center to improve efficiency and reach maximum effectiveness.
Day 1 Absence Management & Casual Absences
The key to effective and efficient absence management lies in responsiveness and adaptability. Tracking absences from day 1, segregating absence types, and managing various kinds of absences allows corporations to respond quickly to change and to avoid confusion. In this way, absence management is quite similar to FNOL. For more information on absence management, FNOL, and other related queries, contact us.
Five C's of Full-Cycle Claim Reporting
Full-cycle claim reporting is an indispensable and highly detail-oriented aspect of FNOL and absence management implementation. As with many concepts in the business world, the idea is simple yet the execution requires a high degree of training and precision. Here are the ‘Five C’s’ of full-cycle claim reporting:
- Control – containing costs is what brings the ROI to full-cycle claim reporting solutions
- Configure – customized workflow is what where you find the adaptability to optimize for any claim intake situation
- Capture – effective, efficient, and accurate notice intake is indispensable in achieving timely and successful claims resolution
- Complete – post-notice services, including cast resolution, follow-up, and documentation make the system concretely successful
- Communicate – dissemination and reporting keep everyone on the same page, making full-cycle claim reporting effective for companies of nearly any size
Claim Intake and Claims Management Best Practices
Incident reporting must be cost-effective to achieve long-term success in any organization. Cost-effective incident reporting and claims management is dependent upon capturing accurate information in a prompt and well-organized manner. When policyholders report a notice, greeting them professionally is important. Of equal importance, of course, is the professionalism exhibited on the other end of the process – data entry. Trained intake specialists must quickly and accurately ask the right questions and enter the appropriate information into the applicable form using a best practices workflow.
Only through years of first notice of loss (FNOL) experience can claim intake best practices be honed into a streamlined training program. Whether entering notices into a custom application, a standardized application, or your in-house claims management system, capturing the vital details quickly and effectively while maintaining a pleasant demeanor is paramount. Providing medical coding, duplicate checking, quality assurance reviews, and notice completion in addition to streamlined and skilled services keeps costs down and satisfaction up – where they belong.