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:
Tag: FNOL
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.
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.
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.
Catastrophic Incident Reporting
Catastrophic incidents can overwhelm your in-house claim reporting center. Professional call centers can help. For example, our call center is equipped with multiple T-1 and T-3 lines and state-of-the-art VoIP switch technology to handle high volumes. We design custom scripts to capture the information you need and implement them for call center intake, email/fax entry and/or Internet self-service immediately. These attributes are critical to proper catostrphic incident reporting. To learn more, contact us.
Popular FNOL and Absence Management Blogs
Here at Actec we’ve been blogging about the importance of FNOL and Absence Management Solutions for several years. Here are a few of our most popular recent blogs:
- Overflow and Call Center Closure Preparedness
- Absence Management and Your Business
- After-Hours Reporting and Claims Management
For more on these and other important topics, return to our blog soon!
EDI Filing – A Vital Component of Claim Management
Actec Systems is a leading provider of incident reporting and claim management services in the insurance industry. Having been in this field for many years, they have special expertise in handling workers’ compensation claim administration, short-term and long-term disability claims. The specialists pay special consideration to quick and accurate
capturing of complete information. It is vital that when an incident occurs, complete and critical details are collected. First Notice of Loss is the first report of a claim and forms an important part of your risk management program.
Whether it is commercial and personal lines claims, non-claim reports and inquiries or catastrophic events, Actec Systems is the best source for all of your risk management needs. The intake specialists are available 24/7, 365 days a year so that all vital details can be recorded in First Notice of Loss. The incident notices are then distributed to other
specialists for a quick turn-around. With Actec Systems, you need not worry about the security of the information as their internet self-entry is completely secure. It is integrated with a back-end intake system to ensure there is no loss of functionality. EDI filing is also a part of their services. Claims are submitted via electronic data interchange for the purpose of submission, dissemination and data consolidation.
EDI filing is required to be done by every company and most of them find it difficult to complete the complications involved. With the increasing role of e-commerce, no business can afford to ignore the relevance of the internet in the success of their enterprise. The requirements of EDI filing are different for different states and without the help of professionals; it can be a time-consuming task. Also, missing or invalid data or delays in filing can cause you more fines and troubles. The specialists at Actec Systems
are committed to helping you with all of your EDI filing needs. They carefully review FROI, SROI and medical bill filings before submission to filing to avoid delays and time-consuming submissions. The best practices followed by Actec reduce the need for follow-up. For more details, please browse through www.actec.net.
After-Hours Reporting and Claims Management
Actec specializes in after-hours claims intake and management. Processing claims in an accurate and timely manner is crucial to effective FNOL. Achieving this requires an internal department trained in such practices, or seamless integration of an outsourced call center. Though there are many such solutions, the integration and customization of outsourcing is imperative in reaching the desired outcome. Actec’s many years of experience and highly skilled personnel serve to enhance the efficiency of a business while minimizing risk. To learn more, ask us.
Popular FNOL Blogs
First Notice of Loss if an issue that effects the bottom line of companies around the world. Though it is both important and ubiquitous, it is often overlooked or misunderstood. Here are some recent articles that shed light on this important topic:
Principles of Claims Management
Cost-effective 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 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.