Mandatory EDI (electronic data interchange) filing may be the biggest of all headaches in Workers Compensation Claim administration. Requirements vary from state to state. Missing or invalid data leads to time consuming resubmission, filing delays, excess staff time, and even fines.
Our Electronic State Filing Program carefully reviews all submissions for both FROI and SROI as well as annual filing requirements. We follow up for any missing or incomplete information making sure submissions received are accepted. Though these tasks can be accomplished in-house, for most organizations it is more efficient and effective to outsource it to experts in the field.
The state of California recently released statistics to all companies filing Workers Compensation (FROI). Actec had a success rate of 99.1% of all reports submitted that were accepted by the state on the first submission. The industry average for the one-year period was 77.4% acceptance on first submission. Actec works diligently to make sure your reports are filed timely and accurately, thus avoiding re-filing and potential fines. To learn more about how an ESF program can improve operations at your organization, contact us.
Mandatory EDI filing may be the biggest headache in Workers’ Comp claim administration. Requirements vary from state to state. Missing or invalid data lead to time-consuming resubmission, filing delays, customer frustration, and even fines. If EDI filing gives you pain, Actec spells relief. Our experts carefully review FROI, SROI and medical bill filings prior to transmission to make sure your filings are done once, Done Right!.
Contact Paul Neleman to learn how Actec can improve your Electronic State Filings
When a human resources administration service company developed an in-house absence management system, they wanted their previous after-hours call center vendor to enter claioms directly into the new application. The vendor refused, offering instead to develop a custom intake solutiong – at the client’s expense. Without an intake service, the client risked alienating their most important customer accounts. The client came to Actec with two absolute requirements – use the newly developed application and start within nine days.
Each of the client’s accounts – primarily large, Fortune 500 companies – requires special handling, from caller authorization to terminology. This was not provided on the custom intake system. Therefore, training and manual documentation was extremely critical. Within seven days, Actec was trained on the client’s system. Actec then prepared workstation manuals and developed backup intake forms to use during the client’s nightly system maintenance downtime. With an intensive week of training, manual preparation anc connectivity and user setup, we opened our phone lines right on target. The client extended coverage to daytime overflow.
Factors contributing to Actec’s success were:
- Intake Specialists could call on their familiarity with a broad client base in the absence management, FMLA and disability arena – minimizing training time.
- Utilizing extensive experience to provide intake services on client applications.
- Agile organization showed the flexibility required to implement a complex client on a short timeline.
Do you have high ASA’s? Do you have high abandonment rates? Your call center is the first contact that your customers have when problems strike. As with most call centers, there are times when your occupancy rates are at 90% – and no one is available to answer the phone.
You could return the call an hour later or the next day, but that 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.
“We utilize Actec 24/7 first notice reporting services as a key component of the overall cost containment program for a large West Coast public entity. Actec has set the gold standard of quality, flexibility, and technical expertise during the last five years with this client. Actec’s ability to deliver the details of each first notice encounter in a timely, accurate, and highly customized fashion enables our client to quickly assess and assign resources to
incidents efficiently and rapidly. The Actec team is made up of true professionals with a high degree of focus and expertise in their niche industry and a true ‘can do’ attitude and aptitude with in comes to technical integrations and custom business requirements.” – Regional Vice President, Fortune 500 Business Process and IT Services Company
Full cycle claim reporting refers to a comprehensive approach to claims and incident reporting. In some instances, full-cycle claim and incident reporting is also referred to as claims intake and reporting, or even within the general context of first notice of loss (FNOL). The concept is fairly simple; an individual has experienced a loss, theft or damage and needs to reports the specifics to their insurance carrier, third party administrator or self insured organization. It is, of course, important that this intake is professionally handled, promptly addressed and accurately recorded. The intake is extremely important to ensure the resulting claim is accurately reported. Full-cycle claim and incident reporting refers to a comprehensive, one stop approach to this situation. Key elements of a full-cycle solution include:
• Companies can report all incidents to a single claim reporting service
• Claims and incident reporting are fully integrated into the system
• All the information needed for processing is completed on the first report
• Workflow changes can be easily to accommodated to meet new requirements
• There are accurate metrics to determine the actual cost of claim and incident reporting
With first notice of loss, it is important to close claims quickly and manage risk at all levels of the organization. FNOL intake specialists should be available 24/7,365 days a year, to ensure accurate and timely intake whenever an incident occurs and to handle after-hours incidents and overflow. It is also an opportunity for companies to demonstrate their commitment to employees, by ensuring employees receive rapid and professional response, during what is likely to be a very stressful time, namely the reporting of a loss or theft. Creating a full-cycle claim and incident reporting system to respond, monitor and measure the FNOL process is a key component in success in this complex scenario. Many companies outsource their first notice of loss to a full cycle claims and incident reporting specialist, particularly when the consider the challenge of a 24/7, 365 day a year schedule.
Read more: http://www.articlesbase.com/outsourcing-articles/what-is-full-cycle-claim-and-incident-reporting-3698144.html#ixzz1692j4VAK
The state of California recently released statistics to all companies filing Workers Compensation(FROI). Actec had a success rate of 99.1% of all reports submitted were accepted by the state on the first submission.
The industry average for the 1 year period was 77.4% acceptance on first submission.
Actec works diligently to make sure your reports are filed timely and accurately thus avoiding re-filing, and potential fines. If you are not using Actec for state FROI filings feel free to call Paul Neleman at 770-916-6847.
Most people and companies are often unaware that when they first contact their insurance provider to report theft, loss or damage that they are actually contacting a first notice of loss (FNOL) call center. FNOL call centers typically operate 365 days a year, round the clock, ensuring policy holders can easily report a loss, and further, that the respective insurance companies receive timely and accurate claim loss data.
First notice of loss operations are sometimes staffed internally, but more frequently these days, the operations are outsourced to a specialist. As one can imagine with any 24/7 by 365 day a year operation, staffing, training and accurate claims intake are challenging for any organization. There are different types of vendors which offer solutions for FNOL, some offer software, others offer a comprehensive call center based on a proprietary application, and still others customize their call center operation to accommodate any platform. These are platform agnostic vendors who claim to work with insurance companies’ existing platforms.
Why is first notice of loss important to both policy holders and insurance companies? Obviously the key function of a notice of loss is to alert the insurance entity as to the theft or destruction of something which is covered under the terms of the policy. In some cases, notification will precede the filing of a formal claim. In certain circumstances, the insured may contact a FNOL representative and follow specific rules of engagement relating to the policy parameters. This is happens often when a provider underwrites different types of insurance coverage and uses a specific format for each type of policy offered to consumers. Herein lies the challenge for many insurers, and the frustration for many of those insured, as policy specifics dictate both the necessary information intake, and the resulting claims processing process. In many cases, speed is of the essence. For example, theft relating to jewelry would require very specific loss notification, and further, rapid notification to the authorities and insurance provider can help result in improved odds of recovery.
First notice of loss has also been undergoing a metamorphosis offering insurers an opportunity to demonstrate their relative professionalism at a time where their policy holders are likely upset and under stress. This is an optimum time, regardless of whether the call center is in house or outsourced to demonstrate a customer centric attitude increasing customer satisfaction and loyalty. Thus, first notice of loss (FNOL) is a critical component of client satisfaction and customer retention.
Close claims quickly and manage risk at all levels of your organization with Actec’s Full-Cycle Claim and Incident Reporting Solutions. Actec FNOL Intake Specialists are available 24/7,365 days a year to be there when incident occur and to handle after-hours incidents and overflow. Actec is changing the rules of claim and incident reporting management with Claim and Incident Reporting solutions that improve productivity and reduce costs for commercial and personal insurance carriers, self-insured companies, third party administrators, and managed care organizations. Our highly customizable claim and incident reporting approach moves beyond just transferring information from policyholders to designated stakeholders to provide you with total information management.