Data is the key to any business. It drives
everything. Sales, operations, finance. You name it. It’s an
axiom as old as business itself. It’s like saying the sun rises in the
east. Today more than ever, businesses want as much data as they can get
their hands on…and they sit on a mountain of it...especially in the business of
insurance. Or do they?
Most WC claim operations use a variety of outsourcing
partners; from Utilization Review, Medical Case Management, Independent Medical
Exams, Pharmacy Benefit Management, Translation, Transportation, Diagnostic
Imaging, Durable Medical Equipment, to Medicare Set Asides, and Medical bill
review sees and captures MOST of the data.
Utilizing specialty companies, experts in their respective
fields, is a great strategy. Harnessing all of their (technically your)
data is a challenge. Utilizing a “one-stop shop” may make full data
capture seem easier, perhaps even safer, but it results in a one size fits all
approach to claims cost management. Strong in some areas, weaker in
others. The Jack of all trades, master of none approach.
So much data today is “smoke stacked” or “stove
piped”. State and NCCI reporting are just two examples of the need for
complete capture and the submission of all data. Check to see if your specialty
partners are reporting on your behalf or providing a file so you can blend the
data and submit reports.
A former boss of mine used to say, “Take data, turn it into
information, then turn it into intelligence.” To do this you must be
extremely diligent to collect and funnel all of it into one place.
Medical bill review is the most natural place to house, report and analyze
medical claims information. It makes the most sense.
Alpha Review works with its’ clients to ensure we capture as
much data as we can and as much data as our client wants or needs us to.
Complete data capture is a key building block for the future of management
reporting. It is the absolute foundation for claim analytics and predictive
modeling. These are two exciting areas in the future of WC claims
management to be addressed next time.
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