WHY QUALITY OF CLAIMS SERVICES MATTERS

For an adjuster or examiner, the process of administering a claim and dealing with several providers for a single claimant is typically quite common and routine. However, the claims process from a claimant’s perspective can be rather complicated and, more often than not, a major source of frustration for claimants. This is doubly true when multiple providers are involved in a single claim.  When high quality services are provided to claimants at all points throughout the claim, claimants will experience a higher level of satisfaction and therefore will be much more likely to renew their policies with your insurance company. There are several areas that your insurance company should be gathering and analyzing data on to determine how the quality of claims services is impacting your claimants and their renewals.

The first touchpoint of many claims begins with the adjuster or examiner assigned to the claim. Not only are they responsible for indemnifying the claimant while concurrently managing the cost of the overall claim, but it is vital that they ensure each claimant is satisfied with his or her experience. Put simply, it is no longer enough for a claimant to simply be indemnified by the insurance company. Renewals are impacted by the claims experience so delighting claimants is mandatory.

Providing an exceptional claimant experience may prove even more challenging when a claimant requires physician prescribed services from multiple providers. As an insurance company, you must ensure that all providers are meeting your high standards of claimant care. This encompasses everything from offering prompt, courteous customer service to the availability of clean and well cared for equipment. If a claimant requires the use of a wheelchair and will need home health care for a period of time during recovery for instance, the claimant is much more likely to be satisfied with the claim when he or she is treated with respect and kindness and has access to the proper size and type of wheelchair.

In light of the challenges involved with managing the quality of services in any given claim, insurance companies should consider working closely with a third-party administrator (TPA) such as Northwood. A TPA will be able to streamline the claims process for claimants and adjusters and examiners in a variety of ways that also assure high quality claims services.

Partnering with a TPA offers an array of benefits such as a network of quality providers and convenience for claimants. For instance, Northwood has curated an extensive network of the highest quality providers that offer convenient access to physician prescribed services for claimants. We also implement pre-authorization processes that assure injury relatedness and eliminate claimant out of pocket expenses.

By analyzing the quality of claims services and optimizing them, you will ensure your claimants experience a more streamlined claims process that fuels a higher level of claimant satisfaction. In turn, this will impact your bottom line because satisfied claimants are much more likely to renew their policies with your company.

For a customized audit of your claimant experience and personalized improvement recommendations, please contact Rosanne Brugnoni at 586-755-3830 ext. 3771.

Is your claimant experience resulting in renewals?

At first glance, claims experience and policy renewals may not seem directly linked. However, insurance companies must uphold stringent standards of excellence to ensure their claimants experience the highest levels of satisfaction throughout the entire claims process. Unsatisfied claimants translate into unhappy insureds, which can often lead to the loss of those same insureds when it comes time for them to renew their insurance policies with your company.

The frequency and style of communication factors in to the level of claimant satisfaction as well. According to Agencybloc’s blog entitled, “The #1 Reason Clients Leave Your Insurance Agency,” a Rocket Referrals study showed that 81% of clients exit due to the absence of consistent contact with the agent or agency. Furthermore, another study cited in the same piece showed about 44% had been in touch with their agent in the last year and a half.

It’s important that your insurance company keeps these statistics top of mind when administering claims. Even though the claims department is not an agency, these facts highlight the need for regular communication with claimants on all levels. The direct reason for this is because that even though your adjusters and examiners are dealing with claims every day, your claimants typically are not. Claimants may be calling in to report an auto accident with injuries and may be experiencing an array of emotions; adjusters and examiners have an opportunity to excel at customer care with these types of claims especially.

https://www.northwoodinc.com/claimant-experience-resulting-renewals/

Northwood: Helping to Improve Your Claimant Engagement

The administration of claims can be incredibly complex, particularly if the claimant involved suffered catastrophic injuries. Adjusters and examiners are often on the front lines of the claim, tasked with many duties including claimant indemnification. Whether a claim falls under workers’ compensation or automobile no-fault coverage, it’s important for an insurance company to also focus on claimant engagement and claimant satisfaction levels. Ultimately, an increase in claimant satisfaction levels translates into increased retention for an insurance company. The reverse is also true: if your insurance company fails to improve claimant engagement and satisfaction, your retention levels will drop and you may lose insureds.   

https://www.northwoodinc.com/northwood-helping-to-improve-your-claimant-engagement/

Impact Of Provider Networks With Discounted Rates

Within the field of claims administration, there are many avenues that insurance companies may choose to take to assist in holding down costs and in lessening the administrative burdens placed on adjusters and examiners. One such avenue that brings a multitude of benefits to an insurance company is to partner with a third-party administrator (TPA) on each claim, whether auto no-fault or workers’ compensation claims.  

One major benefit that comes from a partnership between an insurance company and a TPA involves the access that the insurance company will gain to a network of providers that has undergone a thorough credentialing process. Northwood is a TPA that has been in operation since 1992 and has drawn upon its extensive experience to create an expansive network of such providers. Providers within this network must adhere to Northwood’s high standards, including accreditation,  applicable licensure and the assurance of liability insurance coverage. Northwood maintains an electronic database of the providers’ insurance expiration dates and requests updated certificates annually. Once providers have been credentialed and become part of this trusted network, they are recredentialed every 2 years. 

https://www.northwoodinc.com/impact-provider-networks-discounted-rates/

Benefits of a Pre-Authorization Process

The proper and efficient administration of workers’ compensation and automobile no-fault claims is vital to an insurance company’s continued success. As every adjuster and examiner knows, the first duty is to restore the claimant to his or her previous state after he or she experiences an injury due to a claim. Another responsibility of adjusters and examiners is to control costs, improve productivity, decrease cycle time and improve customer service.  

With the myriad of responsibilities and tasks assigned to adjusters and examiners daily, it can be incredibly challenging for them to efficiently administer claims at times. Having an experienced resource to draw upon can dramatically increase adjuster and examiner productivity as well as assist in controlling claims costs. In addition, productivity levels can be increased when adjusters and examiners have access to proven systems within this resource that streamline claims adjudication. These benefits are realized through a partnership with a trusted third-party administrator (TPA) that has the experience and knowledge to act as that resource as well as implement efficient processes that can impact an insurance company’s bottom line. 

https://www.northwoodinc.com/benefits-of-a-pre-authorization-process/

HOW THE HEALTHCARE COMMON PROCEDURE CODING SYSTEM CAN COST YOU MONEY

As all adjusters and examiners working within an insurance company know, both automobile no-fault claims and workers’ compensation claims come with inherent complexities and intricacies. Besides being responsible for indemnifying each and every claimant, adjusters and examiners are also responsible for holding down the cost of each claim administered. Controlling claims costs and preventing overpayments and unnecessary payments is not an easy task and requires a significant portion of administrative time on each claim.  

While there are many factors that come into play when it comes to the increasing cost to administer both auto no-fault and workers’ compensation claims, one particular factor stands out. The Healthcare Common Procedure Coding System, or HCPCS, as it is commonly referred to within the industry, contains its own unique complexities that can be tricky to navigate. The time-consuming nature of reviewing provider HCPCS codes for accuracy means that adjusters and examiners may spend a significant portion of time on this aspect of many of their claims. Increased time spent on this facet of no-fault and workers’ compensation claims translates eventually to an overall increase of claims costs for an insurance company. 

https://www.northwoodinc.com/healthcare-common-procedure-coding-system-can-cost-money/

Workplace Eye Wellness Month

March is Workplace Eye Wellness Month. Your eyes are something you use every day and sometimes take for granted. You just expect them to work and do their job. A startling fact is that over 2,000 Americans, every single day, suffer some form of eye injury. This equates to over $300 million in medical expenses, workman’s comp claims, and lost work time.

When you think of an eye injury, you most likely think of something striking the eye, splashing into the eyes, or having debris or dirt enter the eye, but these are only some of the injuries that can happen to your eyes. With the advent of all the electronic devices that you can use, eye strain and fatigue is also a frequent problem. If you work on a computer, you could be staring at your screen for six to eight hours per day. This is work time computer use; most people also jump on their computers at night to catch up with family and friends. If not their computers, then they are looking at their phones to catch their mail or text messages. This can lead to eye fatigue and possibly dry eye, along with headaches and body aches from remaining in the same position for an extended period. With all of these potential dangers to your eye, how can you protect yourself?

https://www.northwoodinc.com/workplace-eye-wellness-month/

Rising Costs In The Insurance Industry: What Can Be Done

With a new year comes additional challenges for insurance companies administering both workers’ compensation and automobile no-fault claims. Continually rising costs for prescription medications as well as durable medical equipment, prosthetics, orthotics and medical supplies (DMEPOS) bring ever-present challenges and obstacles for insurance companies to work around. While there are several factors that figure into the increasing costs, the most important thing for insurance companies to focus on involves ways to mitigate the cost challenges within their control.

As an experienced third-party administrator (TPA) of auto no-fault and workers’ compensation claims, we at Northwood recognize these challenges and have compiled four ways that will assist insurance companies in addressing this problematic topic. 

The first and most efficient way to combat the ever-rising costs in the industry is to partner with a TPA. Each claim administered by your insurance company will benefit from the thorough and objective review provided by the TPA. Innovative procedures developed through years of experience translate to savings for insurance companies. 

Secondly, insurance companies will reap significant cost savings within claims administration by gaining access to discounted rates on DMEPOS services and prescription medications. Building a network of providers that agree to lower rates does take an enormous amount of time and effort. Fortunately, a TPA with its own network of trusted providers will offer access to this network to your insurance company as well as your claimants. 

Download our PDF to continue reading and see additional solutions for reducing costs.

A third method to battle rising costs involves implementing a pre-authorization process on each and every claim. The frequency of overpayments and payment of non-injury-related services will be greatly reduced by pre-authorizing every medication and treatment for each claimant. Claimants will still have access to the appropriate care they need yet insurance companies will avoid paying for treatments and medications that do not fall within the scope of the claim. 

Finally, bundling of Healthcare Common Procedure Codes (HCPCS) during the pre-authorization process is essential to saving money for your insurance company. Many providers unbundle components of DMEPOS services in an attempt to receive a larger payment from the insurance company. Northwood’s process of rebundling procedure codes reduces costs for your company. 

It is more important than ever for insurance companies to control costs. Partnering with a TPA, accessing a trusted provider network with discounted rates, implementing pre-authorization and bundling HCPCS codes are all essential to saving your company claims dollars. Northwood will bring its decades of experience to your company and save you time and frustration in the process. Please call Rosanne Brugnoni at 586-755-3830 ext. 3771 to discover additional solutions that are customized to your needs.

Clarity In Billing Improves The Bottom Line

A seemingly endless variety of factors contribute to increased claims administration costs. Whether your insurance company administers automobile no-fault claims or workers’ compensation claims, it is essential to always take a proactive approach to controlling the cost of claims. An important topic to address within your company concerns the matter of clarity, or lack thereof, in billing. Overall, achieving clarity and transparency in billing can improve the bottom line. 

A major opportunity to achieve greater clarity in billing pertains to building a trusted network of providers. It is vital to both the bottom line and to claimant satisfaction to provide access to high-quality medical providers. This can be a very time-consuming avenue and can also be very difficult to achieve, so insurance companies will save both time and money by partnering with an experienced third-party administrator (TPA) that has already taken the initiative to build a credentialed network of providers. Furthermore, the network of providers should be expansive enough to serve claimants all over the United States and also provide discounted rates to both the insurance company and its claimants. 

These providers that are in the TPA’s network and that agree to give the insurance company discounted rates should also offer access to prescription medicines at no out-of-pocket cost to claimants. Claimants who are given the opportunity to obtain their injury-related prescriptions without the need to pay up front or submit reimbursement requests to their insurance company tend to report much higher satisfaction levels with the claim and with the insurance company itself. Therefore, the elimination of out-of-pocket claimant costs contributes to increased clarity in billing that further impacts the bottom line. 

Insurance companies can also look to the Healthcare Common Procedure Coding System (HCPCS) for an opportunity to achieve more clarity in billing. The HCPCS procedure codes are notoriously complex and inherently provide the potential for overpayments to providers. Additionally, some providers may use not otherwise classified (NOC) codes frequently in an attempt to request higher payments from the claimant’s insurance company. Access to an experienced TPA that has the knowledge and resources to review and bundle these codes together where appropriate can significantly increase clarity in billing and reduce costs to the insurance company. 

At Northwood, we are committed to providing excellence to the insurance companies that partner with us. We offer a trusted provider network, discounted rates, the elimination of out-of-pocket claimant costs and our extensive experience with HCPCS procedure codes and bundling.

For a more customized look at the ways Northwood can help you achieve more clarity in billing and improve the bottom line, please contact Rosanne Brugnoni at 586-755-3830 ext. 3771 to schedule a meeting.    

Get A Jump Start On Controlling Costs This Year

As adjusters and examiners are reviewing claims statistics and planning for 2018, take a look at some of these challenges and associated suggestions that are designed to help you get ahead on controlling costs for the coming year.

With every claim comes unique challenges and situations that are complex. Claimants who sustain catastrophic, orthopedic or soft tissue injuries because of a workplace incident or an automobile accident may require anything from surgeries to home health care services. These types of claims represent additional challenges because many providers choose to unbundle the Healthcare Common Procedure Coding System (HCPCS) codes.  The best practice on all claims is to reduce unbundling and the use of not otherwise classified (NOC) codes to increase transparency and reduce the chance of your company paying too much.

Discounted rates are vital to the success of an insurance company as well. The average wholesale price (AWP) of prescriptions is continuously rising as you have likely observed within claims you administer that require the use of claimant prescription medications. While you may not have the ability to control those prices, you do have the option of negotiating discounted rates for your company.

Those same providers that agree to give your company discounted rates could also offer access to prescription medicines at no out-of-pocket cost to your claimants. This suggestion has a more indirect impact on saving claims costs. When claimants are offered the opportunity to fill their injury-related prescriptions without the need to pay up front and submit reimbursement requests to their insurance company, their satisfaction with the claim and with the company increases significantly. Over time this translates into increased claimant loyalty and additional premium dollars for your company.

These are things to consider as you look toward the remainder of 2018. The most efficient and practical way to implement these ideas and solve the challenges outlined above is to form a partnership with a third-party administrator (TPA) of both workers’ compensation and automobile no-fault claims. Northwood is one such TPA with more than 20 years of experience in saving money for insurance companies.

At Northwood, we strive to bring proven processes and procedures to our clients and their claimants. From an expansive provider network offering discounted rates and the elimination of out of pocket payments for claimants to pre-authorization processes and the practice of transparency in HCPCS use, Northwood brings innovative solutions to your company.

For a more customized look into how Northwood can help you get a jump start on cost savings for 2018, please contact Rosanne Brugnoni at 586-755-3830 ext. 3771 to schedule a call.

Benefits Of Working With An Experienced Third-Party Administrator

Insurance carriers administering automobile no-fault and workers’ compensation claims that encompass claimant use of durable medical equipment, prosthetics and orthotics services (DMEPOS) find themselves facing several challenges, especially in regard to claims involving multiple services and treatments.  

The Healthcare Common Procedure Coding System (HCPCS) is utilized by providers to code services and equipment used in claimant treatment regimens and request payment from insurance companies. The complex nature of HCPCS represents the potential for rising claims administration costs and overpayments to providers due to the common practice of unbundling services. Fortunately, a third-party administrator (TPA) such as Northwood is able to assist in minimizing costs and challenges. The following are three commonly seen challenges with unbundling along with efficient solutions that help mitigate them.  

One such challenge pertains to providers unbundling services since HCPCS procedure codes are available for individual components. The process of unbundling increases the number of claim lines and unnecessarily increases costs for insurance companies. Bundling services will have the opposite effect and assist insurance companies in reducing costs.  

Secondly, providers that unbundle services and utilize more claim lines also typically generate additional paperwork for adjusters and examiners. In contrast, the process of bundling actually significantly reduces the paperwork for insurance companies. This, in turn, allows adjusters and examiners to more efficiently administer claims which contribute to a reduction in claims administration costs.  

Finally, the use of not otherwise classified (NOC) codes drives up the cost of claims for insurance companies. With the thousands of HCPCS codes available there is almost always an accurate code to use for each and every procedure. The use of NOC codes represents an opportunity for insurance companies to greatly minimize them by partnering with a third-party administrator.  

While these three challenges are significant, working with an experienced TPA can mitigate these issues. Northwood has partnered with insurance companies for more than 20 years to proactively manage claims. We execute a pre-authorization process to reduce the utilization of not otherwise classified (NOC) codes, increase transparency and reduce unbundling. Insurance companies can confidently partner with Northwood as their DBM to assist with reducing claims costs due to unbundling. For additional information, please schedule a meeting with Rosanne Brugnoni at 586-755-3830 ext. 3771.