With $110 million in written premium, Compensation Risk Managers LLC (CRM) is a relatively small third-party administrator of self-funded workers' compensation programs.But an integrated claims management solution from Insurity Inc., a ChoicePoint company, is providing the Poughkeepsie, N.Y.-based TPA with a level of automation typical of larger insurers.
Insurity's Pyramid system is integrated with the medical bill repricing engine from Medata Inc., Newbury Park, Calif., and with a case management system that uses IHQ medical protocols from McKesson Health Solutions LLC, Marlborough, Mass.
The integration of these three typically separate systems has enabled CRM to form a subsidiary managed care business-called Eimar-that saves $30 to $35 for every dollar spent on bill review and PPO charges, according to Adam Strong, vice president of claims at CRM. That's well above the industry average of $8 to $9 in ROI, he says.
"A TPA of my size would typically latch onto a regional or national managed care company," says Strong. "But through Eimar, we have a staff of six bill reviewers, and every day, I know how many bills came in, how many were received, how many bills were paid, what the total inventory is, and the productivity of each person."
Eimar bill reviewers are using a different module of the same software that CRM uses for claims management. "They don't have to re-enter information such as the person's name, the doctor, the history," Strong explains. "They just pull up the claim that's already established in the system and review the bill."
In addition, Eimar staff uses the system to document efforts to schedule medical exams. "Adjusters don't need to be told an exam took place, because any time they look at the file, they're going to see it. It's right there in chronological order," Strong says.
As for telephonic case management, registered nurses also use the system. "And they are here on site," Strong adds. "That allows for more direct communication about what action is needed for a particular claim. It's not a referral that goes to the nurse who never sees the adjuster who has no idea who she is and isn't really accountable."
