Pinnacle Assurance, a workers’ compensation mutual insurer in Colorado, has been working to improve the customer experience for internal and external customers.

The insurer now is in the process of rolling out a range of document and content management technologies intended to speed the payment of medical bills and claims, facilitate internal and external customers’ access to documents, reduce the burden of administrative tasks, reduce costs and contain premiums for the company’s 55,000 policy owners/stakeholders.

“In insurance, it’s very document intensive. We probably receive 20,000 faxes per week,” says David Hoffman, Pinnacol Assurance’s AVP of application services. “We also produce 7,000 to 10,000 pieces of correspondence per day, so we have a lot of documents going in and out of the building, and then we probably receive 1,000 pieces of mail per day, if not 2,000.” And there’s more, including surveillance video generated by the fraud detection department, MRIs, X-rays, and images from CAT scans, and 2,000 inbound medical records per day, which the company needs to process payment and claims, and that the company is required to make available to injured workers.

Pinnacol uses Perceptive Content, from Perceptive Software to scan, index, route, store and distribute electronic documents, Hoffman says. Perceptive Content incorporates Intelligent Character Recognition (ICR) functionality – the automatic recognition of claim numbers, dates of service and other details – for automatic indexing and intelligent routing of the documents to drive workflow, Hoffman says.

“The first time anybody sees a document is when it’s actually in their queue, ready for them to do whatever they need to do with that document.” For example if medical records are above a dollar threshold, the documents are added to the document repository and initiate a review process with a senior medical pay processor. “Once it’s in the repository, based on the information associated with that document, it will automatically determine all of the privileges and the security rights of who can see that,” Hoffman says.

Another benefit is accelerated access to care. As soon as nurse case managers have that information and understand the nature of injuries, for example, the sooner they can respond and offer better healthcare, Hoffman explains, adding that paper-based records limit opportunities to share information across departments and increase hand-off time, which delays payments to insureds.

“We have 30 days to pay those medical bills,” Hoffman says. “There was a time where that was tough to hit, but the more bills you can pay accurately, with a fewer number of people processing them, ultimately you’re reducing operational costs. By the time we have implemented all this technology, it will probably reduce the total number of FTEs [full-time employees] by 15 or 20,” Hoffman says. “We’re a mutual insurance company, basically owned by our policyholders. The more we can reduce operational costs, the more that reduces our combined ratio. And if your combined ratio is lower, then you can potentially pay out dividends to your policyholders.”

For external customers, including injured workers and payees, the technology makes communications, documents, medical records and paperless invoices available through a portal, Hoffman says. They also are offered the opportunity to complete policyholder satisfaction surveys, which specifically cover their experiences with Pinnacol’s technology and website.

Hoffman says in 2011, when the company began the project, Pinnacol didn’t intend to implement the document management system across the entire organization, but the company now plans to rollout Perceptive Content for the rest of the claims and underwriting teams, which could take another year and a half, Hoffman says.

“Our internal customers who use this software all love the direction that we’re going in. They can do a lot more with less of their time. A lot of that manual stuff? That’s the part of people’s jobs they hate,” Hoffman says. “It’s not only an efficiency gain, it increases job satisfaction.”

Also see Top Tech Priorities for Workers' Comp Insurers

 

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