Helping organizations engage people and uncover insight from data to shape the products, services and experiences they offer
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Helping organizations engage people and uncover insight from data to shape the products, services and experiences they offer
Learn MoreHelping organizations engage people and uncover insight from data to shape the products, services and experiences they offer
Learn MoreMedical benefits associated with workers’ compensation claims have escalated dramatically, more than tripling since 2003. For one global insurance carrier, excessive or unnecessary treatment associated with these claims resulted in medical claims leakage of a staggering 7% to 9% annually.
The company needed a strategic solution as traditional cost containment strategies, such as bill review, utilization review and nurse case management, were failing to address the leakage. The company partnered with Cognizant to find a solution.
We helped the insurer implement Cognizant Workers Compensation Care Analysis, a customizable treatment plan engine for automating claim processing, and combined it with trained clinical services staff to review claims requiring intervention.
This “medical necessity review as a service” capability enables the establishment of injury-specific treatment plans. It also validates clinical activities against those plans, automatically reviews every claim and routes exceptions to trained registered nurses for review.
Integrating medical necessity review into the carrier’s claims process helps facilitate medical care for injured workers, achieve better outcomes and reduce medical costs without increasing claims allocated to loss adjustment expenses.
in excessive or unnecessary claims identified in three years
in savings since going live
of medical bills auto-adjudicated
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