Workers’ compensation medical costs are rising faster than the medical consumer price index. For insurers, that means claims payments are cutting into profitability, posing a potentially existential threat to the business.
Cognizant’s OptimaMedWise™ can help. With this solution, insurers can take full control of workers’ comp claims management costs, and deliver positive outcomes for members. By bridging gaps between traditional cost containment strategies like medical bill review, nurse case management, and utilization review, OptimaMedWise can eliminate up to 40% of manual claims decisions, reducing your operating costs.
With OptimaMedWise, you can:
Medical 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 OptimaMedWise™, 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 six months
projected annual savings
of claims identified as compliant and processed automatically