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Cognizant Business Consulting
Helping organizations engage people and uncover insight from data to shape the products, services and experiences they offer
Learn More

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Can you afford medical benefits to rise further?

Improve your workers’ compensation loss ratio with better medical benefits control.

OVERVIEW

Claims processes of the future are available today, thanks to rapid developments in technology and services.

The continued rise in workers’ comp medical costs have already cut into your limited margins, posing a challenge for the sustainability of your business and for the workers’ compensation insurance industry in general. Cognizant OptimaMedWise™ provides you a way of automatically comparing individual claims to a massive knowledge base of existing cases, in order to flag treatment that deviates from the norm.

FEATURES & BENEFITS

Leverage a Full Compliance Framework 

Cognizant OptimaMedWise is a complete framework for medical necessity review, combining a software platform with clinical services delivered by registered nurses, which comes with full integration and staff training. You can choose to deploy it in-house or have it hosted on private or public cloud infrastructure. You can be up and running within four months. 

Reduce Your Claims Leakage and Loss Ratio 

Every medical bill and record is reviewed and screened against a vast database of other similar case histories. Our medical experts review those that do not conform to the norm. And they will tell you which claims and conditions you should question, saving unnecessary expense. 

Pre-Define Expected Treatment Plans

Cognizant OptimaMedWise includes a knowledge base of almost all standard treatments, including those specified by the ODG (Official Disability Guidelines), American College of Occupational and Environmental Medicine, or state-specific guidelines. This allows you to establish an anticipated treatment plan for every claim and update and modify it as needed and provides an evidence based guide which Claim Examiners can leverage in making medical treatment approval decisions. 

Gain a 360º View of Claims

Cognizant OptimaMedWise doesn’t just help you with claims reviews, but gives you a holistic view of each claim, with details about treatment plans, current status, payment and medical histories and so on.

On Premise or Cloud Hosting

Solution is hosted on premise or in the cloud with Amazon Web Services (AWS) or with your preferred private infrastructure deployment option.

RESOURCES

Cognizant OptimaMedWise Solution Overview

Learn how Cognizant OptimaMedWise can quickly transform your journey towards better medical claims payment management.

Cost-containment Strategies for Worker’s Comp Claims

Property Casualty 360, an online news source edited for professionals and executives in the property and casualty insurance industry, published a byline article: Cost-containment Strategies for Worker’s Comp Claims. The article discusses using claims management, including data access and standards, to better manage costs related to worker’s compensation as well as providing four strategies for cost containment. 

Improve Your Workers’ Compensation Loss Ratio

Medical benefits on lost time claims have more than tripled since 2003, outpacing medical inflation from $9,000 to nearly $30,000 per claim. How to control that cost has become a top priority for the industry. Cognizant OptimaMedWise can save your business up to seven dollars out 
of a 100 that you currently pay in medical benefits, without affecting patient outcomes.

RESULTS

Cognizant OptimaMedWise™ Reduces Claims Leakage and Saves Millions

Challenge 

A global property and casualty insurer wanted to address leakage from workers’ comp claims while maintaining quality of care.

Solution

The company engaged Cognizant to develop a medical necessity review capability that would identify claims for excessive or unnecessary treatment. Cognizant OptimaMedWise™ implemented its technology framework to automate the claims process and provided 100-plus trained registered nurses to review exceptions. 

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Impact

Identified $50 million 

in medically excessive or unnecessary claims within six months of deployment

Projected annual savings 

of approximately $60 million

Improved claims leakage 

by 7% to 9%

Identified 40% of claims 

as compliant and processed automatically

Reduced the total cost of ownership, 

resulting in a 20X return on investment

OptimaMedWise™ | Medical Claims Management Solution | Cognizant Technology Solutions