Ventiv Technology

2 6 | 360º Aon eSolutions bringing claims in-house with ivOS "Our clients are city departments. By moving our claims management in-house, we improved service and were able to be more responsive to agency needs. At the same time, we've reduced our costs," said Phillips. "Our previous TPA [third party administrator] had a system that was not equipped with contemporary claims-handling capabilities, and it was not flexible in terms of risk management reports. We were forced to receive hard-copy reports of our loss activity. When we went shopping for a system, we knew we wanted a robust claims and risk management system." e City now leverages Aon eSolutions' iVOS claims management system. With the system's automation tools, Santa Monica transitioned its claims operation from a manual, paper-based operation to a more streamlined electronic workflow. "We use iVOS to automate as much of our claims process as possible," said Fuleihan. "For example, the system offers an advanced diary system to open, transfer and close claims. Many of our standard forms and letters are automated. We can change and manage reserves, make notes for ongoing follow up and upload digital photos. is wide range of functionality is not available in other systems." "In addition, since the system is browser- based, we carefully define access and security rights," said Phillips. "For example, we have defined 'view-only' rights for users who are external to our risk management division, like the city attorney's office and nurse case managers. ese users view claims information, but are not allowed to change the data." integrating medical bill review With the iVOS one-system platform, the City tightly integrated the medical bill review into its claims management process. In the past, a third-party bill review company picked up the City's paper-based medical bills and manually re-entered the information into its system. "Now, iVOS Review Service scans our bills directly into the claims system," said Phillips. "We electronically receive batches of medical bills to authorize for payment. Today, the industry's average turnaround time to pay a medical bill is 30 days, while our average turnaround time is five days – that's fast." "is efficiency gain was a huge benefit – both to our medical providers and our claims staff," said Phillips. "With paperless bill review, we reduced administrative demands on our examiners. In addition, we've been very happy with the cost savings. Within three years, we saved $7.2 million in recommended amounts according to fee schedules, and an additional $100,000 in discounts through the usage review process. In addition, our reconsideration rate remains low." leveraging Six Sigma e City of Santa Monica also employs claims best practices based on the Six Sigma business model to support the application of consistent policies and procedures and ensure quality results. "It's a very rigorous process that enables us to have a thorough and systematic approach to claims investigation, evaluation, recovery, medical management, disability management, and provision of benefits," said Fuleihan. "ese guidelines help to implement best practices and clearly define the information required in each claim. is model ensures communication is clear and information is accurate. We also perform random spot checks to ensure information is complete." Managing enterprise risk "At the macro level, we practice a comprehensive risk management approach," said Phillips. "We're able to do this because we leverage city of santa monica ivos case study » " We have twelve people in our risk management division, and our overall goal is to reduce our total cost of risk in order to maximize city tax dollars," said Tom Phillips. In the last six years, Phillips led the city's risk management team to achieve outstanding results in its workers' compensation program, achieving a 35 percent savings in claims costs, improved service and increased operational efficiency.

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