Ventiv Technology

The Essential Guide to Claims Technology in a Changing Environment 15 The Role of EDI in Claim Organizations EDI (electronic data interchange) enables the electronic exchange of standardized data between companies. As claim organizations are required to report on an increasing amount of workers compensation data, EDI plays a vital role in transmitting data in an accurate and timely manner. As more states continue to change regulatory requirements and adopt the IAIABC's electronic reporting of FROI (first report of injury) and SROI (subsequent report of injury), organizations need compatible claim reporting systems to meet the needs of each jurisdiction. Ventiv Claims has integrated compliance reporting solutions that capture all mandatory data and support EDI reporting, making it quick and easy to remain compliant. C H A P T E R 5 : T H E I M P O R TA N C E O F D ATA I N T E R C H A N G E Smarter Data Interchange Solutions Legacy systems simply don't provide the ability for dynamic business rule automation and intuitive data interchange. Claim organizations need to look to dedicated providers that continuously improve and invest in new technology. For example, Ventiv Technology's Ventiv Claims delivers an integrated, configurable platform that promotes best practices and improves claim quality through effective data interchange. • Claim organizations should seek out systems designed to maximize the opportunities for electronic intake of claim-related documentation. Workflows built on electronic intake of the widest possible range of documents can significantly increase efficiency for claim organizations, allowing examiners to perform initial reviews quicker and begin the process of facilitating an injured worker's return sooner. • A system should connect with external parties to help relay information quickly and accurately. Adjusters can easily access and distribute information to third- party administrators, nurse care managers, and independent medical examiners, thus improving efficiency. • Systems should provide a centralized method for compiling and distributing claim information. Automating the distribution of claim packages can reduce manual administration time and allow adjusters to attend to more caseloads. • For worker's compensation claims in particular, identification of claim drivers is a significant asset. Better insights lead to better decisions which can help supervisors reduce costs and close claims more quickly. • Early intervention is the key to delivering the best possible outcomes for workers and companies. Ventiv Claims, for example, can be configured to automatically trigger a workflow once there is a report of injury. This enables the facilitation of medical assistance at an earlier point in time, delivering the best outcomes for both parties. • Worker's compensation claims are heavily regulated, with statutory timelines attached to nearly every process. A missed deadline can result in penalties, so it's important that claim organizations manage deadlines effectively. Systems should help supervisors take a proactive approach by keeping track of statutory timelines and advising supervisors of upcoming dates. • Claim organizations need to remain compliant and keep up with legislation, federal mandates, and state-specific regulations. Ventiv Claims, for example, pushes out continuous updates to ensure claim organizations always remain compliant. • Legacy systems can often result in manual caseload management through Excel and Access spreadsheets. Current systems have moved to newer data transmission methods including XML file formats and web services, which can strengthen and automate large sections of the workflow.

• Cover