Integrated End-to-End Technology Solutions
Auto Injury Solutions offers an integrated solution for end-to-end medical claims processing including:
- Mailroom – High-speed imaging of inbound documents and/or outbound document handling
- Document Management – Web-based presentation layer to adjusters with adjudication functionality
- Bill Review – State-of-the-art medical bill audit
- Medical Records Collection – Complete digital claim file presentation
- Utilization Review – Statutory pre-certification requirements (e.g., New Jersey)
- Nurse Review – On-staff nurses
- Code Review – Certified professional coders review bills
- Evaluative Services – Medical professionals on staff and access to a nationwide panel
- 24/7 Customer Service – Call center located in Springfield, Massachusetts
- Adjuster Desktop – Real time interaction with the adjuste
Auto Injury Solutions' integrated approach eliminates the burden of using multiple vendors for these functions.
Mailroom Services
Images of medical bills and supporting documentation are collected through the use of high-speed scanners. Auto Injury Solutions supports three mechanisms of data collection:
- Carrier scans documents and submits images electronically to Concentra,
- Concentra provides scanners and staff on-site to scan documents on behalf of the carrier, and
- Concentra receives mail from carriers, or providers, scans documents, and archives paper on behalf of the carrier.
Auto Injury Solutions utilizes its MedFlow - Document Management software to manage receipt and processing of these images.
Document Management
The key to our integrated approach is our proprietary document management system, Medflow - Document Management. The entire path through which documents travels during the review process is accomplished by moving the electronic representation of the document to each step of workflow as that step becomes eligible for completion. All transition dates (including initial receipt) are tracked using the unique identifier assigned to each document. Medflow - Document Management has robust functionality that includes:
- Image Splitting (multiple generations)
- Advanced Labeling
- Document Linking
- Automated Routing
- Workload leveling
- Document Profile Sorting
- Priority age handling
Medflow
Document Management utilizes a rule-based workflow engine allowing documents to be routed electronically to the appropriate review resource. Flags for identifying bills requiring specialized review can be customized for any customer’s workflow.
Bill Review
Data from a medical bill is captured in our proprietary application, Medflow - Bill Review Management and processed through a series of decision engines designed to calculate a recommended reimbursement amount, as well as to flag procedures and diagnoses requiring special review, audit, negotiation or evaluation services such as professional code review, nurse review, peer reviews or Independent Medical Evaluations (IMEs). As rules from these specialized decisions engines are applied, a transaction log is maintained to allow for the subsequent review of the underlying context in which a bill was adjudicated.
The rules and flags comprising each decision engine are maintained as structured statements in a custom rules language. This abstraction promotes the maintenance and customization of this content being done by content analysts rather than programmers. This content can be modified and applied dynamically without the need to deploy new software. Rules can be added with “effective dates” to allow for advanced coding of rule changes and provide referential integrity as the content changes over time.
Medical Records Collection
Critical to consistent and correct reimbursement recommendation is the medical records. Auto Injury Solutions' integrated approach and advanced technology allows for the systematic request of records when needed resulting in our electronic patient file to be complete before a file is sent on for professional review.
Professional Review
In cases that require a review by a certified professional coder, nurse, or physician, the electronic file is routed to that professional to address appropriately. In jurisdictions where pre-certification is required, MedFlow - Case Management software facilitates oversight and measurement of this process. During the initial contacts, the Case Manager works with the Eligible Injured Party (EIP) and the medical service providers to review and approve the treatment plan which is than entered into MedFlow - Case Management and fed into the MedFlow - Bill Review Management to ensure proper payment of medical expenses.
In addition, any Medical Professional Evaluation Services such as IME, Peer Review, PHAD, and Radiology Review are all seamlessly referred, documented and results fed into the MedFlow - Bill Review Management.
24/7 Customer Service
Our focus on customer service is primary. We understand that there will be inquiries by providers, patients and others as to statuses and outcomes. Servicing the inquiries in a timely and accurate manner is essential. As such, in addition to our sophisticated telephonic software that allows us to achieve excellent ASA and abandonment rates, we have developed MedFlow - Customer Service Management software to track, document, and report on inquires.
Adjuster Desktop
The MedFlow - Adjuster Desktop allows online review by the adjuster so that the result is completely synthesized with the adjuster's file. The adjuster is provided online access to medical bills, records, and Explanation of Reviews (EOR) before the final EOR is sent and can communicate with us real-time.
The data representing the final results can be fed into any claim system to populate claim logs, and it can be fed into any payment system for payment of the bill.
Auto Injury Solutions' fully integrated approach contrasts with the highly fragmented process that is traditionally found in personal injury protection (PIP), medpay, and bodily injury claims handling. The result of fragmentation is a drain on insurance carrier resources attempting to synthesize the results of each of these functions into their final determination. This can result in inconsistent outcomes. Auto Injury Solutions' integrated product provides value to the automobile insurance carrier by producing consistent results and eliminating the time and cost associated with coordinating these many functions.
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