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Workers' Comp News Release

Enlyte Names Steve Laudermilch EVP of Mitchell Casualty Solutions Group

May 17, 2022

P&C executive will head company’s auto casualty and workers’ comp technology division. SAN DIEGO—Enlyte, the parent brand of Mitchell, Genex and Coventry, has announced today that Steve Laudermilch has joined the company to serve as executive vice president and general manager of Mitchell’s casualty solutions group (CSG). With 25 years of senior leadership experience in workers’ compensation and auto casualty claims, Laudermilch will be charged with leading Mitchell’s CSG, bringing cutting-edge claims technology and workflow connectivity solutions to the auto casualty and workers’ comp markets, while helping restore the lives of injured drivers and employees. “We’re very excited and honored to have Steve Laudermilch join the Enlyte team,” said Alex Sun, Enlyte CEO. “Steve is a proven leader who comes to us with a successful track record of delivering results in workers’ compensation and auto casualty for global claims organizations. We look forward to him utilizing his extensive experience and knowledge to propel our products and services for years to come.” Prior to joining Enlyte, Laudermilch served as U.S. chief claims officer with Argo Group, a major underwriter of specialty insurance products in the property and casualty market. In this role, he led the technical claims teams for casualty, workers’ comp, financial lines, property and programs, and had oversight for claims operations and shared services. Prior to Argo, Laudermilch held key positions at Chubb, a leading property and casualty insurance company, and Deloitte Consulting. Laudermilch holds an MBA from Saint Joseph’s University, Philadelphia, and a BA in economics from Ursinus College, Collegeville, PA. *** About Enlyte Enlyte (www.enlyte.com) is the parent brand of Mitchell | Genex | Coventry, a leader in cost-containment technology, independent medical exams (IME), provider and specialty networks, case management services, pharmacy benefit and disability management. The three businesses have recently aligned their joint industry expertise and advanced technology solutions into a combined organization of nearly 6,000 associates committed to simplifying and optimizing property, casualty and disability claims processes and services. About Mitchell Mitchell International (www.mitchell.com) delivers smart technology solutions and services to the auto insurance, collision repair, disability and workers’ compensation markets. Through deep industry expertise, connections throughout the insurance ecosystem and advanced technology such as artificial intelligence and cloud-based solutions, Mitchell enables its customers and clients to succeed in today’s ever-changing environment. Each month, Mitchell processes tens of millions of transactions for more than 300 insurance providers, 20,000 collision repair facilities and 70,000 pharmacies. Its comprehensive solution and service portfolio empowers clients to restore lives after a challenging event.

Workers' Comp Article

Ask the Pharmacist

February 14, 2022

Are there times when it’s better to dispense a brand drug instead of its generic equivalent? Before answering that it would be good to briefly review some basic information regarding the differences between brand name and generic medications.  The Food and Drug Administration (FDA) is responsible for the approval of drugs in the U.S. In the case of a new drug, the process usually begins with “Discovery”. The drug will then typically proceed into a “Preclinical Research” phase where animal testing is applied. The drug manufacturer can then apply for an “Investigational New Drug” (IND) application. If approved, the IND would allow the drug manufacturer to proceed to “Clinical Studies”. All the while, the drug manufacturer is gathering data about safety (side effects, tolerance in specific patient populations, etc.) and efficacy. Once the manufacturer has enough information, a “New Drug Application” (NDA) will be filed, and if the drug is approved, it can be produced and made available for use in the U.S.  When a new drug is produced the drug manufacturers typically give it a brand name, and the FDA grants a period of exclusivity during which time the drug maker has exclusive marketing rights to that drug. Once exclusivity expires for a particular drug, generic manufacturers may begin making their versions of the brand name drug.  The generic manufacturer submits an “Abbreviated New Drug Application” (ANDA), which in essence allows them to request approval of the drug without having to include the Preclinical and Clinical Study data that the original manufacturer must supply. Instead, the generic manufacturer must prove to the FDA that the generic drug is comparable to the brand name drug in quality, purity, strength, dosage form, route of administration, efficacy, and intended use (aka, bioequivalent). That being said, the generic form will always have some differences as they cannot be exact copies of the brand, but these differences are not considered medically important in a bioequivalent drug. This abbreviated approval process allows the generic manufacturer to provide the drug at a significantly lower cost than the brand name counterpart. To address brand usage, Pharmacy Benefit Managers (PBMs) require medications be dispensed at the pharmacy as generics where possible and when substitution is not restricted by the prescriber or market conditions. To address missed generic opportunities, outreach programs and detailed reporting can also notify the claims examiner if a brand drug with a generic available was dispensed. While 9 out of 10 prescriptions in the U.S. are filled as a generic drug, there can be reasons a pharmacist or doctor chooses to dispense a brand over its generic equivalent, ranging from clinical to financial. The most common clinical scenario for use of brands over generics is for a group of drugs called “Narrow Therapeutic Index” drugs. The medications in this classification include anticonvulsants, which are used for treatment of seizure disorder but not pain, and blood thinners like Coumadin®. These medications are monitored via blood tests where a small change in blood concentration can affect the management of the disease. For example, if a patient is stable on a 5mg dose of Coumadin, switching to a generic warfarin may cause a small fluctuation in blood concentration and result in lower effectiveness and an increase in clotting. Another possible scenario where a brand might be substituted for a generic, although rare, is in the instance of a drug shortage. For example, if there are limited generics available of a specific drug or there is a recall or interruption in the supply chain, the pharmacist may choose to substitute the brand in order to fill the prescription with an available medication. An even less common scenario could involve a patient being allergic to an inactive ingredient in the generic product, as the generic may contain different ingredients including additives, coloring, etc. To find out more about brand and generic medications, visit the Food and Drug Administration (FDA) Generic Drug Facts website.

Workers' Comp Article

CPT 2022: Care Management and Other CPT Coding Updates

February 2, 2022

CPT Copyright 2021 American Medical Association. All rights reserved.CPT® is a registered trademark of the American Medical Association. It's that time of year again! The American Medical Association (AMA) recently updated its CPT® codes. The most significant changes in the 2022 code set include: Care Management CPT Codes Digital Medicine CPT Codes Anesthesia for Percutaneous Image-Guided Spinal Procedures Summary of the 2022 CPT Code Updates Let’s take a closer look at these changes and what they mean for the workers’ compensation and auto casualty industries. Care Management CPT Codes As healthcare systems across the U.S. strive to treat patient populations while keeping health risks and healthcare costs low, care management has emerged as a useful tool. Care management, which is based on the principle that intervening with individuals from certain populations will reduce health risks and decrease the cost of care, is a team-based, patient-centered approach to assist patients and their support systems in managing medical conditions more effectively. Care management also encompasses care coordination activities required to help manage chronic illness (AHRQ, 2018). Progression of Code Development Care Management codes were first introduced by the AMA in 2013, when they added the transitional care management code set. As health care has continued to evolve over the years, the AMA has continuously refined and added codes to report various Care Management services. See the chart below to better understand the progression of these codes over the years. In 2022, the AMA added four new CPT codes to report Principal Care Management services, created an add-on code for CPT Code 99491 and revised existing procedure codes. In order to fully grasp the addition of the new Principal Care Management codes, it is vital to first understand the three care management paths. Chronic Care addresses multiple (two or more) chronic conditions expected to last at least 12 months, performed either by (a) the clinical staff directed by a physician or other qualified healthcare professional (QHP) or (b) by the physician or a QHP. Complex Chronic Care addresses multiple (two or more) moderate or highly complex chronic conditions expected to last at least 12 months, performed by clinical staff directed by a physician or other qualified healthcare professional. Principal Care address one single high-risk, complex chronic condition expected to last at least three months, performed either by (a) the clinical staff directed by a physician or other qualified healthcare professional (QHP) or (b) by the physician or a QHP. These services are mutually exclusive and should not be reported together during the same calendar month, noted throughout the parenthetical guidelines in the CPT 2022 Manual. Procedure Code Description Changes Care Management Services Table Per a comment made at the 2022 CPT Symposium, the chosen care management path determines the code assignment. The AMA provided a table outlining the codes, service, staff type, unit duration, maximum monthly units to assist in code selection (AMA, 2021). Digital Medicine CPT Codes Like Care management, digital medicine continues to evolve, and thus, the AMA introduced a new CPT code section this year to report remote monitoring of non-physiological parameters. Remote Therapeutic Monitoring Unlike Remote Physiologic Monitoring (RPM), which measures a physiological parameter, such as heart rate, weight and glucose levels, Remote Therapeutic Monitoring (RTM) reviews data related to therapeutic responses, including signs, symptoms, and functions. RTM devices must be ordered by a physician and FDA approved. Additionally, RTM services are mutually exclusive to RPM services (Kanter, 2021). Remote Therapeutic Monitoring Treatment Management Service Remote Therapeutic Monitoring Treatment Management Service (RTMTM) utilizes RTM results to manage patients under a specific treatment plan, requiring at least one interaction with a patient or caregiver. Providers can report RTMTM and Care Management services together, but the time is separate. The guidelines state to report new code 98980 once, regardless of the number of therapeutic monitoring modalities performed in a calendar month (Kanter, 2021). New Procedure Codes Anesthesia for Percutaneous Image-Guided Spinal Procedures In 2022, the AMA also introduced a new family of anesthesia codes. Prior Anesthesia Codes The AMA Editorial Panel noted prior CPT codes 01935 (Anesthesia for percutaneous image-guided procedures on the spine and spinal cord; diagnostic) and 01936 (Anesthesia for percutaneous image-guided procedures on the spine and spinal cord; therapeutic) were reported inappropriately with other services. Furthermore, the panel concluded that there is no need for separate diagnostic and therapeutic codes— the anesthesia work was the same (Vorenkamp, 2021). New Family of Codes In the 2022 update, the Editorial Panel created a new family of codes, placing them in three categories sorted by type of service and body site. According to the presentation at the 2022 CPT Symposium, new codes 01937 and 01938 are considered “diagnostic.” New Procedure Codes Summary of 2022 CPT Code Changes New Principal Care Management codes should be used for a single complex condition. CPT code selection for care management is dependent on the path chosen for treatment. Parameters for Remote Therapeutic Monitoring are based on response to a therapeutic treatment. Remote Therapeutic Monitoring and Remote Physiological Monitoring are mutually exclusive. Anesthesia for percutaneous image-guidance spinal procedures are now by type of service and body site. References Agency for Healthcare Research and Quality. (2018, August). Care Management: Implications for Medical Practice, Health Policy, and Health Services Research. Retrieved from Agency for Healthcare Research and Quality: https://www.ahrq.gov/ncepcr/care/coordination/mgmt.html   American Medical Association. (2021). CPT | Changes 2022: An Insider's VIew. Chicago, IL, USA.     American Medical Association. (2021). CPT 2022. Chicago, IL, USA.     Hollman, P. (2021, November). Evaluation and Management Changes Presentation. 2022 AMA CPT Symposium. Chicago, IL, USA: American Medical Association.     Kanter, D. (2021, November). Digital Medicine Changes Presentation. 2022 AMA CPT Symposium. Chicago, IL: American Medical Association.     Vorenkamp, K. (2021, November). Anesthesiology and Pain Medicine Changes Presentation. 2022 AMA CPT Symposium. Chicago, IL: American Medical Association.  

Auto Casualty Article

The 5 Essentials Every Third Party Claim Workflow Needs

August 10, 2021

Recent third party claim costs have risen significantly— from the start of 2018 through the end of 2020, average charge per claimant in Mitchell’s aggregated industry data has increased 53% for third party claims. As costs rise, claims organizations need to make sure their organizations are set up to make consistent, accurate claim evaluations efficiently. Keeping up with the latest technologies or trends is an important way to stay relevant, remain competitive and enhance efficiencies, but if carriers lose focus on establishing good third party fundamentals as a priority, they may create inconsistencies across their organizations. This makes it challenging for adjusters to succeed and for carriers to ensure accurate claim evaluations, which is especially problematic in an environment where claim costs are on the rise. Carriers should try to avoid focusing too much on the latest trends or only managing to their bottom line, and instead, first check their third party claims processing foundations to ensure they have a comprehensive, end-to-end liability and injury program that supports settling claims accurately, efficiently and consistently. Want to Learn How You Can Establish The Fundamentals of Your Third Party Program? Talk to a Mitchell Expert > Auto insurance carriers can make significant improvements, like boosting consistency or improving evaluation accuracy, just by putting an extra emphasis on getting the essentials of third party claim handling right. Mitchell has worked with more than half of the top 20 auto insurance carriers to help build out their third party claim workflows. We’ve analyzed why programs succeed and the common challenges that sometimes cause inconsistent or inaccurate evaluations. As a result, we’ve compiled a list of the top five third party claim processing fundamentals we think every carrier should have in place. 1. Build and Standardize Best Practices in the Third Party Claim Handling Workflow Depending on the carrier’s size, there could be hundreds, or thousands, of third party claims adjusters throughout the organization. A large adjuster workforce often translates to monumental expertise and industry skillsets, which are truly some of the carrier’s best assets and competitive differentiators. While adjusters carry expertise and practical experience, without some guardrails or guidelines, they will may develop individual best practices for claim evaluation, and in the process, even the best adjusters may develop bad habits and blind spots or become overly aggressive. When adjuster teams are not working from a common set of best practices, it can lead to missed opportunities for a carrier to settle claims efficiently, accurately and effectively. To avoid inconsistency, carriers should establish and maintain their own third party claim handling best practices for various claim scenarios. By doing so, carriers set the baseline for what type of information adjusters should collect and how that information should be used to evaluate the claim. By just taking this one foundational step, a carrier might notice a dramatic increase in consistency across the organization. 2. Establish a Clear Process to Connect Senior Management’s Goals and Adjusters’ Day-To-Day Claim Processing Practices As mentioned, Mitchell has worked with many claims organizations over the years and has witnessed first-hand why certain carriers succeed. Overwhelmingly in our experience, organizations that maintain a keen focus on consistency and take the time to create processes within their workflows that help them achieve it, versus processes that purely manage their bottom line expenses, tend to succeed time and time again. It’s not enough to solely determine best practices—carriers also need to establish a way to connect those best practices with adjusters’ everyday claim handling processes. One of the most effective ways to do this consistently is to use a liability and injury evaluation technology system. This type of technology collects information about the claim and provides liability and general damages recommendations that companies can then use to reach a settlement for the claim. What liability and evaluation recommendation model is right for you? Find out with Mitchell’s easy-to-use guide. Go to Guide > 3. Provide Automation, Technology and Partnerships that Allow Adjusters to Focus on Their Core Tasks Third party adjusters are often tasked with a wide variety of assignments, from dealing with complex bodily injury claims to studying police reports and demand documents. In addition to their core claim resolution duties, adjusters in many claim organizations also are required to manage many administrative tasks. With competing priorities in their workload, some best practices in claim handling may suffer or go unaddressed, hurting settlement accuracy. Each carrier’s goal should be to let their third party adjusters focus on what they do best—evaluating and resolving claims. In order to do that, carriers should consider incorporating some of the following foundational elements into place in their workflows: Outsource demand-sorting to a trusted partner to eliminate the need for adjusters to endlessly sort through documents and find the claim information they need. Automation and technology that surface the most important claim insights, for example, flagging when a medical bill was submitted for a treatment that went outside of the expected treatment timeline, so adjusters can make informed decisions at the right time. A medical bill review platform to automate parts of the medical specials evaluation process by applying custom business rules and pricing adjustments to consider during negotiation. Technology that facilitates automated triaging to assign specific types of claims to certain adjusters, ensuring claims are routed right from the start and helping promote specialization for adjusters (i.e. high dollar claims). 4. Create an Efficient, Integrated Claim Workflow for Adjusters As mentioned above, adjusters are busy and third party claim processing can be especially complex. Carriers can set their adjusters up for success by providing an integrated, end-to-end third party evaluation solution that makes it easier for adjusters to accomplish their jobs. Here are a few of the most important essential elements every carrier should establish to build an efficient workflow for their adjusters: Technology systems that surface the right information for adjusters exactly when they need it. Standardized data exports, making sure adjusters not only receive the facts they need, but also ensure it is automatically delivered in the right format every time, reducing any administrative work needed. Systems that synthesize and store data in a way that can be leveraged by a carrier to evaluate adjuster performance. A workflow and interface that encourages adjuster critical thinking by presenting key findings and guidance throughout the claim process. Platforms that provide a responsive, modern and easy-to-use user experience for adjusters. 5. Use Reporting and Management Tools for Clear Insights Without proper reporting tools, pinpointing outliers or identifying problematic types of claims can be like finding a needle in the haystack. Establishing foundational reporting and management practices is essential to successful third party claim processing. One of the benefits of applying some of the technology systems suggested above is that those types of platforms will also generate data needed for reporting that gives managers and other decision-makers clear insights into their third party performance at multiple levels. For example, carriers can use operational reports to help ensure compliance with regulations or easily identify gaps in performance and coaching opportunities at an adjuster or team level. Other types of reports can show carriers' medical specials and generals trends, allowing them to focus on specific areas like a certain county or injury group. Using reporting tools as a regular part of an organization’s bodily injury processes can help claims managers spot potential problem areas before they become worse, make shifts and improvements in real-time and easily identify ways to help employees reach their potential. Establishing the Foundations Securing the right foundations first is crucial to long-term third party claim success. At Mitchell, we’d like to encourage every third party claim organization to take a step back and ask themselves, which of the five most foundational elements do they have in place today, and where are their opportunity areas? Initiating each of these five elements in their programs can help carriers establish consistent, accurate and efficient claim handling practices, setting themselves up for success now and into the future. Mitchell can help you establish a solid foundation for your third party claim program. Find Out How Now >

Auto Casualty Article

Most Common Characteristics of High-Performing Third Party Claim Workflows

August 10, 2021

While every carrier’s exact workflow and claim processing techniques are distinct, most claim professionals across the third party liability industry operate with the same goals in mind—settle claims accurately, efficiently and consistently. But sometimes, the complexity of third party claim processing can cloud these seemingly simple objectives. By using a combination of data, technology and expertise—and putting a special focus on the foundations of third party claims processing—third party carriers can overcome a myriad of barriers that can make it challenging to achieve their goals. So, how can you determine if your program is set up for success? In addition, if you’re looking for a new technology or services partner, how can you be sure it’s the right fit? Below, Mitchell has created a guide based on our work with high-performing claim organizations that go beyond the fundamentals and highlights what we believe to be the most important characteristics your third-party claim program should embody in order to excel. Processes & Program-Level Characteristics There is no shortage of tools available for claims handling. While it may be tempting to provide adjusters with the largest possible set of tools at their disposal and leave them to process claims their way, the top-performing third party carriers take the time to focus on setting up their foundations in a way that allows adjusters to work smarter. On a program level, that means committing to developing and following processes, and collecting and evaluating data to learn how they can continuously improve their workflow and overall programs. By establishing best practices and connecting those management goals to adjuster day-to-day activities, carriers can develop consistent, accurate and efficient claim handling processes, setting themselves up for both short-term and long-term success. Here’s a checklist of the program-level characteristics every third party carrier should strive for: Commitment to establishing and following a set of best practices. Dedication to a data-driven approach to evaluating performance and continuous improvement. Focus on establishing the foundations of third party claim processing so that adjusters realize maximum benefit from new tools and technologies. Find out the five foundational elements every third party claim workflow needs. Learn More What Your Program Needs in Each Stage of the Claim Lifecycle Once you’ve committed to laying the right foundations for your third party workflow, the next step is evaluating each step of the claims process. Below, we’ve included a checklist for all of the characteristics that a top-performing third party organization should possess, whether it’s your current program or one you’re evaluating with an external partner. Investigation Early in the life of a claim, it’s crucial your program helps adjusters collect the right data at the right time, and supports them by collecting the most important information for a specific loss scenario. Here’s a list of what we believe to be the crucial elements in the investigation stage: Clear investigation standards to ensure adjusters across the company gather consistent information about each loss based on best practices. Guidance for adjusters so they can clearly adhere to those standards, while also providing the flexibility to make decisions based on the exact scenario. Claim system integration, both in-bound and out-bound, to ensure your adjusters always have the information they need when they need it. The ability to collect the right data and prioritize it by loss scenario.   Liability In the liability stage, carriers should focus on helping adjusters use best practices in their evaluations for accuracy and consistency. Here are the items we recommend you execute in the liability stage: Clear liability evaluation best practices and standards that utilizes data already collected during FNOL and investigation. A liability evaluation recommendation tool that helps apply those best practices throughout the organization, so your adjusters can have guidance right at their fingertips for consistent evaluations. A tort-duty framework specific to each loss type that you can configure. Reduced cycle times through a consistent and repeatable claim evaluation approach and manager analytics dashboards that help identify areas to improve cycle time.   Injury Evaluation In order to make sure your organization thoroughly evaluates claims consistently and accurately, the injury evaluation stage should not only be comprehensive but also fully integrated with all data streams for the claim, including investigation and demand package review. Here’s how we believe your company can achieve optimal injury evaluations across the board: Clear injury evaluation standards based on company best practices. A services partner that has extensive bill review and third party experience that is backed by industry-leading technology to not only manage documents but also manage your bill review process. An industry-leading bill review platform that presents billing adjustments in a way that adjusters can clearly understand and utilize in the negotiation stage. Deep integration with the investigation and liability stages to ensure your adjusters have the data they need, where they need it.   Negotiation In the negotiation stage, carriers should focus on providing their adjusters with clear, easy-to-explain facts, so they are fully prepared with all of the information they need to negotiate with attorneys or claimants. We recommend that carriers understand and incorporate the following items that may help improve the negotiation process: A negotiation module that includes fact-based information using artifacts from the entire evaluation, including liability percentage and specials and generals amounts. The tools to help adjusters develop a clearly documented strategy with a clear line of sight back to key points documented during liability and injury evaluations.   Want to dive deeper into any of these key steps of the claim process to learn more about the best practices Mitchell has seen succeed? Consult with a Mitchell Expert Setting Your Third Party Program Up for Success The right organizational processes and solid claim processing foundations combined with best practices at each stage of the claim lifecycle can help your organization succeed. Mitchell’s end-to-end third party solution addresses each of these areas individually and holistically. To learn more, visit https://www.mitchell.com/solutions/casualty/third-party-liability-solutions.

Auto Casualty Article

Liability and Injury Evaluations: Understanding the Two Types of Recommendation Models

August 10, 2021

Third party bodily injury teams use a number of different approaches and tools to settle claims, but they do share a similar set of goals—settling claims efficiently and accurately. With so many factors at play in the third party claims process, including adjuster turnover, workload, aligning adjusters with management’s objectives, lack of reporting and more, many carriers struggle to achieve these goals consistently across their organizations. Establishing a consistent approach to liability and injury evaluation is foundational to effective bodily injury claim handling. Moreover, implementing this step is vital to consistent and accurate claim negotiations and settlements in practice. Many auto insurance carriers equip their adjusters with a set of tools and guidelines to help them during this stage of the claims process, but without a programmatic approach to assess and calibrate liability and injury across the organization, adjuster teams will likely diverge in their claim handling practices. A liability and evaluation recommendation model can help improve consistency and accuracy, but it may be challenging to understand which type of model is right for you. Below, we’ve outlined some key information to help you get started. What is a Recommendation Model? Many carriers provide their adjusters with technology to help them through the liability and injury evaluation process. These technologies collect information about the claim and help create liability and general damages recommendations that adjusters can use to reach a settlement for the claim. For example, depending on the accident details, these types of technology platforms will collect information like: Accident scenario (i.e., intersection vs rear end) Weather conditions at the time of loss Relevant tort factors (speed/control of vehicle) Medicals evaluation data (injuries considered or severity/causation factors) Based on the data collected, the tool will then use its pre-set model to calculate a potential liability evaluation range. It then walks the adjuster through a similar process to arrive at a recommendation for general damages and medical specials. Does your workflow incorporate the 5 fundamentals of third party claim processing? Find Out Now > What Types of Recommendation Models are Available? Two types of recommendation models are the most prevalent in the market today: models based off of pure statistical analysis of historic carrier data and models built based on a combination of statistical analysis and on an insurance carrier’s best practices. While both types of models are built with the same purpose in mind—helping auto casualty insurance carriers improve consistency and accuracy in third party bodily injury claim evaluations—we believe the best practices recommendation model provides carriers with a slew of advantages over the historical data model. This type of recommendation or “knowledgebase” model helps carriers establish their own best practices, connect management goals with adjusters’ day-to-day claim handling processes and helps set adjusters up for success in the negotiation process. Why the Best Practices Model is Right for You To help you understand in more detail why we believe the best practices model is the best option available in the market, and to help you clearly see the differences between the two types side by side, we’ve outlined the similarities and differences of a historical data model compared to a best practices model. Interested in seeing a best practices recommendation model in action? Find out more about Mitchell ClaimIQ > Key Features and Benefits Analysis As you can see, each type of model brings something different to each insurance carrier. To help easily visualize the differences, we’ve also put together a simple table that highlights the key features and benefits of each type of model. The Best Practices Knowledgebase Model: Frequently Asked Questions While it may be easy to understand how a pure statistical model is built based on historical claims data, you may be wondering how the best practices model works and is created. Below, we’ve answered the most frequently asked questions we’re asked about the model. How Are Best Practices Collected and Entered into the Model? Typically, the best practices model is developed based on consensus modeling surveys of a carrier’s adjusters, which provides a high degree of data confidence due to the abundance of data points. Carriers select their adjusters to be surveyed to help determine accident scenarios, interview questions, define the tort duties relevant to each accident type, determine severity and causation questions and more. How Does Surveying My Adjusters Help Create Better Results? Adjusters are the most important asset a claims handling team has—they carry the knowledge and expertise that help each company succeed. By leveraging the skillsets of the highest performing adjusters to help empower the rest of the claims team, an insurance carrier sets themselves up for consistent and accurate claim evaluations, regardless of the adjuster working on a claim. What if My Organization Doesn’t Have the Expertise to Build the Models? Typically, an organization needs seven or more adjusters and other experts to build a best practices knowledgebase model. The model can be built from scratch, or carriers can choose from a starter menu of investigation and injury questions, liability duties and more to help them build their best practices model. The software provides detailed reporting and analytics to allow carriers to see their claim trends in real-time. Choosing the Right Recommendation Model The liability and injury evaluation step of the third party claims process is essential to get the liability and injury evaluation step right each time to can lay the foundation for timely and accurate claim settlements. A best practices model helps carriers align their claims handling philosophy with the day-to-day activities happening across the company and provides adjusters with the tools they need to succeed. While the historical claims data model may be somewhat quicker to set up, we believe using a best practices recommendation model is the right choice for long-term success. Learn more about Mitchell ClaimIQ—our highly-customized knowledgebase is built based on your best practices.

Auto Casualty Article

5 Steps to Prepare for a Successful Post-COVID Future

August 9, 2021

In the span of just about a year and a half, the auto casualty and workers’ comp insurance industry has seen more transformation than perhaps in the past decade. From increased technology implementation to changes in the makeup and frequency of claims, the industry appears much different than it did at the start of 2020. As we look ahead to the future, it’s important that the industry prepares now for whatever comes next, and eventually, for success in a post-COVID-19 world. Specifically, there are five key steps insurance carriers and other claims organizations can take today in order to stay competitive as the industry continues to change and evolve post-pandemic: Plan for Future Scenarios Assess and Apply Technology Automation Integrate Intelligent Workflows and Reduce Paper Dive Into Data Analytics Establish Strategic Relationships   1. Plan for Future Scenarios If there’s one lesson the world learned from COVID-19, it is to be prepared for anything. Now is a great time for carriers and other types of claims organizations to assess their emergency plans and make sure they’re prepared for all types of situations that could happen into the future. Some key areas to consider when building out plans for all scenarios include: Managing Claim Volume Changes: As states continue to change COVID-19 restrictions and businesses across the country are making different decisions about their working models, it may be difficult to estimate claim trends for the next few months, or even years. It’s vital that every organization stays prepared and can scale up and down as claim trends change. Preparing for Outages: Again, although it may be hard to predict how the world and industry are going to change over the next few months, it’s important that in the event of an outage or employee absences, your organization can easily shift capacity to other teams, areas or office locations to help prevent any delays or issues.   2. Assess and Apply Technology Automation Manual workflows and workarounds can make it difficult for claims organizations to adjust and adopt changes on the fly—which many companies realized pretty quickly during the pandemic. About 88% of insurance executives reported that they increased their rate of implementation of automation and artificial intelligence since the start of the COVID-19 shutdowns, according to a McKinsey study. About 71% of claims professionals reported that their organizations implemented some type of new technology into the claim process during COVID-19, according to a 2021 Mitchell survey. Specifically, at Mitchell, we’ve seen many of our clients make one or more of the following three changes: Added electronic billing and electronic payments Increased straight-through processing Enhanced security and shift to the cloud As we all prepare for what’s ahead, incorporating these changes are a great way to help make claims programs more nimble. Here are some questions claims executives should consider asking themselves now about their programs: Is there any way we can reduce the number of different systems that my adjusters are required to go into in order to do their jobs? Are my team members inputting data manually anywhere? Has my vendor established electronic touchpoints with all managed care services? Can I increase my straight-through processing throughput? Is there any part of my bill review program that I can outsource to help free up time for my adjusters?   3. Integrate Intelligent Workflows and Reduce Paper Efficiency is one of the top challenges workers’ compensation and auto casualty claim professionals have struggled with for years, even prior to the pandemic, according to Mitchell’s annual industry survey results. Many adjusters are asked to constantly manage and oversee administrative tasks, in addition to their core duties. Additionally, many claim organizations still utilize a great amount of paper in the claims process, which can result in slowed processes and increased costs. As we look ahead to the future, there are a few different steps companies can take to help boost claim processing efficiency: Break processes out of silos to create integrated workflows. Automate routine and repetitive tasks. Supplement internal processes with outsourced services for non-core tasks. Explore ways to remove or reduce paper in the claims process. By striving to strike the right balance between automation and outsourcing, claims organizations can help free up time for their adjusters to focus on their core responsibilities—processing claims and restoring lives. 4. Dive into Data Analytics Throughout the COVID-19 pandemic, trends changed quickly, and auto casualty and workers’ compensation teams began to see patterns they had never witnessed before. As the world emerges from the pandemic, the trends will most likely continue to be somewhat unpredictable. It is virtually impossible to manage trends if you aren’t tracking and identifying them on an ongoing basis, which is why it is vital that claim professionals lean into data analytics now more than ever. Data can help claims organizations debunk their own biases, provide claim trend analyses and compare their performances to the industry. Here are a few areas organizations can use data analytics to help make improvements for claims programs: Detect the risk of fraud. Triage claims quickly and appropriately. Identify providers with outlier behavior. Compare performance to other carriers. Improve experiences for your customers.   5. Establish Strategic Relationships To help better manage all of the changes and challenges brought on by the COVID-19 pandemic, many companies started building and enhancing their strategic relationships, whether to outsource non-core functions, improve performance or achieve cost savings. Outsourcing non-core tasks can not only save time, but can also help companies be better prepared in the event of unexpected changes or emergencies. As we look ahead to the future, strategic relationships will continue to be a vital piece of the strategy for auto casualty and workers’ compensation carriers, and other claims organizations. Here are some key questions claims organizations should ask their current and prospective vendors to make sure they are building and maintaining the best possible relationships: What is the company’s business expertise? Do they specialize in bill review? What technology does the company leverage, and what is their relationship with the owner of that software? What are the company’s typical results? Is the company prepared to help you scale if you experience changes in volume? What processes has the company implemented to ensure quality?   Looking Ahead Though it is impossible to predict what challenges may lay ahead for our industry, by starting to take the five steps we recommended above, claims organizations will likely be more prepared for whatever comes their way as the world continues to evolve. Interested in hearing more details on Mitchell’s recommendations on how to prepare for success post-COVID? Watch our on-demand webinar now! https://www.mpower.mitchell.com/event/claims-orgs-post-pandemic-preparation/