Solutions > Business Process Services > Workers' Comp Services
WORKERS' COMP SERVICES
Workers' compensation costs represent approximately 70 percent of every primary casualty dollar paid by employers. And workers' compensation medical losses represent more than half of all total losses. These staggering numbers have prompted 41 states to enact reforms to their workers compensation laws. These laws have not stemmed the rapidly rising costs driven in large part by year on year increase of 15% in medical expenses. The laws, however, have added to the challenges faced by companies involved in funding, delivering, and administrating workers compensation programs. Legacy technology and tighter operational budgets have increased the challenges for companies to keep up with regulatory changes.
The iSpace Risk Insurance practice provides the expertise and services required by third-party administrators, managed care organizations, cost containment companies and pharmacy benefit managers to improve operational process efficiency and achieve administrative savings. Our services revolve around Information Technology Services and Business Process Services.
INFORMATION TECHNOLOGY SERVICES
iSpace information technology services cater to a diverse client base within the healthcare and workers' compensation domain. Our innovative and leading-edge Technology services are leveraged by organizations to improve delivery and operational capabilities.
- e-Billing & EDI Connectivity: iSpace helped customers build, improve and enhance their e-Billing and EDI capabilities. Our services helped companies to achieve electronic data interchange (EDI) connectivity and e-Billing compliance with state mandates, along with electronic payment and denial management. Our services can help with creating and maintaining an e-billing platform that can interface with the existing legacy systems using HIPAA compliant (837, 275, NCPDP) and client specific formats to convert paper to electronic bills. The platform helps with recon files back from customers and help to manage the denial and short pay's. The application interfaces with a Document Management System to send any attachments (Nursing notes etc) required by customers for processing payments.
- State Reporting Engine:iSpace built a custom state reporting engine to replace old legacy applications for reporting transactions to different states. The engine was built on the latest technology and was built to be scalable and flexible to handle reporting to multiple states including handling Florida proprietary flat files to ANSI X12 837 in Texas and California. The engine handles data requirements for supported states in addition to managing mandatory, conditional, and optional edits and to view acknowledgment information for correction.
- Master Database Management: iSpace built a data warehouse to manage data from multiple product lines, financial applications and external sources including carrier data. The master database acted as the repository for all clients reporting and the database for the customer facing portal.
- Customer-Centric Portal: iSpace built and maintains a client facing portal that acts as the primary interface for claims adjusters to seek information. It is a front end portal for all clients related reporting.
- Case Management System:iSpace built a custom case management system that helps manage long term patient cases and reduce costs.
- Document Management System: iSpace partnered with EMC2 to set up a Captiva system enabling clients to move to a paperless environment.
- MMSEA: Reporting Engine. For more information Click Here.
- Medical Provider Network (MPN) Management Engine: iSpace helped build a Healthcare PPO engine that is customizable for workers' comp MPN's. The engine allows the flexibility to customize an existing PPO, contract providers from the ground up, or blend multiple networks to each client's specific needs. With disruption, savings and gap analysis tools, the engine balances inclusion/exclusion criteria against regional coverage requirements.
BUSINESS PROCESS SERVICES
Our BPO capabilities revolve around the following areas:
- Finance & Accounting:iSpace currently helps clients improve their service levels and reduce costs related to Cash Posting, Accounts Receivable & Collections, Accounts Payable and Analytics.
- Medical and Pharmacy Bill Review:iSpace works with clients on their Bill Review requirements including reviewing medical costs for appropriateness and in accordance with fee schedules and provider discounts. iSpace associates log into the client's bill review platform to review bills and help with cost containment. iSpace has worked on multiple platforms including PowerTrak. Bill review services have resulted in tremendous improvement in quality, turnaround time and costs.
- DME Order Processing:iSpace helps with the order life cycle including coordinating care with DME vendors.
- Bill Data Capture:iSpace can help with data capture requirements including mail room services based out of our centers in Los Angeles.
- Legal Services & Litigation Support:Litigation expenses are one of the major cost drivers associated with Workers' Comp claims. iSpace and its team of dedicated Legal Professionals and Attorneys can work in tandem with your legal team to reduce costs related to Medical Summaries, Deposition Summaries, drafting of Pleadings and document review.
- Medical Provider Network Management Services:Maintaining a Provider network is costly and time consuming. iSpace can help with credentialing, demographic changes, network analysis, reprising and reporting.