Auto Casualty Claims Processing

Fighting Back Against Rising BI Severities

By Christopher Tidball, Senior Director, Casualty Claims Consultant, Mitchell

Looking at insurance-loss trends can be quite baffling at times. Perhaps no more so than when trying to figure out why BI severities continue to rise despite frequency declining at a time when the safest cars ever produced are on the nation’s highways.

According to a recent study by the Insurance Research Council, the costs associated with bodily injury claims have exceeded the rate of inflation during the period of 2007-2012. While this is an interesting statistic, perhaps it would behoove us to take a deeper dive into this trend to try and shed some light on what insurers can do to improve outcomes.

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Unlocking Big Data Benefits: Driving Claims Efficiency and Customer Satisfaction

By Ed Olsen, DC, CPCU | March 25, 2014

Today’s claims executives face tremendous financial pressures and must make better use of information and automation to respond faster and more effectively to an ever changing landscape. Many have focused their attention on data and analytics for help with loss management, resource planning, process improvement and policyholder satisfaction only to discover their datasets do not provide the level of detail or marketplace insight to create competitive advantage. As such, there is an evident market need for comprehensive real-time information that provides actionable insights, especially for insurers who do not have access to large amounts of historical claims data.

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Posted in: Articles, Auto Casualty Claims Processing

The ACA’s Anticipated Effect on P/C and Workers’ Comp Lines

By Denise Johnson | February 10, 2014

Though parts of the Affordable Care Act have been in place since 2010, key reforms began on January 1, 2014. According to industry experts, the ACA won’t affect the medical bill payment process; however, insurers will likely see an increase in the cost of medical care for auto accident patients, more subrogation liens from health insurers and the potential for delayed treatment in workers’ compensation claims.

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Posted in: Articles, Auto Casualty Claims Processing

Property and Casualty Alignment with HIPAA

Guest Post by Tina Greene, Senior Regulatory Affairs Consultant

There are major healthcare regulatory mandates going in effect, at the federal and the state level, which will significantly impact property and casualty (P&C) insurance medical bills payers. The Administrative Simplification provisions of the Federal Health Insurance Portability and Accountability Act of 1996 (HIPAA, Title II), state mandates for property and casualty eBilling and more regulatory initiatives are forcing payers to understand these regulation’s requirements and be prepared to implement new processes and technologies in order to be compliant.

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Benefits of ICD-10 in Casualty Claims

Guest Post by Michele Hibbert-Iacobacci, Vice President, Mitchell International

The casualty claim arena involves evaluating and payment of claims for claimants who have suffered from an auto accident or workers’ compensation injury. This side of the health payment continuum has been omitted from the Health Insurance Portability and Accountability Act (HIPAA) as a covered entity.

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How to Seamlessly Integrate ICD-10

Guest post by Michele Hibbert-Iacobacci, Vice President of Information Management & Client Services

Seamlessly integrate ICD-10? How is that possible? Realistically, yes, ICD-10 is new and the United States will start to utilize the new code set effective October 1, 2014.

Is ICD-10 really new, though? Not really, and frankly many entities are so ready they are looking forward to ICD-11, which has a “who knows when” implementation timeframe.

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Posted in: Articles, Auto Casualty Claims Processing

A Day in the Life of a Claim: The Review and Processing Phase

Part II: Best Practices and Liability Determinations
By Vidya Dinamani, Vice President of Product Management & Marketing,
Auto Casualty Solutions, Mitchell
Paul Rosenstein
Vice President, Claims Solutions, Mitchell

Once a claim has gone through the initial FNOL process, it moves on to the review and processing phase. Typically, the desk reviewer (DR) examines the damage repair estimate to ensure it is compliant with all of the business rules in place. If the DR finds any discrepancies or if the carrier is required to do so on direct repair shops, then a re-inspection may be ordered. This can set in motion several additional processes involving more people and more reports, for example:

  • A claims manager may need to report the results of the re-inspection to various state agencies.
  • Results may also be used to confirm compliance and to ensure that the body shop has adhered to the carrier’s direct repair program guidelines, as well as repair industry standards.

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Posted in: Articles, Auto Casualty Claims Processing

Medical Bill Review and Claims: The Devil is in the Details

By Christopher Tidball, Senior Director,
Casualty Solutions Consultant, Mitchell

Having been on the front lines of claims vendor management for a number of years, I will be the first to attest that things are not always what they seem. As much as insurers would like to commoditize many aspects of the claims procurement process, the reality is that vendor selection is far from simplistic.

From subrogation and salvage to legal counsel and private investigators, there is often a temptation to shoot for the lowest price. But is the lowest price really the lowest price? Rather than focus on price, the focus should be on the ultimate net cost. Perhaps nowhere is this more evident than on the medical bill review front.

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Lean Agile: The Customer-Centric Approach to Software Development

By Mike Bishop, Vice President, Product Development, Auto Casualty Solutions, Mitchell
Robin Peters, Manager, Business Systems Analysis, Auto Casualty Solutions, Mitchell

Technology companies using Agile development offer a variety of benefits for their customers, and ensure that the voice of the customer is truly integrated into all aspects of the software-development process.

Lean Agile is a software-development methodology that emphasizes incremental and iterative development, and is a departure from the more traditional waterfall style where work is planned and performed in a sequential manner (requirements, design, implementation, verification, maintenance). Where waterfall lends itself to so called “big-bang” releases, Lean Agile favors a more rapid and flexible approach where small amounts of functionality are delivered at more frequent intervals. This allows product organizations that employ Lean Agile concepts to be more responsive to customer requirements and needs as they evolve.

Lean Agile runs on a two-week cycle (termed a sprint), with the first few days devoted to planning and prioritizing what is next for development. Once the planning is completed for a specific sprint, the work is divided up among teams so the development is done in a simultaneous manner (as opposed to the sequential development in waterfall). The spirit of collaboration is essential to Lean Agile, since programmers and developers form self-directed teams to accomplish the many tasks necessary to create software.

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Posted in: Articles, Auto Casualty Claims Processing

A Day in the Life of a Claim: The Initiation Phase

Part I: FNOL Sets the Stage
By Vidya Dinamani, Vice President of Product Management & Marketing,
Auto Casualty Solutions, Mitchell
Paul Rosenstein
Vice President, Claims Solutions, Mitchell

As a light turns green, a driver, whom we'll call Bob, proceeds into the intersection. Moments later, Bob is broadsided by another car, becoming one of the more than 5 million traffic accidents reported in the U.S. each year, according to National Highway Traffic Safety Administration (NHTSA) data.

Fortunately, both Bob and the other driver carry automobile insurance. They exchange information, and each begins the process of filing a claim. This article, the first in a series of three, follows the path that Bob’s claim will take during the initial phase.

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Posted in: Articles, Auto Casualty Claims Processing

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