Empowering Your Adjusters and Improving Your Bottom Line
The Acrometis flagship claims processing solution offers unparalleled workflow management, with documents automatically routed by a configurable rules engine. Based around claim assessment scoring, body part to claim compensability matching, jurisdictional directives, relatedness scoring and a host of other claim elements the Acrometis business rules are designed to reduce claim duration and costs.
CLAIMExpert automatically processes 65 percent of incoming medical bills and non-medical documents with no user intervention. Documents requiring adjuster intervention are flagged and sorted for easy review and straightforward decision making.
How Can CLAIMExpert Help You Reduce Costs?
Acrometis offers several services to be incorporated into CLAIMExpert, but if desired will enhance your claims operations separately as standalone upgrades
Acrometis has partnered with MCG to embed their Official Disability Guidelines (ODG) directly into our systems. These evidence-based guidelines are the product of decades of research and over 10 million cases. They have been adopted by 100,000 users and are widely considered to be industry-best standards when it comes to treatment and return-to-work.
With this integration, adjusters will have every aspect of their claim available to them in one spot, presented in an easy-to-use interface that allows them to monitor their claims easily and accurately. Our system continually cross-references claims against the ODG knowledge base and can determine if claims are performing as they should. If they are not, adjusters are quickly alerted and can take action.
Taking an evidence-based approach to ensure successful claims management
Evidence-based treatment and return-to-work guidelines are applied to claims
Automatically flags services that exceed best-practice recommendations or user defined allowances
Identifies claims that may be candidates for nurse case management, etc. triggering a referral if necessary
Identifies potentially problematic claims early on, saving money and time
Assists with reserve oversight, takes the guesswork out of reserve setting
Automatic and pre-populated referrals save adjusters time and reduces errors
Embedded directly into our systems, changes in ODG scoring or best practices are automatically reflected in the user interface
Claims are continuously monitored against guidelines
From MCG: Every claim is assigned a Risk Assessment Score (RAS) which changes as claim characteristics and comorbidities are added. The higher the score, the more closely adjusters should pay attention.
Pre-populates and Automatically Sends Referral Requests to Negotiated Partners
Uses indexed data to pre-populate forms
Automatically sends reliable referral requests to pre-negotiated partners
Users can check on a referral status at any time
Pre-populated forms save time and avoid potential errors
Maximizes network penetration
Status check-in ensures claims are staying on track
Embedded directly into our systems, user selection of a specific partner network presents the appropriate and agreed upon services offered by that partner
Our systems scan bills for relatedness to claims at-hand
Also cross-checks for rarity in workers’ comp
Mechanism to ensure UR reviews are compliant
Avoid allowing things to slip through the cracks
Pay for claim related services and ensure they are medically necessary
We can use the claim feed you already share with a vendor or partner
We support medical bills and document images in their existing forms
Acrometis integrates with bill review partners