San Diego, CA – Mitchell International, a provider of technology, connectivity and information solutions to the Property & Casualty claims and Collision Repair industries, recently announced the SmartGuidelines™ tool, the latest component of the Mitchell SmartAdvisor™ bill review software. The SmartGuidelines feature provides an integrated framework for bill review professionals to streamline the claims process, reduce costs and focus resources to increase quality of care by incorporating Official Disability Guidelines (ODG), a standard set to improve and benchmark claims within workers’ compensation.
With integrated guidelines, the SmartAdvisor bill review solution quickly and automatically identifies the frequency of medical procedure use, expected duration of a disability and average duration trends based on the combination of International Classification of Diseases (ICD) and Current Procedural Technology (CPT) codes. This reduces the possibility of unnecessary treatments or payments for non-compensable treatments. With the ability to identify potential outliers early in the claims process, reviewers can focus on more intricate and complicated cases requiring a greater level of handling to positively impact the overall quality of patient care.
“As an analytics-focused company, it’s important to us that we continually utilize data to improve claims processes for our customers,” said Shahin Hatamian, Vice President of Product Management and Strategy for the workers’ compensation division of Mitchell International. “Due to the rise in non-compensable claims, there’s currently an upward trend that is being witnessed in the adoption of medical treatment guidelines across the workers’ comp industry. Given that the medical industry is highly regulated and ever-changing, we wanted to eliminate these challenges by automating a large portion of the decision-making process for our customers, allowing for more time to focus on delivering the best possible service to patients.”
Other notable features include:
- One location for viewing medical evidence applied to the bill / line for greater efficiency
- Easily viewable colored flags / indicators from the Claims Examiner Portal™, adjuster portal, to enable users to take accurate and faster action
- A single look-up screen in the Claims Examiner Portal component for easy view and analysis of the detailed treatment thresholds
The SmartGuidelines tool is currently being evaluated by a select group of Mitchell clients and will be generally available by Fall 2014.
Source: Mitchell