San Jose, CA – Multiple third-party administrators (TPA) continue to allegedly fail in providing necessary documentation for independent medical review (IMR) in a timely manner. The California Department of Industrial Relations proposed $8 million in penalties for several agencies and insurers back in March for the same issue, however, the penalties were not something that could prevent this phenomenon from happening again.
A recent news article published by WorkCompCentral on July 27th mentioned how State Compensation Insurance Fund had to pay the California Department of Industrial Relations $350,000 in penalties for delayed submissions of medical records. Jennifer Vargen of State Fund mentioned that the carrier needs to implement some changes to its internal processes as well as oversight to ensure its sending documents on time, in addition to training staff members on how to scan and index records submitted to Maximus. Based on these details, it is imperative that other TPAs and insurers become aware of the issue at hand, as well as what they need to do in order to prevent it from happening again.
All agencies need to establish an increased level of accountability for IMR submittals, given that the amount filed each year has been increasing steadily. The California Division of Workers’ Compensation IMR search yielded the following results:
- 2013 – 46,788
- 2014 – 132,447
- 2015 – 154,077
Numbers obtained from DWC IMR Search
These numbers indicate why some agencies may face a higher level of scrutiny and greater penalties for delayed document submissions. For the same reason, all agencies responsible for filing the determinations should anticipate an increase in the following year and make the necessary changes to keep up with this trend.
DataCare noted that one solution that all agencies and insurers can consider in order to prevent future delayed submissions is implementing its Doc Packager into their current workflow. Although most TPAs, Utilization Review, and payer platforms are able to store documents in a concise manner, a significant amount of time can be saved in the process of locating these documents with the use of this tool. It generates a query based on the preconfigured user categories and pulls up all associated documents. The user is able to see how many pages the query contains, the number of documents, and the total file size. In addition, it also has the capability of auto-generating a table of contents for the user and exporting all documents into a single PDF file or separately in a zip folder. The Doc Packager eliminates the need for manual uploads into external systems, and has the ability to fax or email from directly within the system. Lastly, one important feature to consider is that it also has EDI capability for IMR submittals, but can be used to allocate documents for various other scenarios including subpoenas, audits, and hearings.