By Matt Engels, Vice President of Carepath Navigation, Talisman Systems
Workers’ Compensation insurance provides employees with benefits when they become injured or ill due to their job. The aim of Workers’ Compensation is to ensure that employees receive medical care, financial support, and other benefits to help them recover and return to work. Medical provider information is critical to the effective management of workplace injuries – from initial injury care to specialists and hospitals.
Outdated medical provider information, however, can lead to delayed medical treatment, inaccurate billing, and miscommunication, which can lead to increased costs and a slower return to work for employees.
In the past, managing medical provider information in Workers’ Compensation was a challenge due to the sheer volume of data. Providers retire, die, and/or change their contact information and billing practices, and keeping up with these changes manually is a time-consuming and costly process. Additionally, there is often a lack of standardization across different providers and organizations, making it difficult to reconcile different data sources and ensure data accuracy.
To address these challenges, many workers’ compensation programs are now turning to advanced data management techniques. Advances in data management techniques have made it easier for Workers’ Compensation stakeholders to address the challenges of outdated medical provider information.
Data normalization, which involves standardizing data across different sources so that it can be easily compared and analyzed. This can help programs ensure that they have accurate and up-to-date medical provider information, regardless of the source. Another data management technique that can improve injury management is data enrichment. Data enrichment involves adding additional data fields to existing data to provide a more complete picture of the information. For example, programs can use data enrichment to add information about the provider’s area of expertise or the languages they speak, making it easier to match injured employees with the right providers.
Data deduplication is another important data management technique that can help programs address the challenges of outdated medical provider information. Deduplication involves identifying and removing duplicate data from a dataset, which can help ensure data accuracy and reduce the risk of errors. For example, if an injured employee is referred to multiple providers with different contact information, data deduplication can help programs identify the correct provider and ensure that they receive timely and accurate medical treatment.
In addition to these data management techniques, Workers’ Compensation programs can also use data visualization tools to help them analyze and understand medical provider information. Data visualization tools can help programs identify patterns and trends in medical provider information, making it easier to identify areas where improvements can be made. For example, workers’ compensation programs can use data visualization tools to identify providers who are frequently used by injured employees, which increases the likelihood that the data is accurate and reliable, and therefore can help programs channel patients to these providers’ offices.
Data verification is another tool workers’ compensation programs use to improve the quality of a data set. Data verification involves identifying and removing inaccurate or outdated data from medical provider databases. There are various methods of data verification, and one of the challenges in Workers’ Compensation is when a provider’s policies conflict with its contracted status, i.e., “We don’t accept work comp patients” even though the provider is listed in a Workers’ Compensation PPO directory. To address, some carriers engage vendors for proactive call campaigns, phoning providers directly to verify the data and ask the question “Do you accept work comp patients?” Data verification can help improve the accuracy and completeness of medical provider information, making it easier to manage and use this data effectively.
Overall, the use of these advanced data management techniques is helping to improve the way that workers’ compensation programs manage medical provider data. As these techniques continue to evolve and improve, we can expect to see even greater benefits for workers’ compensation programs and the injured workers they serve.
About Matt Engels
With over 25 years in claims management and managed care, Matt Engels is Vice President of Carepath Navigation at Talisman Systems, the innovators behind TalisPoint. Building better ways to structure and move data and injured workers through the care chain by leveraging technology, Matt is passionate about improving patient care, automating communication, and driving optimal outcomes. Matt earned a BA in History from Columbia University in New York City and his JD from Loyola University Chicago.
About Talisman Systems Group, Inc.
Just as a bridge connects two points, the full service, interactive TalisPoint provider search engine gives the Workers’ Compensation industry fast and easy web-based access to medical provider network data. Carepath Navigation is a Referral Clearinghouse designed for the P&C Industry. Operating in Workers’ Compensation, General and Auto Liability, and Property service lines, Carepath connects claims managers to their preferred and contracted vendors and providers.