In respect to disability claims, case management encompasses the coordination of all services on behalf of an individual, who is often considered a case. This coordination of services improves many aspects of a patient’s care, putting emphasis on communication and claimant advocacy. Upon claim intake, case managers focus on early intervention activities that will enable the employee to return to work more quickly based on knowledge of the claimant’s medical condition, the physician’s diagnosis, and the case managers experience.
Before a streamlined case management process can be implemented, the right technology platform needs to be in place. Legacy software often results in data silos, which makes it difficult to integrate the information needed to automate claims processing. Automated claim processing is the future for insurance carriers, third-party administrators (TPA’s) and large employers, to improve efficiency and reduce the resources required to process claims.
Traditionally claimants would need to submit paper documents when making a claim. Today, claims can be initiated through a variety of ways, including mobile applications, phone calls placed to call centres or management, or through online forms. Each claim type has a whole different set of requirements. All relevant details should be collected at intake ensuring that the claim can be processed. Depending on the details given at intake, different tasks and workflows should automatically generate to start the claims process.
Each organization should have a clear list of activities that need to be performed within a claim lifecycle. Depending on the type of claim, different activity tasks should automatically generate based on specific details. For example, a short-term disability claim may require the claimant to provide a doctor’s certificate before the approval process can begin. This gives the case manager an action plan, highlighting the steps necessary to process the claim efficiently.
4. Early Intervention
Early intervention in disability claims can lead to better outcomes for employees and employers. The longer an employee is off work, the less likely they are to return to work. While 75% of employees return to work after 12 weeks of absence, only 20% return after an absence of a year. This leads us to the next point on the importance of integrating claim management.
5. Claim Integration
Integrated Disability Management (IDM) is an important element of case management. The benefits of IDM are often highlighted as a process improvement. Case managers will be alerted to an integrated claim to review the preceding claim. This review allows the case manager to gain a deeper insight into the claim as a whole. The case manager can then decide if the employee can be returned to their original position, be offered an alternative position with their current employer, or be offered job training and placement services to help the employee return to the workforce.
6. Document management
Each step of the claim process has its documents and notes attached to a claim. The collection of documents is used to trigger the next step in the process. It is beneficial to be able to view all relevant documents in one place. By storing all of the content in one place, it is easier to collaborate with other case managers or specialists.
Case managers will often have access to a team of rehabilitation specialists, registered nurses, occupational therapists, and social workers. This collaboration of specialists allows the case manager to manage the claimant’s claim efficiently from beginning to end, making it easier for the claimant to return to work quicker.
This highlights seven parts of case management which improve claim processing efficiency. Early intervention of disability claims is vital to ensure employees can return to work more quickly.