Cutting Complexity in Workers' Compensation Utilization Review Programs

SAN JOSE, Calif., July 21, 2011 /PRNewswire/ -- DataCare Express Approval(SM) reduces utilization review program costs by enabling claims adjusters and trained administrators to routinely approve 80% or more of all treatment requests and by significantly reducing the number of referrals to more expensive nurse or physician reviews. Quick approvals also shorten the time it takes for employees to return to work.

With Express Approval:

• Clients use their own business rules as the basis for configuring the system and can take into account evidence-based guidelines and state-specific mandates.
• Using predictive modeling methodology, we help locate the critical information needed from medical reports to prioritize and route the referral to facilitate initial processing of requests.
• Client-defined workflows then route treatment requests to appropriate personnel and non-medical personnel can handle 80% or more of request.
• Non-medical personnel views request for authorization and medical reports with all the information they need for a quick and thoughtful decision. This includes a summary of all past requests and past-paid treatments. Claims examiners and administrative staff select treatment options from a menu written in plain English. They do not need to understand medical codes or complex treatment guidelines or answer complex medical questions.
• Claims examiners or administrative staff can immediately escalate a file for nurse or physician review, based on treatment history or any other issue within the application. This takes away inefficiency and time spent in generating referrals to the nurse or physician reviewers.
• If the treatment is approved, the system automatically sends authorization notification letters and faxes to injured workers and providers.  

Paulo Franca, Ph.D., DataCare's President and Chief Technology Officer, commented, "Our customers have told us that systems claiming to provide 'automated approval' end up approving too many expensive treatments which should have gone to physician review. Our system balances a decision support system with human judgment on complex treatment needs of workers' comp claims."

DataCare's new Express Approval offering can support multiple business rule sets, depending on the type of claim, and works well for organizations operating in multiple locations.

About DataCare Corporation (http://www.datacare.com)

Headquartered in San Jose, California, DataCare software supports evidence-based treatment decisions with defensible supporting documentation for workers' compensation claims. DataCare supports the highly specialized workflows for workers' compensation claims management, case management, express approval and utilization review. Web-based DataCare solutions have been reducing workers' compensation program costs by enabling teams to make quick decisions, and at the lowest appropriate level.

For more information, contact:

Mike Allen
DataCare Corporation
Phone: 866-834-2334
Email: [email protected]

This press release was issued through eReleases(R).  For more information, visit eReleases Press Release Distribution at http://www.ereleases.com.

SOURCE DataCare Corporation

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