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Medical

Medical Claims Management

IME’s

Independent Medical Examinations (IME’s) are an effective tool for medical claims management costs associated with Accident Benefits, Bodily Injury, WSIB, Life, Health and Disability claims. Medical FileIns is a collaborative electronic workspace designed to make an insurer’s job easier. It allows insurers, and preferred IME providers to electronically send and receive referrals with full tracking, analysis and authorization capability.

More importantly, it allows insurers send confidential material in a secure, encrypted, PIPEDA compliant manner. An optional rotation feature ensures that files are assigned impartially and distributed evenly. Vendor compliance against published guidelines is an important performance management metric in a highly regulated environment. Medical FileIns not only tracks these KPI’s, but reviews financial compliance with invoice submission and review.

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The ability to track the trajectory of MIG and Non-MIG accident benefit files through the FSCO resolution process, with fluid changes and process reviews on every rendered decision, is a labour intensive process. Medical FileIns electronically tracks files by task and phase and when used in conjunction with Litigation FileIns (on the same sign-in) becomes a powerful claims management tool.

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Corporations, governments and human resource departments can also utilize FileIns to manage employee referrals and request services from preferred vendors and service providers. A multi-language, self-administered system with automatic form generation tools, gives companies total flexibility in a global marketplace. No IT involvement or up-front costs coupled with quick implementation, makes FileIns a comprehensive, yet affordable solution.

TREATMENT FACILITIES

In addition to the features listed above, treatment Facilities (except those servicing Ontario Auto) can submit treatment plans and invoices to insurers and collaborate on service and fees electronically, with full tracking capability. In addition, insurers can track each treatment facility by location, medical doctor, credentials, licensing and expiry dates –a powerful tool in the fight against fraud.

Medical Claims Management

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