Workers’ Compensation Claims Solutions
Data-driven insights to improve workers’ comp claims
Slash time and spend on record review
Slash time and spend on record review
Discover how much time and money your claims organization can save by trying our virtual Savings Calculator Now.
Lighting the path to better workers’ comp outcomes
Discover how workers’ compensation data can provide valuable insights through advanced automation technology for improved results.
Identify severity faster with predictive analytics
Detecting claim severity early can help you improve triage, contain costs, and enhance employee return-to-work timelines. Our solution leverages predictive analytics to accurately identify workers’ comp claim severity as early as day one.
- Scores and re-scores claims daily as new information is received
- Integrates prescription and medical data directly from your PBM and MBR providers
- Accurately predicts 88 percent of high severity claims within first 30 days
Speed and precision at claim intake and investigation
Streamline claims processing and improve SIU referrals with powerful tools that leverage robust industry data and analytics to deliver critical insights early in the life of a claim.
- Accelerate your FNOL process with automated pre-fill at claim intake
- Get insights from a cutting-edge claim intelligence platform that analyzes 1.5 billion claims
- Access more than 500 data reports, including reports tailored specifically for workers’ comp claims
Discover the latest workers’ comp claims insights
CMS releases updated Workers’ Compensation Medicare Set-Aside Reference Guide (Version 3.8) – changes impact CMS’s WCMSA re-review process
The Centers for Medicare and Medicaid Services (CMS) has released an updated Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide (Version 3.8)
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COVID-19 and Workers’ Compensation in 2022: The Great Resignation and Closing the Talent Gap
We continue our look at how the COVID-19 pandemic continues to impact workers’ compensation.
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Are indemnified EBMSAs still an effective tool after CMS released Section 4.3?
When the CMS released version 3.5 of the WCMSA reference guide on January 11, 2022, it redefined the potential risk and settlement considerations.
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COVID-19 and Workers’ Compensation in 2022: Legislative Update and Clearing Presumption of Coverage Hurdles
After two years, COVID-19 continues to impact workers’ compensation claims. In previous entries, we provided a broad look at the industry.
Read articleDetect fraud in workers’ comp claims
Detect fraud in workers’ comp claims
Workers’ comp fraud is one of the fastest-growing types of insurance fraud. Fight it with our extensive suite of claims fraud solutions that leverages robust data and innovative technology.
- Predictive analytics fueled by more than 1.5 billion claims
- Medical provider fraud analytics that score more than 1.5 million providers
- Advanced link analysis software that uncovers organized fraud activity
Streamline data reporting, improve compliance
Accurate, on-time compliance reporting
Accurate, on-time compliance reporting
Data accuracy and timely reporting are critical to EDI compliance, but varying reporting requirements make compliance challenging. Our leading solutions help you save time and improve workers’ comp reporting accuracy and timeliness.
- Meet data collection organizer (DCO) requirements for aggregation and valuation of policy and claim data for the submission of unit statistical reports (USRs)
- Consolidates medical bills into one data warehouse to manage compliance reporting for all DCOs
- Meets requirements for aggregation and valuation of indemnity claim data for the submission of the indemnity data call to the DCOs
States: Capture workers’ comp data efficiently
States: Capture workers’ comp data efficiently
States seeking to initiate EDI reporting or transition to a new IAIABC release can get precise, cost-effective data intake for workers’ compensation claims and medical data through wcCapture™.
- Helps collect FROI and SROI from insurers with greater efficiency
- Gathers medical data needed to set fee schedules, identify fraud, and implement cost containment strategies
Actionable insights, better outcomes
Actionable insights, better outcomes
Learn how workers’ comp analytics helped improve EDI compliance at Liberty Mutual and for the Commonwealth of Virginia.
Achieve full Medicare compliance, reduce exposure
Achieve full Medicare compliance, reduce exposure
Whether you need to quickly and accurately identify and report Medicare recipients, dispute conditional payment liens, or allocate future medical costs, our solutions and services help you comply with CMS and avoid costly penalties by providing you with key information to:
- Satisfy Section 111 reporting requirements
- Automatically fulfill MRN reporting obligations
- Reduce conditional payments
- Determine accurate workers’ comp Medicare Set-Asides
Verisk also provides additional claims reporting compliance solutions
Child support intercept matching
Casualty reporting
Questionable claims reporting
OFAC screening
Optimize claims resolution
Close complex claims faster
Close complex claims faster
Open claims costing your organization? Our team of medical and legal professionals can remove obstacles to closing claims with fast settlement approvals.
- Coordinated settlement conferences for large-scale claims resolution
- Expedited Medicare Set-Asides or conditional payments preparation
Automate the retrieval of medical information
Automate the retrieval of medical information
A cutting-edge that tool utilizes natural language processing (NLP) and offers options for identifying and extracting certain terms within unstructured medical records resulting in expedited file review at a far lower cost than manual review.
Facilitate fast and fair claims resolution
Facilitate fast and fair claims resolution
Improve settlement decisions and negotiation strategies with a claim-matching solution that analyzes a claim’s attributes against your company’s historical data and provides guidance on settlement amounts and likely length of time to settle.