Workers' Compensation

With workers' compensation costs mounting on many fronts, we can help you take control and turn things around.

In the workers' compensation arena, the volume of data is massive and continues to grow. Being able to extract meaningful information from that data and find critical insights necessary to manage the line profitably is more important than ever. That is precisely what we do.

Our expertise provides us with the ability to manage, mine, and analyze large volumes of data that you can use to your advantage. Our comprehensive set of products and services helps you find patterns in complex data sets and navigate the complexities of this dynamic and data-intensive line of business.

Products and Services for:

Fraud Detection and Mitigation

Workers' Compensation Fraud

ISO ClaimSearch
The property/casualty insurance industry’s first and only comprehensive system for improving claims processing and fighting fraud.

Medical Fraud

ISO MedSentry
Medical fraud detection model that integrates the strength and efficiency of highly advanced analytics with a clinically expert, human-touch validation process

Premium Audit

PAAS Classification Guides
Detailed information on the intent and application of each general liability and workers' comp classification

Premium Audit Advisory Service (PAAS)
Technical information and training for premium auditors

QC3 (Query Commercial Classification Code)
An online lookup tool that finds the commercial classification code for workers' compensation or general liability in a specific jurisdiction or in reference to an NAICS or SIC code

Compliance Reporting

State Workers' Compensation Compliance Reporting

wcAnalyzer
Sophisticated analytical and report-writing tool that you access through a web browser lets you use your compliance data for an in-depth look at your workers' compensation business

wcPrism
A comprehensive suite of data-management and compliance solutions for workers' compensation insurers

wcPrism Injury Reporter
Using the claim transactions you report to ISO, service automatically triggers the appropriate first and subsequent reports of injury (FROI/SROI) as required by each EDI jurisdiction

wcPrism Medical Reporter
Service helps you manage the detailed medical claims reporting to meet data collection organization and jurisdictional requirements

wcPrism Policy Reporter
Service helps you maintain accuracy in reporting policy information (WCPOLS) to individual data collection organizations

wcPrism Detailed Claim Information Reporter
Service automatically triggers detailed claim information (DCI) reports and individual case (ICR) reports from insurer-reported claims transactions for claims satisfying the current DCI and ICR requirements

wcPrism Unit Statistical Reporter
Service produces required unit statistical reports from the policy and claim transactions you provide

State Filing Handbook for Workers' Compensation
Your online source of information on state filing laws, regulations, and procedures for workers' compensation

Medicare and Medicaid Compliance

Section 111 Reporting

MSP Navigator
A comprehensive Section 111 reporting tool with integrated conditional payment and Medicare Set-Aside guidance

MMSEA Section 111 Compliance Audit
A review of your Section 111 reporting process to help you avoid penalties, improve workflow, and reduce loss costs

Medicare Set Asides

Legal Zero
Services — based on legal advocacy — to help you reduce the cost of Medicare Set-Asides to $0 in appropriate cases

Limited Allocation
A plan to cover the future medical costs when a beneficiary receives a settlement not meeting Medicare Set-Aside review guidelines

Medicare Set-Aside
A medical and legal approach to help you comply with Medicare requirements, regardless of the type and size of your settlement

MSA Clinical Review
An analysis of the pharmaceutical costs associated with a Medicare Set-Aside

Pre-MSA
An analysis of the potential amount of the Medicare Set-Aside for a claim to help you determine if settlement of the case is feasible

Pre-MSA Plus
An analysis of the potential amount of the Medicare Set-Aside for a claim, together with an assessment of the prescription medications involved, to help you determine if settlement of the case is feasible and proactively address the cost drivers

Conditional Payments

Conditional Payment Services
Investigation, consultation, and compliance services to help you challenge and reduce Medicare’s demands for reimbursement of conditional payment claims

CP Link
The most cost-effective and streamlined way to handle Medicare conditional payments

Protocol Design for Medicare Secondary Payer (MSP) Compliance

Protocol Design Service
Help with designing your own procedures for complying with Section 111 reporting, conditional payments, and Medicare Set-Aside requirements

Claims Management

wcNavigator^®
Predictive modeling system that helps you spot difficult workers' compensation cases before they spiral out of control

Liability Navigator^TM
An expert tool that enables claim handlers to take the best course of action and increase efficiency in the evaluation and resolution of liability claims