Volume Five Number Three Q Published by Mitchell International. Industry Trends. Report

Transcription

1 Volume Five Number Three Q Published by Mitchell International Industry Trends Report FEATURED IN THIS ISSUE Five Qualities of an Effective Business Workflow Solution By Shahin Hatamian Vice President, Product Management and Strategy, Casualty Solutions Group, Mitchell

2 Industry Trends Report Table of Contents 4 70 Years of Supporting Our Clients and Their Important Work An Interview with Alex Sun on Technology Trends 12 Quarterly Feature Five Qualities of an Effective Business Workflow Solution 20 Bonus Features Break Down Traditional Bill Review Procedures Make a Bigger Impact on Third Party Auto Claims 28 WCS Medical Price Index 34 ACS Medical Price Index 38 Compliance Corner 42 Current Events 43 Partner Spotlight 44 About Mitchell 45 Mitchell in the News Volume Five Number Three

3 A Message from the CEO What s Trending in Technology? Welcome to the Q3 edition of the 2016 Mitchell Casualty Industry Trends Report. As you know, we are celebrating our 70th anniversary this year. In the last issue I shared some of my thoughts around how the company has evolved throughout the years and where we re headed next. This quarter, I m excited to share some of the current and emerging industry trends I m following. There are so many interesting things happening in technology today, and it s fascinating to see the impact and opportunities they will bring to the insurance industry down the road. Alex Sun President and CEO, Mitchell In this issue, we have several articles from our in-house experts that look at additional ways organizations can approach challenges in our industry for better business results. First up is our feature article, Five Qualities of an Effective Workflow Solution, by Shahin Hatamian. Shahin explains how these qualities can help companies that process medical bills outperform their goals and differentiate themselves from the competition. Shahin also emphasizes the need for insurers and third party administrators to tailor workflow solutions to their individualized business needs. Our bonus articles this quarter include an analysis of traditional bill review procedures and detail how specialty bill review can achieve better results. We also discuss the current state of third party claims and a few recommended methods to contain the associated costs. View the Auto Physical Damage Edition As I finish up the second half of my interview for this issue, I d like to take a moment to remind you of how important you are to Mitchell. We certainly wouldn t be here today without you, and I m excited for what we can achieve together in the years ahead. Enjoy the rest of your summer, and thank you for your continued readership of the Industry Trends Report. Report. Alex Sun President and CEO Mitchell Q3 2016

4 70 Years of Supporting Our Clients and Their Important Work Mitchell was founded in Glenn Mitchell s garage 70 years ago. The world has changed a lot since 1946, and Mitchell has evolved right along with it. While remaining true to our roots in collision repair, we ve expanded our reach into auto physical damage, auto casualty, workers compensation, out-of-network solutions, and now pharmacy. Another way we ve evolved is through the adoption of technology. We ve come a long way since our manuals were printed on paper and the current explosion of both available and emergent technologies promises further change and opportunity.

5 As we look toward the future, we anticipate ongoing evolution, but here s what will remain the same: we ll continue to focus on technology, expertise and connecting to bring additional value to our clients. We ll also continue to support the important work they do by focusing on empowering better outcomes. Another way we ve evolved is through the adoption of technology. As part of our ongoing celebration of our 70th anniversary, we asked President and CEO, Alex Sun, about some of the technology and trends that are not only changing the world we live in, but also having an impact on both insurers and collision repairers. Alex Sun, President and CEO Read part II of our 70th anniversary interview.

6 What technology and trends are you following that you anticipate will have an impact on the P&C industry? There are a number of big trends that are affecting the entire industry. The first is a general recognition that in order to remain competitive you need to have the right technology infrastructure to do so. Many insurance companies across all lines of coverage are beginning to go through very large scale technology transformations, starting with either their claims systems, their policy administration systems or their billing systems. Many insurance companies across all lines of coverage are beginning to go through very large scale technology transformations. The intent is to create a unified, scalable and extensible environment so they can create new experiences and new capabilities for reaching out to their customers and managing them. A second major trend that is really just starting to emerge, is we re all beginning to recognize there is real, tangible, practical use for things like machine learning or artificial intelligence. We re beginning to pilot ways to leverage these types of technologies, marrying them with the vast amounts of data we captured in our systems to drive either better decisioning, or using machines to automate tasks that may have historically been done by individuals. And the third trend I m seeing is the focus on the digital consumer experience. Insurance, generally, is a very competitive marketplace. One area where many carriers, particularly on the personal lines side, are beginning to focus as a point of differentiation is on creating interesting consumer experiences. This encompasses everything from how they quote, to how they manage their daily interactions, to how they handle a claim. With the ubiquity of mobile smartphones and increased access to broadband, we re beginning to see clients embracing major digital consumer initiatives. Other things that are impacting the insurance industry, both in favorable ways and in ways that need to be considered as they relate to future business models, are technologies like the Internet of Things whether that s the connected car, the self-driving car or nanotechnology related to healthcare. These are part of a spectrum of new technologies being deployed that will not only affect how customers expect to be interacted with, in terms of either buying insurance or having their claims handled, but also how companies themselves will operate.

7 Watch the video of Alex Sun discussing what trends he s following closely. 3 Key Trends Impacting the Insurance Industry 90 % % Technology Transformation Machine Learning Consumer Engagement 90% the amount cost performance can improve over time by scaling across siloed functions and reducing redundant processes. 95 the number of the world s 100 largest enterprise software companies by revenues that will have integrated cognitive technologies into their products by % the probability that satisfied customers are more likely to renew their policies than unsatisfied customers. 1. McKinsey.com 2.Deloitte.com 3. McKinsey.com

8 What trends are top-of-mind for you in auto physical damage? On the auto physical damage side, there are a number of external pressures affecting collision repair shops that are creating an incredibly complex operating environment. These trends are causing them to seek more sophisticated technology solutions to operate efficiently and meet the demands of OEMs, insurance companies and consumers. First off, advances in automotive manufacturing the incorporation of more sophisticated materials, technology and safety features are making it even more complicated to repair a vehicle today. And it raises the question, for the first time in a decade or so, of whether or not cars are being repaired safely and correctly. So not only is it extremely important for repair shops to have access to the information they need to repair a car and certify that it was repaired correctly, it also increases the burden on them to invest in both training for their staff and new equipment. The Changing Face of Automotive Materials Advanced High Strength Steel 90%+ The projected percentage increase in the use of advanced high strength steel in light vehicles in North America between 2014 and Aluminum 26%+ The projected percentage of body and closure parts for light vehicles in North America that will be made of aluminum by 2025 (measured by volume rather than weight) Ducker Worldwide. (2015). Metallic Material Trends in the North American Light Vehicle. Accessed online Aug. 3, Ducker Worldwide. (2014) North American Light Vehicle Aluminum Content Study. Accessed online Aug. 3, 2016.

9 Insurance companies, for their part, are becoming increasingly reliant on collision repair partners in their vehicle repair programs to manage more administrative and customer service-oriented tasks like estimating, coordinating vehicle rentals and ultimately, doing whatever it takes to get an owner back into their vehicle. Today, we re really focused on the technologies collision repair shops need to employ to allow them to operate more efficiently. are looking to leverage technology to do things like streamline parts procurement and manage client scheduling. Lastly, consumers are driving another big trend that is affecting collision repair shops and really operators of any small business. More consumers are looking for outside information sources to aid them in making decisions on what collision repair shop to work with, and social media is increasingly influencing this decision. I believe now more than ever, collision repairers are going to need to be smart about how they leverage social media and their presence on the web in order to position themselves for success. Today, we re really focused on the technologies In addition, many insurance companies are focused not just on the safety and quality of a repair, but also on the timeliness of the repair process. This puts significant pressure on the collision repairer to make sure they can perform their work not only cost efficiently, but also on a timely basis, and with regular status updates. As a result, collision repairers collision repair shops need to adopt to allow them to operate more efficiently, especially with all the increased demands placed on them by OEMs, insurance companies and consumers as well as the changes in what is required to deliver a safe repair.

10 Are there any trends specific to auto casualty that you are following? One trend that s having a big impact on auto casualty insurers is that both frequency and severity continue to rise. Cost containment solutions that address these issues are top of mind both for us and for our clients. On the first party side, we continue to look for ways to adapt elements of a managed care cost containment model to a non-managed care setting in order to drive more efficient, accurate claims outcomes. Whether we re focusing on provider networks, out-of-network discounting capabilities, out-of-network pricing capabilities, nurse review, or even pharmacy, we re really taking a lot of the concepts that have evolved in the managed care world and adapting them for use in the auto casualty model. On the third party side, there s been about a 12 percent increase in bodily injury claims costs over the last five years. The average use of medical services is up about 18 percent, and many injuries are becoming more expensive to diagnose and treat. As a result, our insurance carrier clients are operating in an environment in which, more than ever, they need to keep third party claims costs in check. At the same time, the adjuster workforce demographics are starting to change. Many seasoned adjusters are now reaching retirement age, so there is a loss of expertise in an extremely complex space. It s becoming imperative for the insurance industry to adopt technologies that allow them to codify in a system the best practices of their third party adjusters. That s a big focus point for us it s a problem we re really working to solve. The Rising Cost of Third Party Claims 18 % Increase Claims costs over the last five years 11 % Increase Frequency of use of medical services over the last five years 36 % 15 % Increase Claimants with nerve or disc injuries over the last five years Increase Average charge per claimant with nerve or disk injuries over the last five years 1. ISO Fast Track data Mitchell data

11 What trends are you seeing in workers compensation? The workers compensation market has been dynamic for quite some time, due in part to the recession. It s further complicated by an equally dynamic market on the healthcare delivery side. The consolidation that s taking place with health insurers, health systems and managed care organizations and, of course, the implementation of the Affordable Care Act are all contributing factors. Despite a small decline in the volume of claims, we re continuing to see rising medical care costs. Another trend that is contributing to this dynamic environment is the dramatic rise in opioid abuse. In fact, there were a record number of drugrelated deaths in 2014, and 61% of these were caused by opioids. This prompted the CDC to issue new prescribing guidelines earlier this year. Many states and organizations such as the Work Loss Data Institute that publishes the Official Disability Guidelines are also tightening their recommendations to keep patients safe and curb the threat of addiction. Because of these factors, we re seeing an increased focus on pharmacy benefit management as a way to more appropriately manage the distribution of opioids and to keep claimants safe and on the road to recovery. As a result of these trends, it s become even more It s become even more important for our workers compensation clients to focus on enabling technologies that allow them to operate their organizations more effectively and efficiently. important for our workers compensation clients to focus on enabling technologies that allow them to operate their organizations more effectively and efficiently. Our clients are looking to use technology to more tightly integrate with the other service providers and partners they interact with throughout the claims resolution process. They re also looking for ways to leverage data that is captured in the use of these technologies, in a way that gives them greater insight into cost drivers and helps them deliver better outcomes for their organizations and their claimants. For more industry insights from Alex and other Mitchell leaders, follow us on LinkedIn and read our corporate blog.

12 12 Quarterly Feature Five Qualities of an Effective Business Workflow Solution By Shahin Hatamian Vice President, Product Management and Strategy, Casualty Solutions Group, Mitchell Decision makers need to have complete control over what happens to a bill after it gets imported into the system. No two payors are the same, so their business workflow solutions shouldn t be identical either. Every insurer or third party administrator knows their business best and needs a workflow solution which adapts itself to their unique business priorities and rules. Now learn the five qualities that make a business workflow work for your business. 1) Customizable and Flexible Why It s important for companies to be able to optimize their workflow to their own specific requirements since every business has different needs. Businesses shouldn t be limited to a one size fits all model. A workflow, or a set of business processes that work together, should be customizable so each business can create a process order that works best for them. For example, each company should be able to decide at which point in the workflow business rules should be triggered, when bills should be routed for nurse review and adjuster authorization and when to pend and transmit bills for preferred provider organization repricing. Insurers, TPAs and managed care companies shouldn t be limited to one static, pre-defined process that mandates one process - bills go through bill review, then trigger rules, then go to the PPO network. Decision makers need to have complete control over what happens to a bill after it gets imported into the system.

13 13 Quarterly Feature How In combination with the workflow solution, the rules engine should allow for complete flexibility in creating business rules in order to get the best outcomes. The rules engine should be separate from the application logic, giving more control to the business user. The engine should be robust enough to allow the user to modify rules as the user requires. This ensures the workflow more closely aligns with the company s internal guidelines and goals. A large part of having a customizable workflow solution is being able to update it quickly and easily. This includes being able to update business rules within the rules engine in an efficient manner. A rules engine is not as valuable if a company has to contact an external vendor to request rule changes every time it needs a rule modification. This type of approach may take weeks and can be an expensive process. set up their business workflow to have upfront adjuster oversight since the bill may be denied and will give their resources more time to process clean bill edits. Both companies have their own specific A large part of having a customizable workflow solution is being able to update it quickly and easily. needs, but Company A and Company B should be able to select a workflow process and rules engine solution which is flexible enough to meet their different business needs. If they are both able to customize their workflow and write rules specific to their needs, both companies are closer to meeting their own business goals. To help solve this problem, the rules engine must be easy enough to setup, learn and use so that an employee without a development background could master the knowledge required to make and edit rules with minimal training. If payors are able to customize the workflow process to their needs, they are better equipped to develop new ways to ensure cost containment and improve efficiency. Example Insurance Company A and Insurance Company B are setting up their business workflows. In particular, they are interested in making sure that their team reviews all high-dollar inpatient hospital bills. It s also important to them that in their workflow process, utilization review recommendations are applied before the bill goes through the review process. However, Insurance Company B may have no downstream reporting requirements and may

14 14 Quarterly Feature Benefits Using a fully-customized workflow solution sets customers up to produce the best outcomes and gain an edge on the competition in the process. By choosing a scalable and customizable workflow, a company has a greater opportunity to take the subject matter expertise of their best employees and efficiently scale it across the business. If a company can create rules that are tailored exactly to its needs, they can see huge benefits in return. Expert bill review employees can focus on adjudicating more complex bills. Flexible and customizable workflow and rules engine solutions enable insurers and TPAs to have more control over the business, reduce operational costs, write rules that align with company objectives and improve employee productivity. 2) Facilitates Automation Why With the right automated process, adjusters don t need to review each and every bill. A workflow that uses a rules engine can determine which bills require an adjuster s oversight and which bills can be automatically adjudicated. When a rules engine enables the setup of auto-adjudication within a workflow, it allows the adjusters to focus only on those bills that require an expert decision. How Ideal Automation Rate An efficient workflow usually passes through percent of bills automatically. Though each business might shoot for a different rate of automation, a rules engine should allow them to reach this level of efficiency if they choose. A reliable workflow combined with an intelligent rules engine creates a more effective way of performing the bill review process. For example, by establishing rules based on thresholds, treatment codes or document type, bills can be presented to adjusters only when their oversight is necessary. A strong workflow should include business rules that look for exceptions in the data. This capability helps automate tasks that normally required manual processing, and allow the routing of bills to their required destination. Such a combination of reliable workflow and a robust rules engine can run items through the bill review process faster, and more efficiently than a traditional bill review product. It also can help minimize the variances in adjudication decisions that may arise from different skills and experiences. Example In order to maximize adjuster efficiency, Insurance Company A doesn t want employees spending any time on bills that are under $50 or bills that include physical therapy sessions. The rules engine Insurance Company A uses should let them specify these needs and let the identified bills pass through without any human intervention. So when a bill goes through the system for $40, no employee time will be spent approving the payment. Insurance Company A s adjusters will then have more time to focus on bills that do require their oversight and can give more attention to claims that need further negotiation and investigation. By using a robust workflow and a rules engine that gives Insurance Company A complete control to decide which bills can be automated through the system and which need to stop, the payor is able to improve efficiency.

15 15 Quarterly Feature Benefits Aside from automating bills adjusters don t need to work on, an effective workflow/rules engine combination drives down turnaround time. Efficiency will increase, leaving adjusters more time to focus on their core responsibilities. About the Quarterly Feature author Another benefit of process automation is that it helps the payor stay compliant with timelinerelated service level agreements in order to submit payments on time. By making on-time payments, the payor can avoid late-penalties in some states. A rules engine aids in cost containment by checking that providers are billing correctly and helping payors decide what the correct amount is to pay on each bill. 3) Manages Multiple Workflows Why A good workflow model should make a complex process easy. TPAs work in a complicated environment because they manage multiple unique businesses that have different requirements and goals. It can get complicated to operate separate workflows for each of their clients. As a result, sometimes TPAs can only offer a single business workflow process across all of their clients, meaning each organization cannot set its own guidelines. How TPAs should have a simple way to organize workflows and rule sets separately for each customer. This way, it s easy for each TPA to ensure they are applying the right business rules and sending medical bills to the right destination for each customer. Without an efficient way to customize and manage multiple workflows and multiple sets of rules, TPAs may lose out to more sophisticated competitors. By Shahin Hatamian, Vice President, Product Management and Strategy, Casualty Solutions Group, Mitchell Shahin Hatamian leads the Product Management group and is responsible for product direction, marketing, partnerships and strategic initiatives for Mitchell Auto Casualty and Workers Compensation Solutions. With over 20 years of high-tech industry experience, Shahin has an extensive and proven knowledge of Product Development, Marketing,Organizational Leadership, Business Strategy, Partnerships and Global Business. Shahin holds an MSEE and an MBA.

16 16 Quarterly Feature B Bill A Bill C Bill A Bill Bill Review Business Rules Nurse Review Network Business Rules Payment Print Sent to Adjuster Business Rules Bill Review Business Rules Network Adjuster Approval Payment Print B Bill Business Rules Adjuster Approval Nurse Business Bill Review Network Payment Print Review Rules C Bill Solutions that cannot manage multiple customizable workflows and rule sets often cause companies to have to employ more resources and lose out on efficiency savings. Example The model that TPAs use should allow for bills to pass through different workflows based on their customer mix. For example, the system should recognize that if a bill comes from Company A, it should run through Company A s workflow, while a bill from Company B should run through Company B s workflow and a bill from Company C should run through Company C s workflow. Benefits A system that easily manages multiple workflows improves efficiency, reduces costs and simplifies what could be a complex and confusing process. It allows a TPA to offer a unique service to each of its clients, thus differentiating itself from the competition. Using such a system helps TPAs to efficiently solve problems and produce better outcomes than if they use a one workflow fits all model. 4) Connecting to the Value Chain Why In order to maximize efficiency, a workflow should not only work seamlessly within its own system, but it should also easily connect to other parts of the business. This scales up all of the advantages of automation throughout the company. How Workflows can be complicated, and bills may get stopped during the process, awaiting further action. In order to streamline the process, a workflow and its rules engine should be connected with other parts of the business. For example, a bill shouldn t leave the bill review system just to get to a nurse reviewer. If the workflow isn t connected with the nurse review platform, the business isn t maximizing its efficiency potential. Also, the workflow should

17 17 Quarterly Feature be connected to an alerting system for people who work on bills. An adjuster or nurse reviewer shouldn t be required to constantly check the system to see if there are bills that require attention and/or further action. Employees time can be utilized more efficiently when the workflow is set up to alert when it sends a bill out for review. An adjuster or nurse reviewer shouldn t be required to constantly check the system to see if there are bills that require attention and/or further action. Example Insurance Company A always wants to keep an eye on any closed claims that are being reopened. In order to keep those costs under control, it requires that either Joe or Mary look at any new bills that come through the system that are related to a claim that has already been closed. Both Joe and Mary are very busy, and they don t have time to continuously check the system to see if there are bills to review. If Insurance Company A has a workflow and a rules engine that are connected externally, this won t be a problem. It will be able to create a rule that says: If a bill is related to a closed claim, joe@insurancecompanya.com and mary@insurancecompanya.com for review. Now, Joe and Mary are able to spend less time manually checking the system and more time working on their other duties. Insurance Company B frequently uses nurse reviewers, but has noticed that often, nurses recommendations aren t being applied during the bill review process. Insurance Company B uses a homegrown workflow system. It s losing money on every bill since nurse recommendations are not being applied, all the while the company is still paying for the nurses time. Once they realized the problem, Insurance Company B switched to a workflow solution that integrates with their nurse review platform. Now, the nurses suggestions are automatically applied to every bill when it goes through the company workflow. By switching over to the robust, enterprise-grade solution, Insurance Company B is taking better control of its medical spend and improving efficiency within the nurse review and bill review process. Benefits By integrating the rules engine with other departments and parts of the business, bills get processed more efficiently. It keeps everything in one place, making it quicker and easier for a medical bill to be sent through the system. This ultimately keeps costs low and saves employees time. Also, when a workflow is capable of alerting an employee that a bill is awaiting his or her review, it benefits the company in two ways. First, it allows employees who audit bills as a small part of their job to focus on other tasks when there isn t work waiting in his or her queue. If they know they ll be alerted every time a bill requires their attention, then they don t have to worry about constantly checking in. Second, alerting the employees involved in the workflow speeds up turnaround time and minimizes the chance of a bill pending for an employee to route it to the next step. Connecting the different steps within a workflow with other parts of the company business is an important part in running a productive business.

18 18 Quarterly Feature 5) Powerful & Always Improving Why A powerful workflow is one that can help companies learn and evolve over time to help improve business outcomes. The workflow and rules engine should be powerful enough to meet just about any business need a company could have. The workflow shouldn t be restrictive, but instead, it should empower a business to improve its efficiencies and processes. The rules engine should automate the routing, assignment and tracking of work tasks. It should allow payors to create various types of rules, such as decisioning rules, declarative rules that compute values, transformation rules that map and parse data and integration rules that determine the correct system connection to make in each circumstance. payors selecting workflow solutions. An important way a rules engine can continue to add value to a business is by giving decision makers workflow process suggestions and rule modifications that they can use to improve their business outcomes. It should also be easy to measure the power of a workflow. The financial and operational benefits of a customized workflow and rules engine should be easily determinable. For example, if a bill was reduced by a fee schedule ground rule, a user and a custom business rule, all three savings categories should be available for impact analysis. The ability to run this type of analysis is also important in evaluating the financial and operational benefits that a rules engine can provide. Workflows and rules should be able to evolve over time to continue improving financial and operational benefits. Adjuster Approval Business Rules Fee Schedule Networks External Rules Finalize Payments Business Rules Fee Business Rules Networks Business Rules Schedule Finalize Adjuster Approval Impact Analysis 75% Auto Adjudication Fee Schedule Finalize Business Rules Payments 1.9 Days 55% Turn Around Time Automated Savings Rate How One factor that makes workflow modelers and rules engines powerful is the business value it generates for customers. A commercial-grade rules engine or workflow that s processed hundreds of millions of transactions over its lifetime can provide a lot of value to a business and is an ideal candidate for Example A powerful, mature, dependable and smart workflow allows payors to use it with confidence. Companies should be able to easily customize the workflow to flag bills an employee needs to review and alternatively, pass through bills the company decides adjusters don t need to see. A commercial-

19 19 Quarterly Feature grade rules engine gives companies an unlimited amount of opportunities to make specific business decisions resulting in improved efficiency and better business outcomes and providing both financial and operational benefits. Benefits A powerful, mature, dependable and smart workflow allows insurers to use it without worries. Companies should be able to easily customize the workflow to flag bills an employee needs to review and pass through bills the company has decided adjusters don t need to see. A commercialgrade rules engine gives companies an unlimited amount of opportunities to make specific business decisions resulting in improved efficiency and better business outcomes and provides both financial and operational benefits. Summary With today s continuous goal of achieving cost and quality effectiveness, the flexible and customizable rules engine has become an integral part of an efficient business workflow system. When a workflow is powerful and flexible enough to adapt to any business need, it can automatically produce better outcomes and can help companies that process medical bills outperform their distinct business goals while differentiating themselves from their competition.

20 20 Bonus Feature Break Down Traditional Bill Review Procedures By Greg Gaughan Vice President and General Manager, Out of Network Solutions, Mitchell Casualty Solutions Group By Joshua Dickerson Director of Product Management, Out of Network Solutions, Mitchell Casualty Solutions Group Positioning SBR higher in the stack is easy to do if your bill review engine allows for flexibility and customization and doesn t require one specific workflow. Payors often fall into a pattern of sending their workers compensation medical bills through the same process they always have, and are consequently getting the same results they ve always gotten. Now, a few payors are catching on to a new, innovative trend of switching up their cost containment methods to achieve better results using specialty bill review (SBR) before traditional networks in their bill review process. Many times, network discounts aren t robust, meaning that by only sending medical bills through the traditional network route, some payors are overpaying on medical bills. SBR is already the highest yielding solution applied to a medical bill set. By positioning it in different places in the workflow stack and not confining themselves to one traditional bill review order, payors are seeing even better results through improved savings, specifically on facility bills. What is Specialty Bill Review? SBR is a service that helps provide additional cost containment above and beyond the traditional bill review method. As a differentiated specialty solution, SBR identifies and corrects issues not captured by traditional bill review systems, like coding errors, bundling redundancies and misapplied policies, using repricing algorithms

21 21 Bonus Feature and methodologies based on historical negotiation data and state standards for payment. Payors traditionally use SBR to calculate a fair and reasonable price on medical bills when they don t already have an agreement with the provider. Two different components make up SBR services market value pricing (MVP) and charge validation analysis (CVA). Market Value Pricing is the service that s most commonly used by payors who use SBR. The MVP service analyzes bills line-by-line in an effort to determine a fair value for medical services performed, since many times, items such as implants, devices or drugs don t reflect the appropriate pricing. By using rules-based technology based on jurisdictional case law and legal benchmarks for charge limitations combined with technology that searches and analyzes different aspects like accepted payment comparisons, the MVP service is able to determine the fairest price on medical bills. After the review process, the CVA service reduces invalid and inappropriate charges to help ensure payors are only paying for necessary charges on a medical bill. After review, an SBR service should recommend a payment at a rate that s about 35 percent of the original bill charge, on average. Once the payor then offers the payment to the provider, the SBR vendor should manage and resolve any issues that arise on the payor s behalf. After the review process, the CVA service reduces invalid and inappropriate charges to help ensure payors are only paying for necessary charges on a medical bill. Payors typically use CVA, the other component of SBR, to help catch invalid charges. The CVA service uses automated evaluation technology to identify inappropriate charges through an intensive review for line item and coding accuracy. During the review, CVA looks for errors like charges for items and services that weren t provided, charges that are undocumented or unrelated, and treatment for injuries or illness caused by the facility or provider.

22 22 Bonus Feature Traditional Use Traditionally, SBR has been reserved for medical bills that are out of network. Payors usually set up their workflow so that medical bills are sent through traditional networks before sending any that didn t receive network discounts through the SBR process. For example, a payor will send all of its medical bills through their network and pay the contracted rate on in-network medical bills and send the remaining medical bills through the SBR process for a reduced rate. In this method, the majority of medical bills are sent through networks and only a small portion of medical bills go through the SBR process. Throwing Out the Original Method Sometimes, network discounts aren t enough. Though networks provide discounts on medical bills, many times these rates still aren t the best prices available for payors. Though many payors choose to, it s not necessary to lead with network options first. In fact, in certain jurisdictions, such as Arizona, New Jersey, Iowa and Missouri, leading with SBR instead of network options first produces even better financial results, especially on facility bills. A benefit of placing SBR in the primary position in a payor s stack is that the majority of medical bills will go through SBR, meaning the highest yielding solution will be impacting the most medical bills. When a payor arranges their workflow like this, they are able to achieve better cost containment than if they are relying on networks to do the majority of their medical bill reductions. Positioning SBR higher in the stack is easy to do if your bill review engine allows for flexibility and customization and doesn t require one specific workflow. By simply using SBR before networks, a payor can start seeing an average percent jump in savings and revenue, and will begin to pay better pricing more consistently.

23 23 Bonus Feature

24 24 Bonus Feature Make a Bigger Impact on Third Party Auto Claims By Norman Tyrrell Director, Product Management, Mitchell Casualty Solutions Group By Jackie Payne Vice President, Medical Management Services, Casualty Solutions Group The best way for payors to combat rising costs across the third party auto casualty market is to use a variety of cost containment services on both represented and unrepresented claims. In just one year, the average bodily injury claim cost has risen about 4 percent, from $13,719 in 2014 to $14,280 in As medical costs increase, claims costs increase as well. Since there aren t fee schedules applicable to third party injury claims, or access to traditional Preferred Provider Organization networks, payors need to look for other opportunities to help contain these rising costs. As bodily injury severity and utilization continue to rise, many insurance companies are using a suite of solutions including a few key cost containment methods outside of traditional bill review to reach the fairest price in the settlement of third party claims. What s Happening in Third Party? Third party claim costs have been rising for quite some time. From 2011 to 2015, bodily injury severity rates have increased about 12 percent 1. In addition, we have seen utilization increase about 18 percent 2. These increases are due to several factors, including rising medical costs, a higher frequency of surgeries to treat injuries and more expensive diagnosis procedures. These medical trends are having a direct impact on third party claim costs. The best way for payors to combat rising costs across the third party auto casualty market is to use a variety of cost containment services on both represented and unrepresented claims. In addition to bill review and demand package review services, many companies would also benefit from using nurse review and direct-to-provider negotiations as a part of their third party solution suite.

25 25 Bonus Feature Direct-to-Provider Negotiations Negotiating isn t just for attorneys and adjusters. In the third party auto market, insurance companies should also be contacting a partner to negotiate directly with providers on unrepresented claims on their behalf. Many insurance companies don t use any cost containment methods on these unrepresented claims, instead choosing to focus their employee s time on negotiating demand packages for represented claims. Negotiation services are an easy-to-use solution that won t add too much time to the third party workflow or take up valuable adjuster time. By using provider Negotiation services are a costefficient way to manage rising third party claims costs in all 50 states. negotiation services with a prompt-pay model, payors can often start to see benefits like reductions compared to what they are currently paying, as well as increased consistency throughout the organization s payments. Companies that aren t negotiating third party medical bills are often paying providers on unrepresented claims in full, since they don t have a strong cost containment methodology that they use for these claims. By simply using a negotiation service just like they would for first party auto or workers compensation claims, companies can start to quickly and easily see major improvements on third party payments with minimal internal effort. While many companies that do use direct-toprovider negotiations keep their negotiations in house, choosing to use a strategic partner is often the most efficient and fruitful option. A partner is set up to negotiate more accurately and efficiently than adjusters can, since they are equipped with the right tools and expertise. The strategic partner should be using a combination of a proprietary platform, expert negotiators and data from nearly every provider in the country. If a negotiation service is set up this way, it s much more efficient than in-house negotiations, and often produces much better financial results. In addition, a partner can help free up time for adjusters so they can focus on core tasks instead of spending time calling providers. When executed correctly, a strategic partner can often secure an average price reduction of percent on each bill. Negotiation services are a cost-efficient way to manage rising third party claims costs in all 50 states. Typically, there is no investment required to turn on the service, and insurance companies only have to pay once they start receiving discounts. A negotiation service is a low-cost way to improve third party claim outcomes while streamlining an insurance company s operational workflows. 1. Private Passenger Auto Loss Data and Trends, Multi-state. Fast Track Plus Mitchell Data

26 26 Bonus Feature Nurse Review Another area for increased impact in third party auto claims is the use of professional medical review services. A nurse review service provides adjusters with invaluable information to help them negotiate successfully with plaintiff attorneys, which saves insurance companies from overpaying on medical specials. With bodily injury severity on the rise over the past couple of years, many insurance companies are turning to nurse review to help combat these higher prices and overutilization of medical services. Nurse review is most valuable when the service employs registered nurses who are familiar with trauma care and do a complete deep-dive review of the claimant s current medical record. A nurse should personally look closely at all of the details of the claim and medical records instead of just doing a cursory review of the billing or using algorithms to do the job for them. When the nurse review services conduct their review in this manner, nurses are able to pull out the most important information in the medical record and the claim file and point to any discrepancies in the type and course of treatment, which can be used as negotiation points. When discrepancies are noted, detailed negotiation points can assist adjusters and defense attorneys with settling the claim for significantly lower amounts. Another key benefit to using professional nurse review is that the review and negotiation points are clear, concise and in a format that helps facilitate negotiations. By receiving recommendations in an easy-to-understand layperson s explanation, adjusters at all experience levels are able to not only understand the situation, but also explain and rebut key points with a plaintiff attorney more effectively. The document should contain an overview of the chronology of medical treatment starting with the mechanism of injury and continuing through all phases of treatment. The report should provide detailed rationale to support their recommendations making sure adjusters are prepared for the sometimes difficult negotiation process. Along with an easy-to-read format, a nurse review service should also provide some training around how to use a nurse review report to its maximum potential and also include information around how to contact the nurse reviewer with any questions that may arise. After a minor fender-bender, a claimant had symptoms of chest pain that led to a very costly workup and ultimately, open heart surgery. The hospital bill alone was almost $200,000. When a nurse review is executed correctly, it can help insurance companies achieve significant cost containment on third party claims. In fact, some companies using nurse review have avoided paying hundreds of thousands of dollars for treatments that are completely unrelated to auto accidents. Here s one example: After a minor fender-bender, a claimant had symptoms of chest pain that led to a very costly workup and ultimately, open heart surgery. The hospital bill alone was almost $200,000.

27 27 Bonus Feature Though the plaintiff attorney argued that the claimant s heart issues were a result of the accident, the nurse who reviewed the case on behalf of the insurance carrier found many details of the claimant s history that showed the conditions were long-standing and pre-existing. The adjuster was able to negotiate successfully that the condition was unrelated to the auto claim, and eventually it was determined that the insurance carrier would not be responsible for paying for any of the treatments, saving them from unnecessary payments. By adding robust negotiation and nurse review services into their third party solution suite, insurance companies will be able to control costs on both represented and unrepresented claims. These services will not only improve adjuster efficiencies, but will also better ensure that companies are consistently paying the fairest price on third party claims and result in improved financial results.

28 28 WCS Medical Price Index Workers Compensation Medical Price Index By Ed Olsen Sr. Business Process Consultant, Mitchell Casualty Solutions Group Since Q1 2006, the National Workers Compensation MPI has increased percent while the National CPI for All Services increased percent. The National CPI for All Services, as reported by the Bureau of Labor Statistics, is presently which is down 0.11 percent in Q since Q For the same period of time, Q to Q1 2016, the National Workers Compensation Medical Price Index increased by 3.16 percent and presently sits at Since Q1 2006, the National Workers Compensation MPI has increased percent while the National CPI for All Services increased percent. Charges associated with physical medicine services experienced a 3.8 percent increase since Q This increase brings the total unit cost change for physical medicine since Q to 6.62 percent, significantly below the National CPI for All Services reported by the Bureau of Labor Statistics. Recall that the physical medicine MPI is looking strictly at unit charge while holding utilization constant. No significant changes in technology to deliver physical medicine services have been discovered that might influence the unit charge of these services.

29 29 Bonus Feature Contrary to the trend in unit cost of Major radiology services seen in the auto casualty market, the unit cost experienced by workers compensation claims for this service group remains flat reflecting a 1.0 percent increase since Q This service groups current index value of 98.4 remains 1.6 percent below the Q The unit cost for evaluation & management services increased in Q1 2016, bringing the workers compensation index to from in Q Since Q1 2006, evaluation and management unit charge has increased to Since Q4 2015, the unit charge of professional services performed in the emergency room setting has decreased 3.16 percent. Despite this decrease, the index reflects an overall increase in the unit charge of this service group of percent since Q The index value for this service group has experienced intermittent decreases since Q on it steady drive upward. It is believed that this is just another temporary improvement.

30 30 WCS Medical Price Index National MPI National MPI Millions Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q1 Total Units National MPI CPI All services 2015 Q Q Q4 Q Q1 Evaluation Evaluation & Management MPI Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Total Units National MPI CPI All services 1,400 1,200 1, Thousands Q1 Emergency Room MPI Emergency Room MPI Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Total Units National MPI CPI All services Thousands

31 31 WCS Medical Price Index Emergency Room MPI Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q4 Q1 Workers Compensation CPI All services Auto Casualty Q1 Major Radiology MPI Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Total Units National MPI CPI All services Thousands Physical Medicine MPI 5,000 4,000 3,000 2,000 Thousands 70 1, Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Total Units National MPI CPI All services 0

32 32 WCS Medical Price Index Q1 Nerve Testing MPI Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Total Units National MPI CPI All services Thousands Minor Radiology MPI Q Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Total Units National MPI CPI All services Thousands

33 33 WCS Medical Price Index Major Surgery MPI Thousands Q Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Total Units National MPI CPI All services Pain Management MPI Thousands Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q1 Total Units National MPI CPI All services 2015 Q Q Q4 Q1 0

34 34 ACS Medical Price Index Auto Casualty Medical Price Index By Ed Olsen Sr. Business Process Consultant, Mitchell Casualty Solutions Group Since Q1 2006, the National MPI has increased percent while the National CPI for All Services increased percent. The National CPI for All Services, as reported by the U.S. Bureau of Labor Statistics, is presently , which is down 0.11 percent in Q since Q For the same period of time, Q to Q1 2016, the National Auto Casualty Medical Price Index increased 1.04 percent and presently sits at Since Q1 2006, the National MPI has increased percent while the National CPI for All Services increased percent. Charges associated with physical medicine services experienced a 0.81 percent increase in Q from Q This increase brings the total unit cost change for physical medicine since Q to 4.2 percent, significantly below the National CPI for All Services as reported by the Bureau of Labor Statistics. Recall that the physical medicine MPI is looking strictly at unit charge while holding utilization constant. No significant changes in technology to deliver physical medicine services have been discovered that might influence the unit charge of these services.

35 35 ACS Medical Price Index The unit cost for major radiology services increased 0.91 percent in Q from Q and presently sits at Despite this increase, MPI for major radiology services remains 4.5 percent below the service groups high of experienced in Q The unit cost for evaluation & management services increased 2.67 percent in Q when compared with its Q result. Since Q1 2006, evaluation and management services have seen unit charge increase percent as reflected by the index value of The unit charge for professional services in the emergency room continues to dominate the conversation dealing dramatic increases in unit charge. In Q1 2016, professional services in the emergency room experienced a 2.26 percent increase since Q Since Q1 2006, this service group has experienced a 90.5 percent increase in the unit charge of professional emergency room evaluation and management services.

36 36 ACS Medical Price Index Emergency Room MPI Thousands Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q1 Total Units National Service Group MPI CPI All services Physical Medicine MPI Millions Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q1 Total Units National Service Group MPI CPI All services

37 37 ACS Medical Price Index National MPI National MPI Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q2 Millions 2015 Q Q Q1 Total Units National MPI CPI All services Evaluation & Management MPI , Thousands Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q1 Total Units National Service Group MPI CPI All services Major Radiology MPI Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q1 Thousands Total Units National Service Group MPI CPI All services

38 38 The Compliance Corner The Compliance Corner Medical Marijuana, Telemedicine and Opt-Out By Michele Hibbert-Iacobacci, OHCC, CCSP Vice President, Information Management & Support, Casualty Solutions Group Medical marijuana, sometimes referred to as Medical Jane, has been used for medical purposes since 1550 BC in ancient Egypt to treat inflammation. Medical Marijuana Prescription protocols for medical marijuana are changing monthly due to new studies promoting use and regulatory bodies that allow the prescription of medical marijuana in their states. Medical marijuana, sometimes referred to as Medical Jane, has been used for medical purposes since 1550 BC in ancient Egypt to treat inflammation. It took thousands of years to actually be able to prescribe medical marijuana legally in the United States for the same ailment. In modern history, the Food and Drug Administration (FDA) has been the gate keeper for permitting drug use in the United States. Marijuana was categorized with other illegal drugs like opium and morphine since the early 1990s. By 1970, marijuana was a Schedule I drug and was considered to have no medical use. In November 1991, the very first proposition called on the state of California and the California Medical Association to restore hemp medical preparations to the list of available medicines in California, and not to penalize physicians for prescribing hemp preparations for medical purposes. The vote passed overwhelmingly with nearly 80 percent in favor. The state of California legalized medical marijuana in 1996 (Procon.org, 2016). In addition to the District of Columbia, medical marijuana is currently legal in the following U.S. states: Alaska, Arizona, California, Colorado, Connecticut, DC, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, Ohio, Oregon, Pennsylvania, Rhode Island, Vermont and Washington.

39 39 The Compliance Corner Nearly all other states have propositions on the books for legalizing medical marijuana. Excerpt from National Highway Transportation and Safety Association: There is a large difference between the legalization of medical marijuana and the coverage of the drug under insurance policies. Aside from the workers compensation cases in Minnesota and New Mexico (Lewis v. Am. Gen. Media), there has not been a broad acceptance by payors. This is a legal matter left to interpretation by policy and regulations. Today the FDA has not approved marijuana for medical use and it is still classified under the same umbrella with heroin, LSD and Ecstasy as a There is a large difference between the legalization of medical marijuana and the coverage of the drug under insurance policies. Schedule 1 drug. The latest move to change the drug class was in March 2015, when the CARERS Act was introduced to the Senate proposing to reclassify marijuana to Schedule II, recognizing the accepted medical use. Schedule II drugs are those that can be potentially addictive like oxycodone. PCI applauds the House Appropriations Committee for including language in its THUD report that directs the National Highway Traffic Safety Administration (NHTSA), along with the National Institute on Drug Abuse and other related agencies, to conduct a study of marijuana-impaired driving, (PCI, 2016). This commentary is on the heels of a review by PCI and NHTSA examining the use of marijuana and distracted driving leading to higher claim frequency (NHTSA, 2016). Click Here To View Full Statement How regulations for casualty evolve will take time. The use of medical marijuana, even if compensated routinely, will still have challenges. Employers will need to evaluate patients who are prescribed medical marijuana for on-the-job liabilities and determine the new norm of distracted driving, with driving under the influence as a cause for the rise in claim frequency. On June 2, 2016, the Property Casualty Insurers Association of America (PCI) issued a statement expressing their approval of the House Action on the Marijuana-Impaired Driving Study. 1. NHTSA. (2016, Feb). National Highway Transportation and Safety Association. Retrieved Jun 2016, from nhtsa-releases-2-impaired-driving-studies PCI. (2016, June 2). Retrieved 2016, from Property Casualty Insurers of America: 3. Procon.org. (2016, April 6). History of Marijuana as Medicine. Retrieved 2016, from

40 40 Compliance Corner Telemedicine: New Innovations in the Old Program Telemedicine is the method of delivering health care electronically through applications like smart phones, , and skype. Telemedicine started over 40 years ago with the intention of enabling health care providers, mainly hospitals, to provide services to patients in remote areas. The concept expanded as a means to provide more affordable services and better quality care by health care providers after The Affordable Care Act was introduced in 2012, mandating health insurance coverage for all Americans. This legislation introduced many new-comers to the healthcare system that otherwise may have never been provided health services. Over 30 million people with coverage were added into the healthcare system during this time, with the threat of not enough providers to service those insured. It is estimated that the United States currently holds roughly 200 telemedicine networks, providing connection to over 3,000 sites. A variety of services including consultations, medical education modules, vitals monitoring and meetings with primary care providers are examples of the offerings made available through telemedicine. Timing is critical when it comes to delivering emergency services for some medical conditions. With timing being an influential role, it makes sense that telemedicine continues to think about how to develop quality clinical services and improve innovation. One example of innovation used in the telemedicine realm is telestroke services, which have the ability to send information to neurologists from rural facilities to assist identifying the sources of strokes in patients. Initial studies in Canada have shown a 92 percent decrease in the transferring of patients to more expensive facilities, thus making the care more affordable. What you won t see in telemedicine are chiropractic manipulations and other hands-on care, but instead, the planning and care coordination efforts as it relates to these specific providers. The Institute for Healthcare Consumerism (IHC) has been reporting on wait times and the impact of adding more patients into the system for several years. For example, in San Diego, the average wait time for a provider appointment is 20.2 days, and 27 days in Philadelphia. These long wait times can impact a patient s health and the use of telemedicine can be invaluable in providing quality of care in these instances. When a patient suffers a severe injury as in a motor vehicle accident, they go to the emergency room. The Center for Disease Control has reported that nearly 80 percent of adults are going to the emergency room because of a lack of alternative health care resources, ultimately impacting the people that really need to be treated in the Emergency Room setting. Telemedicine could serve as a solution in these cases. The challenge we face in the Property and Casualty (P&C) industry is delineating the necessity for telemedicine, and positioning the benefit of including it as an add on to services already rendered. The intent of telemedicine is to provide quality and affordable care, not to create another line item on the provider bill for payment. For telemedicine Professional Services claims, services are to use the appropriate CPT or HCPCS code along with the modifier GT (via interactive audio and video telecommunications systems).

41 41 The Compliance Corner Imagine a $50 telemedicine bill on a claim replacing the average $1,000 or more emergency room bill. It certainly makes it a compelling alternative for the future. The market assessments are not bad either, with Insurancenewsnet.com reporting in January 2016 a potential market for telemedicine valued over $45 billion by Opt-Out: Hurry Up and Wait Opt-out in the workers compensation world is 2016 s buzzword for deregulation of payment for workers compensation claims at the state level. Opt-out is an alternate compensation model for the injured worker whereby employers choose to optout of state regulated systems. It has been promoted in some states like Oklahoma and Texas. Although not a new concept, new interests among both advocates and non-supporters have been brought to the horizon, including different proposed models. Last May, the International Association of Industrial Accident Boards and Commissions (IAIABC) published an analysis of the treatment of occupational injuries and illnesses under state workers compensation systems and Opt-out programs adopted in Oklahoma and proposed in South Carolina and Tennessee. The study sought to address key questions outlined below: What part of workers compensation law is the employer renouncing by opting out? What are the conditions, or regulatory requirements, that the state places on opt-out employers? What regulatory monitoring and enforcement system should govern opt-out benefit plan compliance? Click Here To View The Study. The latter half of May was met with the U.S. Department of Labor investigating Opt-out programs due to the interest in the state of Washington. The main concern was the oversight component and whether the injured worker would be harmed. All in all, the consistency in application of plans has been one of the major findings in Oklahoma and whether or not employers will offer plans equal to or greater than what the employee had previously.

42 42 Current Events 6 Keys to Optimizing Claims Performance By Shahin Hatamian Vice President, Product Management and Strategy, Casualty Solutions Group Published June 8, 2016 From: PropertyCasualty360.com Insurance companies and payors of all kinds should be looking for ways to optimize claims performance. With costs rising in both the auto casualty and workers compensation market, insurance companies and payors of all kinds should be looking for ways to optimize claims performance. In order to manage efficiencies and improve cost containment, payors should focus on these six keys, including integrating disparate technology systems and using embedded analytics. Read More

43 43 Partner Spotlight Foresight Medical ForeSight is the latest addition to a portfolio of cost containment solutions offering additional ways to better manage medical bill costs in the workers compensation industry. Mitchell International realized a growing market need for a medical implant cost management solution. With this aim in mind and its dedication to offering its customers a best-in-class portfolio of Strategic Partners in the industry, Mitchell International is pleased to announce its newest Strategic Partner relationship with ForeSight Medical. ForeSight leverages a rich database of proprietary medical implant cost information that will be used in conjunction with Mitchell s SmartAdvisor bill review platform to provide additional medical implant cost containment opportunities. As a Mitchell Strategic Partner, ForeSight is the latest addition to a portfolio of cost containment solutions offering additional ways to better manage medical bill costs in the workers compensation industry. ForeSight provides a comprehensive surgical implant audit and adjudication for the workers compensation industry. Designed specifically for surgical procedures involving implantable hardware, ForeSight s proprietary Fusion audit and adjudication platform employs dynamic modular reduction methodologies to identify and remove inappropriate charges to ensure medical implant charges are appropriately reimbursed. Read more

44 44 About Mitchell Mitchell San Diego Headquarters 6220 Greenwich Dr. San Diego, CA Mitchell empowers clients to achieve measurably better outcomes. Providing unparalleled breadth of technology, connectivity and information solutions to the Property & Casualty claims and Collision Repair industries, Mitchell is uniquely able to simplify and accelerate the claims management and collision repair processes. As a leading provider of Property & Casualty claims technology solutions, Mitchell processes over 50 million transactions annually for over 300 insurance companies/claims payers and over 30,000 collision repair facilities throughout North America. Founded in 1946, Mitchell is headquartered in San Diego, California, and has approximately 2,000 employees. The company is privately owned primarily by KKR, a leading global investment firm. For more information on Mitchell, visit