Fair Isaac helps insurers address three key decision-making objectives for maximizing profitability in claims management: Consistent Application of Best Practices, Reduction of Handling Costs, and Prevention of Unnecessary Payments.
Insurers rely on Fair Isaac technology and industry expertise to more efficiently and effectively navigate through the dozens of decisions they must make for every claim.
We can help you maximize your processing efficiencies and make more effective claims decisions with a variety of solutions:
- Business rules management technology for applying best practices and claims-related decisioning across your organization.
- Advanced predictive analytics to improve the precision and quality of every claims decision.
- Associated strategy and operations consulting to implement new processes, systems and capabilities quickly and successfully.
- Software platforms for automating and improving various stages of claims processing.
Improve your claims efficiency
With Fair Isaac tools and claims expertise, we can help you lower your operating costs while increasing your overall throughput.
At the same time, we can help you increase the number of claims that are auto-adjudicated, and consistently and quickly handle other claims with the experience of your best adjuster.
With Fair Isaac Blaze Advisor™ business rules management system, you can capture best practices and speed claims from decision to decision, allowing adjusters to manage the out-of-profile claims that require special attention. And using Fair Isaac SmartAdvisor® medical bill review software's extensive integrated rules functionality you can direct bills to the right work queue for specialized review.
With our support, you can save time and costs in a number of ways:
- Immediately separate routine claims, which can be fast-tracked for rapid settlement, from potentially fraudulent claims or legitimate claims requiring case management.
- Address the problem of decreasing adjuster experience levels in the industry with efficient work redistribution matching tasks to availability of skills.
- More easily and consistently meet compliance with applicable federal and state regulations.
- Drive down penalties and fines for late reporting with increased auto-adjudication.
- Properly set reserves to maximize capital efficiency
- Review fewer claims manually
Improve your claims effectiveness
It pays off big-time to back your claims efficiency efforts with claims effectiveness. Consider this: Claims handling costs typically represent 10% to 15% of net earned premium, while claims payouts represent 40% to 65% of net earned premium.
That's why when the industry's leading insurers set out to increase the quality of the claims decisions, they turn to Fair Isaac's advanced predictive analytics.
As long as a claim is open, Fair Isaac's advanced predictive analytics can help you identify risk and detect suspicious activity with every new transaction. Our analytics give you timely insight - you can identify emerging problems and opportunistic fraud when the signs first appear so you can stop improper payments earlier. Predictive modeling can provide accurate and defendable responses to claims decision points.
With our 20 years of insurance claims management experience and time-tested fraud and reserving solutions, we help you tackle the questions that appear simple, but that sometimes are difficult to answer:
- Does this claims fall within the terms and conditions of the policy?
- Is this claim fraudulent or abusive?
- Is another party - including another insurer - liable for paying damages on this claim?
- How can the damages or liabilities associated with the claim be managed or resolved in a way that minimizes the final cost?
Automate your workers' compensation and auto injury medical bill review
Fair Isaac brings efficiencies to medical bill review processing, with leading solutions for workers' compensation and auto injury medical bill review.
Whether your bill review need is for a licensed client/server installation, web-based ASP or complete outsourcing through our Insurance Service Bureau, Fair Isaac offers a solution to fit every need. Our solutions - such as extensive EDI and scanning/OCR capabilities, and user-customizable workflow - automate your bill review decision management to dramatically improve bill review productivity, accuracy and consistency.
Our bill review solutions enable your staff resources to focus on the bills that require their specialized expertise. In addition, our powerful decision engines use an extensive database of state fee schedules and the industry's largest number of automated national (and regional) PPO contracts to help you obtain the maximum savings on every bill.
Maximize Savings
No other solution can match Fair Isaac SmartAdvisor software's most important benefit: savings. Our users average more than 50% savings on their bills. In fact, Fair Isaac saved its customers more than $3.3 billion last year.
Fair Isaac SmartAdvisor software can help you capture virtually every penny of savings you deserve via fee schedule, U&C, PPO and even Out-of-Network reductions. Fair Isaac SmartAdvisor software gives you:
- Automated access to the latest state fee schedules and the largest array of national and regional PPO network partners in the industry.
- Support of an experienced team of experts in fee schedule research and PPO network partnerships.
Stop Paying Penalties
So that you're not liable for penalties by being out of compliance, we make sure you're current with the latest fee schedule and rule changes, and we keep you informed on the latest state laws and pending legislation that could impact your business.
Increase PPO Penetration
Fair Isaac SmartAdvisor software provides access to nearly 20 of the nation's largest national and regional Preferred Provider Organization networks. With Fair Isaac SmartAdvisor software, you can get greater PPO savings in every state.
Rather than own any PPO provider networks, Fair Isaac partners with leading PPO networks. This independence allows Fair Isaac to focus exclusively on our primary goal: helping you realize the maximum possible savings on every medical bill reviewed, in every state.
Route Bills to the Right Resources
Fair Isaac SmartAdvisor software lets you create custom rules to automate the workflow and best practices of your bill review operation, so that every bill is reviewed correctly every time. A unique Fair Isaac rules management technology within Fair Isaac SmartAdvisor software adds a customizable set of processing rules and workflow technologies to process significantly more medical bills automatically - without human intervention-greatly increasing your productivity. And managers can customize workflow in minutes, all without reliance on IT departments.
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