Risk Management Information Systems (RMIS) were initially developed as a way for organizations to consolidate data from multiple sources into one platform. This meant your incidents and claims were reported directly to your carrier or TPA, and once a month, the carrier/TPA would electronically return that data for you to download into a RMIS application. Once all the data was loaded into the RMIS, you could run consolidated reports in spreadsheets to track loss counts and financials for a specific period of time. At the time, this workflow was considered cutting edge.
Risk managers today need to track far more than just historical counts and financials. You need real-time trending and analytics for all incidents encountered, not just actual claims filed. So the question is how can you get more immediate and detailed data if you use a carrier/TPA to administer and handle your claims?
The answer can be found with your RMIS. You can use your RMIS as the primary intake vehicle instead of the carrier/TPA. The RMIS can export the necessary data to the carrier/TPA on whatever frequency is deemed necessary. The carrier/TPA then can return financials, notes, and other claim-handling data back to the RMIS with the standard data-update process.
This updated workflow offers numerous benefits and drives lower costs by:
- Immediate notification of new incidents – You get immediate visibility into events as soon as they are submitted. The submission also can automatically trigger notifications to different internal and external parties based on specific data from the event. And for more severe events, you can take immediate action to mitigate the loss exposure and keep costs down.
- Track every incident – Your carrier/TPA’s primary function is handling claims. If you intake using your RMIS, you can require that all incidents – including near misses – be entered for better trending and prevention of future accidents.
- Per-record cost savings – Carrier/TPAs typically charge on a per-record basis. If you are taking in your incidents via the RMIS, you can control which records are sent to the carrier/TPA. For example, you would not export incidents or near misses to the carrier/TPA, but you would use that data for trending purposes within the RMIS.
- More robust data – You can control what data is taken in, what is required, and what format the data is received in. Carrier/TPAs may not capture all of the data you need to understand the details of your loss. Their job is simply to evaluate the coverage and pay out the claim as quickly as possible for the lowest dollar value. Organizations typically want more insight into all events to implement procedures that will prevent similar events from reoccurring.
- More accurate data – If you use a call center to intake incidents, what is stated over the phone may not always be accurately inputted into the system. An electronic reporting tool, on the other hand, enters data right at the source, thereby what eliminating any interpretation discrepancies. The data captured is the data you need.
- Multiple carrier/TPA workflows – If you have multiple carrier/TPAs, you can automate which incidents are sent to each carrier/TPAs based on information entered via the intake tool.
If you are interested in implementing this workflow, explore your options with your RMIS provider and carrier/TPA. There are, however, a few items to consider when determining if this workflow will work for you:
- Will the new workflow benefit your organization? You should mitigate your own risk unless you already have a guaranteed cost program with your current carrier/TPA. Find out from your Carrier/TPA what cost savings you could expect from amending the existing workflows and what cost you would incur to implement a new workflow and determine if the net cost is acceptable.
- Can your carrier/TPA consume electronic incidents? Most current systems have the ability to export and import data electronically with zero to minimal human intervention, so confirm that your carrier/TPA’s system can accommodate that accordingly.
- Can your current RMIS support the export frequency required by your organization and the carrier/TPA? Everyone today wants to send and receive information as quickly as possible. Does your carrier/TPA need information daily, hourly, or even in real time? You can then determine if your current RMIS can support that frequency.
- Are you prepared to design the intake workflow? You are responsible for determining what should be included on the intake questionnaire, as well as testing and internally deploying the changed process. When evaluating what to include on the intake form, your carrier/TPA’s current script can be a good starting point – or you might already have a paper form for initially gathering data. Your RMIS provider also should have some standard forms to get you started, and they can consult with you in the design process. In any event, be prepared to invest the necessary time in designing and testing the intake workflow to ensure a success.
In short, a relatively small upfront investment of time can have a lasting payoff in terms of accuracy, timeliness, and completeness of your claims and incident data – and that can lead to lower costs. Best of all, the technology is already part of your RMIS. So what are you waiting for?