Industry

Automated platform for processing workers’ compensation claims runs on IBM Cloud

Share this post:

Acrometis workers compensationWorkers’ compensation insurance covers employees who get injured at work and lose their ability to earn income. Typically, the employer agrees to pay an injured employee so they are not personally financially affected because of something that happened while they were working.

What that means, though, is the compensation is also high in comparison to other types of insurance. Compensation typically includes wage replacement in addition to coverage of medical costs. Workers are paid until they’re well or determined to be disabled. There is no limit to what could be paid out once a claim has been accepted.

The insurance company that represents the employer must determine the right compensation. It’s a complex decision, and it’s made on an individual basis that involves information from multiple sources. There are fines associated with not following the regulations correctly. There is also a good deal of third-party interest, such as attorneys who are trying to help injured workers maximize their benefits. There is also the potential for fraudulent claims.

The adjuster on the payer’s side must keep up with and manage spending appropriately, which is a big job.

Acrometis offers an automated platform for processing workers’ compensation claims that can help control not only the cost of claims handling, but also the cost of claims themselves.

A rules-based platform for workers’ compensation claims

Processing claims is typically a slow, tedious process.

The proprietary Acrometis solution scans, indexes and applies rule sets to assist the claims processor in validating that the injury is real, as well as whether the claim submitted could actually have happened in the workplace.

Acrometis helps ensure that information about a worker’s health history unrelated to the workplace injury is excluded as early as possible to keep claims processing costs low. The solution also automates simple filings and payments.

After things are screened out or automatically processed, the remaining parts of the claim — approximately 25 percent — are what is left for the adjuster to work on.

A proprietary solution on IBM Cloud

Acrometis leadership decided to migrate from a self-managed private cloud to the IBM Cloud so the company could put in place the infrastructure and framework necessary to scale more quickly and easily as we grow.

IBM partnered with Datica to implement the HITRUST common security framework to help Acrometis meet security requirements inherent in HIPAA.

HIPAA regulations are excluded from workers’ compensation, but Acrometis leaders believe it’s still good practice to protect its client data, and IBM, together with Datica, gives the company the highest level of data protection and integrity.

The migration was a smooth and comfortable transition.

A way to save time and money

The Acrometis platform helps workers’ compensation insurers comply with state mandates and changing regulations. Acrometis customers can choose to automate parts of their workflow or automate the entire claims process.

Point solution customers might experience a 40 percent improvement over a manual process where they have plugged in automation, such as in the document management process where AI increases efficiency. Automation customers are realizing 20 to 23 percent reduction in overall costs, including the loss costs.

Learn more about the Acrometis solution for automating workers’ compensation claims.

More Industry stories

Deloitte’s HealthInteractive Platform on IBM Cloud helps state Medicaid programs innovate

For decades, state Medicaid programs have relied on large, established Medicaid management information systems (MMIS) to support core functions. Historically, these solutions have been inflexible and expensive to maintain with long, and sometimes failed, implementations. To address the costs and complexity in maintaining and updating these platforms, the Centers for Medicare and Medicaid Services (CMS) […]

Continue reading

5 keys to cloud migration in the financial services industry

More than ever, it is imperative for financial services organizations to migrate to the cloud. New demands from customers and shareholders, along with increasing regulatory requirements, require organizations to have an IT ecosystem that can deliver increased agility, innovation and customization. For those hesitating because of security, data privacy and compliance concerns, here are five […]

Continue reading

Profility taps cloud to help transform patient recovery with personalized post-acute care

Post-acute care is becoming a hot topic as the healthcare industry struggles to adapt to the challenges posed by aging populations and spiraling costs. When a patient is discharged from a hospital after surgery, they often require a period of rehabilitation. In some cases, they can recover at home. In other instances, they may need […]

Continue reading