Achieving high accuracy in claims administration is vital to the success of insurance carriers within the automobile no-fault industry. Adjusters assigned to no-fault claims must undertake the task of indemnifying the claimants while ensuring the highest level of accuracy possible. Michigan’s no-fault benefits are becoming an increasingly larger source of cost and administrative burden to insurance carriers; avoiding errors and detecting fraudulent situations within claims involving injuries and durable medical equipment, prosthetics, orthotics and medical supplies (DMEPOS) is a critical component in holding down claims cost for insurers within the state of Michigan.
A 2011 study of Michigan’s auto no-fault claims commissioned by the Michigan Chamber of Commerce gathered statistics on accidents involving injuries to claimants. One statistic highlighted within the study showed that as of 2009, Michigan’s average automobile no-fault claim costs were nearly four times higher than the average no-fault claim cost in other states also offering no-fault coverage under automobile insurance policies. Ultimately, these costs must be accounted for and likely will need to be passed along to an insurer’s clients in the form of rising auto insurance premiums together with increased accident surcharges.
To reduce erroneous claims and decrease no-fault claim costs associated with injuries and claimant use of DMEPOS, insurance carriers should be implementing effective claims review procedures that ensure providers’ treatment recommendations are appropriate. When a medical professional recommends that a no-fault claimant receive an orthotic or durable medical equipment for instance, it can be difficult for an adjuster to accurately assess the need for this treatment due to the subjective nature of some injuries. Furthermore, due to Michigan’s unlimited medical benefits for injured claimants, moral hazards in the form of fraud may occur. Some claimants and medical providers recognize the generous nature of Michigan’s no-fault laws and may attempt to take advantage of them through submitting unnecessary treatments or prescriptions unrelated to the no-fault claim.
Accuracy within automobile no-fault claims administration can be increased and fraudulent claims can be more readily identified and eliminated when an insurance carrier chooses to work with a Durable medical equipment Benefits Manager (DBM). A successful DBM will monitor claims to ensure an accurate review of the usage of DMEPOS services along with performing an objective analysis of the claim itself. Tracking the use of DMEPOS services throughout the life of the claim also assists with ensuring minimal errors and reduces the approval of fraudulent claims submissions from providers.
As an experienced DBM, Northwood offers daily tracking and monitoring of no-fault claims to ensure the highest level of accuracy for its clients. With their paperless claim adjudication system and front-end authorization procedures, Northwood offers insurance carriers several methods proven to reduce claim errors and performs consistently near 100 percent when it comes to claims accuracy. Accurate claims ensure savings for insurance carriers along with increased claimant satisfaction. For more information on the benefits of partnering with Northwood on no-fault claims involving the use of DMEPOS services, please contact a representative.
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