Our compliance technology aims to assist insurance carriers, third party administrators and self-insured employers, in immediately assessing whether medical reports are in compliance with AMA Guidelines, through a fast, cost effective and intuitive process. Our program provides a patent-pending 'compliance ranking system' that allows users to easily understand the potential ramifications of non-compliance, if any, so that users can better assess the costs versus benefit of developing a medical record in any particular case.
This idea was first created in California, in an attempt to assist insurance companies, TPAs and self-insureds in the fight to manage costs in workers' compensation. In California alone, the medical-legal process costs on average $336M per annum, which translates to an average total of indemnity payments to workers totaling $4.65B per annum. Payments to injured workers are largely made on "best estimate" analyses by insurance adjusters as to the medical report's required compliance with the AMA Guides. This culture of paying from "best estimates" is the result of the complicated nature of the Guides coupled with the cost necessarily required to provide adequate resources for a thorough assessment of each medical report. Statistically, the cost and time needed to do a full analysis through traditional methods would outweigh the benefit received. Our program will allow users to pay indemnity out of knowledge instead of cost avoidance or fear.
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