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A popular introduction to local news used to ask, “It’s 10 o’clock. Do you know where your children are?” Along the same lines, many companies in industries as diverse as insurance, transportation, construction, local governments, TPAs, self-insured groups, and restaurants are wondering where their claims managers and risk managers are. They might be in the office. They might be working from home. They might be on the road. It doesn’t matter. Wherever they are, they need access to information. And they need to be able to find the information they need as efficiently as possible.

If that was true to some extent before the coronavirus pandemic, it’s a way of life now. Some folks call it digital transformation. Some folks call it the new normal. We call it evolution and common sense. Paper’s been been on the decline in working environments for more than 20 years because digital technology has been on the rise for that same period of time. And there’s no going back.

Digging Digital

Much of the digital progress has been made in claims management and risk management. Digitization facilitates automation. Automation facilitates workflows. Workflows facilitate efficiency and productivity. Efficiency and productivity improve loss mitigation, customer service, and profitability. Digitization also facilitates better data. Better data facilitates analytics and reporting. Analytics and reporting improve decision-making. It’s a pretty straight line. And there’s more.

As data analytics and decision-making improves, so does claim prevention. By identifying trends, incident types, claims frequency, times of occurrence, affected activities, accident-prone individuals, and more, claims managers and risk managers can work with their customers and their employees to reduce the likelihood of risk.

We’d never say COVID-19 was a good thing. But it did bring about — or at least accelerate — some very good things. Because it created the need for enhanced digitalization, it created the opportunity for claims management and risk management to advance rapidly. If we can keep the momentum going, the future will be bright, indeed.

It’s 2022. You don’t need to know where your claims managers are.

We don’t envy municipal risk managers. Having to contend with claims for property damage, workers compensation, and other liabilities; accidents on school yards and sports fields; resident complaints; and more other things than most of us can imagine must leave most risk managers wishing they were jugglers … or octopuses (octopi, if you prefer the Latin derivative).

But while we don’t envy them, we definitely support them.

Don’t Agonize — Organize

When you’re being bombarded with claims, public safety issues, and the other aspects of managing risk, the last thing you can afford is disorganization. That’s why Cloud Claims is incident-based, tracking each claim related to each specific incident. Consider this, however far-fetched it might be: A Department of Public works employee is out plowing snow one night. He has the driver’s side window of his truck rolled down. A neighborhood kid throws a snowball that hits the employee in the head, causes a laceration, and knocks the employee unconscious. Out cold, the employee, with his foot still on the accelerator of his truck, crosses a yard and crashes into a house.

The employee’s medical claim, his workers comp claim, and the resident’s property-damage claim would track to the same incident, including every attendant document, image, or any other related file. In addition, Cloud Claims allows you to track lost time — and to visualize risk trends, incidents vs. claims, and your areas of greatest exposure to liability.

Don’t Complicate — Automate

Even a small town can generate hundreds, if not thousands, of claims in a year. You don’t want to contend with this equation:

[the number of claims, x the documents and files associated with each claims x the time required to manage each one = weeks or months of work]

In contrast, Cloud Claims lets you contend with this equation:

[the number of claims x entry of details x electronic upload x automated workflow = weeks or months of work saved]

Add dashboards that enable you to get the reports needed, when they’re needed, and municipal risk managers reduce their own risk — of stress, of burnout, of overwork, of overtime, and of sweating the small stuff (but their juggling skills might suffer as a result of all that organization and efficiency).

As an added benefit, happier municipal risk managers may very likely result in better service and happier municipalities.

As Robin Williams would have said, “What a concept.”

Last June, we published a post called, Clean Up Your PAID Act. It laid out the reasons that entities required to comply with the Medicare, Medicaid, and SCHIP Extension Act (MMSEA) of the Centers for Medicare and Medicaid Services (CMS) and its Section 111 reporting requirements would soon be facing new mandates. Those mandates would be coming under the new compliance guidelines of the Provide Accurate Information Directly (PAID) Act. The PAID act was signed into law on December 11, 2020. As promised by CMS, the new law goes into effect on December 11, 2021. That’s Saturday of this week.

The PAID Act enable insurers to better identify claimants’ Medicare plans and to avoid unnecessary litigation. And it prevents the lawsuits that were being filed by Medicare Advantage Plans against insurers for double recovery and for failure to provide primary payment or reimbursement for qualifying charges. But it will require all responsible reporting entities (RREs) to manage additional data from CMS — data they they weren’t required to manage before the PAID Act. More specifically, the PAID Act requires CMS to deliver Medicare Part C (Medicare Advantage Plans) & Part D information to help RREs resolve liens with Medicare. That, however, requires significant changes to Section 111 reporting systems.

That means, beyond your present system’s inability to access the new fields, without changes, many systems won’t be able to process the new CMS query responses at all. That may render your current Section 111 reporting process obsolete. And it will put your CMS compliance at very real risk.

Depending on when your CMS reports are due, you don’t have much time. But with MIR Express™, we do. MIR Express is our secure system for managing your Non-Group Health Plan (NGHP) Medicare reporting. It’ll ensure you’re ready to handle CMS’s changes and to access all the valuable new information you’ll be getting from CMS right away. And we’ll make the transition painless.

If you’re already using MIR Express, you don’t have anything to worry about. And if you’re not already using MIR Express, you still don’t have anything to worry about because you can get it and be using it before your actual reporting deadlines.

We’re ready right now. Please let us know when you are.

December 11 is five days away.

Have you ever played Connect the Dots? At first it might seem like a bunch of dots and numbers. But as the dots begin to connect, the image magically appears. Restaurant claims are similar. At first it might seem like a bunch of events and numbers. But eventually general liability, personal injury, liquor liability, product liability (food poisoning, allergic reactions, hepatitis), and fire can all come together and magically reveal the whole picture.

It’s obvious enough that insurers have an obligation to fulfill the promises they make to protect against losses when they sell policies. But who protects your risk managers? How can they ensure they’re properly identifying all of the risks they’re paid to mitigate? How can they do so efficiently and coherently? And how can they connect the dots between claims to identify patterns, to improve their risk selections, and to maximize guest satisfaction?

The Whole Picture

They can start by tracking incidents, rather than claims. Here’s a scenario: One evening, Gladys, a waitress at Ernie’s Chop Joint, trips on her way across the dining room and drops a tray containing a carafe full of water and eight water glasses. The glasses shatter. As the carafe rolls across the floor, water runs into some electric sockets in the floor, causing a fire. (Claim #1, property damage.)

On its way to the floor, the carafe full of water, ricochets off the right foot of Herb, a gentleman having dinner with his wife, fracturing three metatarsals. (Claim #2, bodily injury). Herb’s wife, Grenadine, believing Gladys dumped the tray on purpose, convinces Herb to sue Ernie’s. (Claim #3, general liability.)

The risk manager now has three claims to contend with, all stemming from Gladys’s stumble, but that may be unrelated in terms of coverage. For that matter, it’s possible for the claims to be managed by different people who may have no way and no reason to connect the dots. If, on the other hand, the claims had been tracked by incident (poor Gladys), then all the dots would have been connected.

If the claims system the risk manager used tracked incidents — used tag-based organization for documents to eliminate network folders and files; attached image files, videos, PDFs, and other documentation to each incident and anchored every claim to an incident — dots would connect themselves. As a result, claims would be managed more efficiently, patterns would be more readily identified, risks would be assessed more effectively, and conditions and circumstances could be adjusted to mitigate those risks.

We can’t promise to protect Gladys. But we can definitely help the risk manager who’s trying to.

Safety First

We were doing some reading about claims in the transportation industry the other day because … well … because that’s what we do. During our reading, we happened to find a post on the website of HUB International. It was called, “Disruption Steers Fleet Operators Into 2021”. The post was full of sound insight and advice. But this, in particular, caught our eye:

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