Claim catcher white paper


Published on

This white paper outlines the ClaimCatcher technology for use with health payers, P&C insurers and work comp carriers.

ICEX, Inc. owns all rights to this white paper as well as to the ClaimCatcher data product.

Inquiries to be made to: or (804) 750-1006.

Published in: Technology
  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Claim catcher white paper

  1. 1. ICEX WHITE PAPERClaimCatcher ®A Shared Tool for Cost Containment
  2. 2. Copyright © 2012 ICEX, Inc. All rights reserved. Unauthorized reproduction is strictly prohibited. Information is based onbest available resources. This white paper is for information purposes only. ICEX may have patents, patent applications,trademarks, copyrights or other intellectual property rights covering the subject matter of this document. Except as expresslyprovided in any written license agreement from ICEX, the furnishing of this document does not provide the reader any licenseto such related intellectual property.
  3. 3. IntroductionCarly Fiorina, the former President and Chairwoman of Hewlett-Packard once stated, “The goal is to transformdata into information, and information into insight”. Never is that more true that in today’s insurance industry,where the most successful health, P&C and workers compensation carriers have radically transformed theircore operations from slow-moving, archaic manual processes into more streamlined data driven operations.In the area of underwriting, insurers have long understood the importance of pooling and sharing key claimsdata through their use of products delivered by analytics vendors such as NCCI®, ISO®, LEXISNEXIS® and MiB®.At ICEX, our intent was to create a similar, widely-adopted data tool, specific to reducing and recoveringoverpayments from casualty, work comp and medical claims.Containing such costs not only provides a clearer path to increasing insurers’ profitability, but also lends greatsupport in forging new and strengthening current client relationships. This is not only true for insurers, butalso for brokers, agents, third party administrators and related claims vendors. Advantages in costcontainment, while directly saving self-insured corporations and municipalities, also show themselves to theindividual American in more affordable premium pricing.ClaimCatcher® marks a new step in the way that insurers will be able to realize cost containment opportunitiesin claims management. Our aim is to have insurers and their claims vendors add onto their predictive analyticsand ‘best guesses’ by layering our data tool into their operations. Onboarding of subscriber data and thedesign of ClaimCatcher allow for easier onboarding for P&C insurers, work comp carriers and health payersnationally.Our intent was never to make a better mousetrap, but rather to simply catch more mice and keep more of thecheese.Stephen D. AmbrosePresident and CEOICEX, Inc.
  4. 4. What is ClaimCatcher®ClaimCatcher® is the insurance industry’s first cross-claims data exchange, utilizing patent pending technologyto provide both P&C insurers and health payers with the mutual benefit of claims cost containment. The web-based index tool has been designed specifically to receive, store and match injured claimant and medicalclaims data, for the purpose of claim payout reduction and recovery, when so indicated.P&C subscribers will regularly submit non-medical and non-financial injured claimant information from all linesof business, which identify all claimants who have filed a claim with the P&C insurer, where such claims involvemedicals. Separately, health payer subscribers will send in their last seven years of medical claims data andregular updates thereafter.Our subscribers will be given the ability to order and receive two key claimant reports, known as InjuredClaimant Exchange (ICE) reports and Diagnosis Exchange (DIXIE) reports. These reports are designed to provideclaims operations with new levels of insight, so that injury and medical claim management can function on amore balanced and fair level.ICE reports are matched and automatically sent by ClaimCatcher to health payer subscribers, identifying payers’members who have filed injury claims. ICE reports verify third party liability involvement instead of using
  5. 5. today’s predictive analytics, data mining and reliance on outmoded form letter responses. For this reason, wesee today’s health subrogation industry growing from its current $2 Billion market cap to near $9 Billion.DIXIE reports will be ordered by claim representatives via aHIPAA-compliant process, coupled with our proprietary All readers are encouraged to watch ourSmart-Search technology. These reports will clearly show introduction and demo videos by visitingany past diagnoses and conditions directly related to the the ClaimCatcher website at:injured claimant’s present injuries. With a conservativeestimated savings of $730 per selected claim, we forecast P&C insurers will see upwards of $8 Billion in savings.Workers Compensation carriers will join ClaimCatcher as subscribers for DIXIE reports. In a later phase, we willbe requiring comp carriers to also submit their filed claims data to our data center. In the nearly $75 Billionpaid out each year in work comp, we estimate that ClaimCatcher will save $5.5 Billion each annually.A Resource That Grows StrongerInsurance data indexes and specialty reports are used regularly by organizations in the P&C, health and workcomp sectors. The success of their use is dependent upon three main factors: size of subscriber base, amountof data regularly submitted and accuracy of such data.Our forecast for ClaimCatcher over the next five years shows steady growth as more health payers and P&Cinsurers become subscribers. Estimates for medium-sized health and P&C insurers* show cost containmentsavings growing to $15 Million and $9 Million per month for each type of insurer respectively. $16,000,000 Cost Containment Dollar Savings (monthly) $14,000,000 Monthly Medical Claims Recovery from $12,000,000 Health Payer Subrogation $10,000,000 Monthly Injury Claim $8,000,000 Reduction from Claims Management $6,000,000 $4,000,000 $2,000,000 $0 1 7 13 19 25 31 37 43 49 55 61 Duration of Subscribership (in months)*Medium-sized health payer having 565,000 members. Medium-sized P&C insurer receiving 46,076 claims (with medicals) per year. Matched reports andresults based upon 10% of all P&C insurers and 19% of all health payers participating as subscribers over five years. Work comp carriers not included.
  6. 6. Health PayersThe health payer subscriber market for ClaimCatcher® includes all Blue Cross/Blue Shield, managed care,indemnity, state and local health plans, as well as Medicaid in all states. State health exchanges, as part of the2010 healthcare law will also be eligible as subscribers.Key benefits of ClaimCatcher for health payers include the ability for far quicker and more exact identificationof members involved in injury claim filings. Projections over a five year subscriber relationship point to anincrease of nearly four times current identification and recovery operations.ClaimCatcher has been designed so that any medical claims data released to outside P&C insurers, via DIXIEreports, must first be authorized by the plan member themselves, and only for specific health criteria relevantto their present injury claim. This allows for the protection of health payers and adherence to HIPAA laws.P&C InsurersP&C insurers utilizing ClaimCatcher will include organizations having both personal and commercial lines ofbusiness, where submitted claims involve ‘medicals’. For the first time, claims managers will have the ability toutilize a HIPAA compliant process so that they may tap into available medical claims data of the injuredclaimant, where the specified data relates solely to the present injury claims filed.The utilization of our smart-search technology allows for claims managers to easily navigate the process ofselectively choosing pre-existing criteria and control nearly 15,000 ICD code record matches. Additionally, P&Cinsurers will find our data specifications for upload, similar to existing batch reporting to ISO’s A-Plus® andLEXISNEXIS’ C.L.U.E. ® products, thus allowing easier onboarding to the product.Workers Compensation CarriersWork Comp carriers will initially join ClaimCatcher as report users for pre-existing medicals. In time,ClaimCatcher will require these carriers to submit their injured claimants, thus adding more benefit for healthpayers and P&C insurers than already stated herein.Our DesignClaimCatcher has been designed to be compliant with the most stringent state and federal privacy laws. Keydesign points include a comprehensive administrative audit database, smart-search technology, automatedhealth payer ICE reports, the application having no access to the database, parameterized stored procedures,anti-forgery token technology as well as all applications and services on the DMZ having no access to SMTPservices.
  7. 7. Praise for ClaimCatcher® “ClaimCatcher is a tool that will revolutionize the subrogation and claims functions for insurance companies. While some very smart people have taken the search algorithm approach as far as it can go, ClaimCatcher still improves detection and resolution of subrogation claims. This will decrease fraud, improve the fairness of outcomes, and will ultimately decrease the cost of insurance for consumers. I expect the companies that use ClaimCatcher to out-perform their competitors that do not.”Lawrence S. Powell, PhDWhitbeck-Beyer Chair of Insurance, and Editor, Journal of Insurance Regulation “This unique, ingenious, proprietary technology has the potential to revolutionize the way insurers use data to save on claim costs as well as to identify and maximize subrogation recoveries. Any insurer that does not utilize ClaimCatcher will be at a great disadvantage relative to the other insurers who do. Moreover -- and most importantly -- insurers who dont utilize this new technology will be doing a great disservice to their consumers and stockholders and/or other stakeholders”Mike PickensFormer Arkansas Insurance Commissioner and 2003 President of NAIC “ClaimCatcher is the key today to a significant portion of claims cost control. In addition, state legislators and regulators are also beginning to recognize this issue and mandating that insurers report similar data. ClaimCatcher will satisfy tomorrows regulatory requirements through its state of the art technology today.”Michael CamilleriPresident and CEO of American Financial Security Life Insurance Company “In the world of health insurance subrogation, nothing trumps the importance of being promptly informed if a member or beneficiary initiates litigation against a responsible third party. If such action goes unrecognized, especially in the current state of ERISA and health insurance subrogation, the chances for an effective recovery fall to almost zero and healthy subrogation potential often literally dies on the vine.”Gary WickertPresident and Shareholder at MWL, S.C., National lecturer and trusted expert on health subrogation “In ClaimCatcher, I find an innovative yet practical solution to combat the fraud, waste, and abuse we see in healthcare reimbursement.”Abe BenitezChief Financial Officer for a healthcare Administrative Services Organization
  8. 8. Strategic PartnersIn conclusion, a little over a year ago, ICEX set out to develop a unique technology which would transformclaims management across the insurance industry. We undertook a journey of interviewing experts, filingpatents and other intellectual property, performing regulatory due diligence and developing an easy-to-implement, secure and highly scalable pilot software solution.The insurance industry now stands at the edge of a great transformation, ready to solve long-standingchallenges in the P&C and health insurance claims communities. The workers compensation community willsoon follow. Identifying fraud, abuse and wasteful claim overpayments will help in the fight to keep insurancepremiums affordable for individuals and organizations.Like data index tools currently used by a large percentage of P&C, health and work comp carriers, ClaimCatcherwill soon become integrated and thereafter, widely adopted as a part of claims management. Because bringing2,500 P&C insurers, 400 commercial health plans, Medicaid and workers compensation carriers together on amulti-sided data platform will be a sizable task, our intent is to find one or more strategic partners withresources which can complement our technology and help to streamline the delivery of ClaimCatcher into themarketplace.We consider strategic partners those companies such as claims analytics vendors, insurance brokers, third partyadministrators, corporate venture capital or insurers with investment divisions. Additionally, we plan to formstrategic alliances with state and national insurance trade associations.If your organization has interest in becoming a strategic partner with ICEX and its ClaimCatcher technology,please contact us at (804) 750-1006 or email: .