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Case management presentation april 2013 v2


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Case management presentation april 2013 v2

  1. 1. AgendaIntroducing… Case Management Solutions for DiverseBusiness Sectors Arcadia Interface For Case Management From the Labs Discussions
  2. 2. • Introducing…Desjardins Insurance Company• Coming Soon…Exacta
  3. 3. Insurer – IME Vendor Management Insurer’s Access SmartSimple’s OntarioReferral Network™• +80+ IMEs, Hospitals and Treatment Centres• +500,000 Cases• +3.5 million Medical Documents• +150,000/year HCAI Submissions
  4. 4. Insurance Adjuster PortalAccess all claim information from your intuitive secure portal
  5. 5. Query and Manage Claims and WorkflowsInsurance Adjuster Portal
  6. 6. Drill Down to View Claim Related ServicesInsurance Adjuster Portal
  7. 7. Instant Analytics for Meaningful MetricsInsurance Adjuster Portal
  8. 8. Employer Services
  9. 9. Access all case information from your intuitive secure portalEmployer Services
  10. 10. All Case Information is Accessible from a Single ScreenEmployer Services
  11. 11. Easily create and monitor case activities.Employer Services
  12. 12. Query/Searchall cases by anycriteriaEmployer Services
  13. 13. Managing Care in Community What are Community Care Access Centres?• Connectors to home care, long-term care destinations, and otherservices in your community.• Funded and legislated by the Ontario Ministry of Health and Long-Term Care.
  14. 14. All Case and Patient Information is Accessible from a Single ScreenManaging Care in Community
  15. 15. Employment Services
  16. 16. Employment Services What does the Employment Services solution offer?• Job Search assistance• Resume assistance and interview preparation• Workshops• Individual Assessment and case management• Labour Market Research and Job Development• Ontario Ministry of Training, Colleges and Universities (MTCU)funds employment training and educational programs to helpworkforce get sustainable employment.
  17. 17. Employment Services
  18. 18. Employment Services
  19. 19. Employment Services
  20. 20. Employment ServicesExample of how various Plan items are tracked on the Case / Service Plan
  21. 21. Structured Settlements What are Structured Settlements?• “A structured settlement is a financial or insurancearrangement, defined by Internal Revenue Code asperiodic payments; a claimant accepts to resolve apersonal injury tort claim or to compromise a statutoryperiodic payment obligation.”• The government of Canada exempted structuredsettlement income from taxation, subject toconditions.
  22. 22. Structured Settlements
  23. 23. Structured Settlements What is the SmartSimple business solution?• A structured settlement is put together a number ofways.• The variables contemplated in the formulationprocess are as follows:1. Amount of lump sum payments;2. Interest Rates3. Frequency of payments (i.e., monthly, annual, etc.);4. The life expectancy of the plaintiff.
  24. 24. Structured SettlementsSmartSimple Solution – Claim Details View
  25. 25. Structured SettlementsSmartSimple Solution – Detailed Annuity View with Products
  26. 26. • From the labs…
  27. 27. Data Exchange Managing Statuses between Insurers and IME’s-The Insurer contains statuses which indicate various milestones of theassessment. e.g Scheduled, Cancelled, Completed, Billed-The IME Status list consists of both insurer related statuses and IME relatedinternal statuses.An Assessment is only sent back to an insurer once it has reached a certainpoint in the process.E.gWhen it is first scheduledWhen it is awaiting additional medsWhen it is completed, cancelled, or there is a change in schedule
  28. 28. Data Exchange Managing Statuses between Insurers and IME’sObjective:1) To increase efficiency, and streamline the process for exchangingassessments between IME and Insurer2) Separate the statuses which are of interest to the Insurer and those ofinterest to the IME (IME internal statuses)3) Reduce the number of data exchange-related statuses in SmartSimple
  29. 29. Data Exchange Managing Statuses between Insurers and IME’s
  30. 30. Data Exchange Managing Statuses between Insurers and IME’sHow do we accomplish this?New Setting that allows defining which statuses are to be included in theexportAdvantage:-Streamlines the status process by preventing new statuses from being created oneach system via exchange.-Ensures consistency among statuses when exchanging with various Insurers orIME’s-Based on status, this ensures that the assessments are not sent back if the reportis still being worked on.
  31. 31. Data ExchangeWhen Exporting, the checkboxis selectable only for thosestatuses that can be exported.List of Services under a Case.In this list, Completed andScheduled are set for export.
  32. 32. Open Discussions
  33. 33. Thank you for Attending!SmartSimple Community Conference 2013Case Management Solutions