How to Make File Review Your New MVP (Most Valuable Practice)​

What's so exciting about file reviews? If they're not on your list of MVPs – Most Valuable Practices – you may be overlooking a key opportunity to get the most from your third-party administrator (TPA). During a file review, an employer and TPA review open claims, often with the broker. Together, they look into the details of those claims, with the TPA sharing insights and best practices to help close files, speed recovery of injured workers, and manage costs.

Done right, file reviews can:

  • Strengthen the partnership with your TPA. As with any business relationship, trust and rapport are essential elements in making sure your goals are understood and addressed properly. File reviews let you see your TPA team and broker in action.

  • Give your TPA a deeper understanding of your business. File reviews are often done on the client's site. This means your claims team can see first-hand the unique challenges of your business. Conversely, employers may want to visit their TPA's claims office, to gain insight into how they work together – in live time.

  • Achieve better claim outcomes. A well-managed file review can result in more strategic handling in the long term and, ultimately, better claim outcomes.

As valuable as file reviews can be, employers and brokers sometimes view them as time-consuming or tedious. Worse, with the wrong TPA, employers may find themselves spending time on a file review, only to see no meaningful follow-up actions from the claims team.

To make file reviews your MVP, follow these five best practices:

1.  Prepare in advance. Reviews work best when everyone connected with a file is involved, including senior management. Make sure your TPA is giving you enough notice, so you can align busy schedules and have the right people in the room.

Once your team is committed to a meeting date, take some time to prepare – you may want to compile a list of claims that concern you, or there may be outstanding action items from your last file review. And feel free to ask your claims team to share an agenda with you in advance. Spending a few minutes to prepare for your discussion can save time in the long run.

2Ask questions. Remember, this is your time! It's important to bring questions for your claims team, and draw on their expertise for solutions.

File reviews can helpful in reviewing your TPA's response time and accuracy in making payments. Ask how they leverage technology like predictive modeling to improve accuracy and create a better claims experience. Have concerns about reserves? This is a good time to confirm that they're where they should be.

Reviews are also a great opportunity to assess the claims team assigned to you – their expertise and specialization, ongoing training, commitment to continuous improvement, and service principles. Is the team adequate, or is it truly contributing to an amazing claims experience?

And if you've experienced a service issue, share your concern. Ask how your TPA plans to correct the problem and how they'll prevent any future issues. The right TPA should have best practices to share, and be ready to offer short- and long-term solutions.

3.  Stay focused. Your TPA should carry the weight in determining which claims to focus on – especially how many you can address effectively in the time you have. A superior TPA will come prepared with concise synopses of claims. Reach out in advance to ensure they'll provide the most important aspects of your open claims:

  • Compensability
  • Medical treatment plan
  • Return-to-work plans and progress
  • Litigation management, if any
  • Resource engagement
  • Resolution strategy
  • Reserve adequacy

4.  Leave with a plan. Before you wrap up your review, plan your next one. Your TPA should be able to recommend a regular schedule that feels right to you.

You can also expect a good TPA to follow up quickly and confirm expectations, actions, timelines, and any other takeaways from your meeting. Look for prompt outreach from all participants, as well as a survey asking for feedback on your experience.

5.  Always work with a TPA that knows how to make your file review an MVP. While all third-party administrators conduct file reviews, the right one will make it easy and effective. Claims experts will know when to recommend specialized resources like defense counsel or nurse case managers. And the right TPA will offer innovative solutions to fit an employer's unique challenges. 

To learn more about how Helmsman Management Services can makes file reviews one of your Most Valuable Practices, contact your Helmsman representative.

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