Upload
smartsimplesoftware
View
373
Download
0
Tags:
Embed Size (px)
DESCRIPTION
Citation preview
Agenda
Introducing…
Case Management Solutions for Diverse Business Sectors
Arcadia Interface For Case Management
From the Labs
Discussions
• Introducing…Desjardins Insurance Company
• Coming Soon…Exacta
Insurer – IME Vendor Management
Insurer’s Access SmartSimple’s Ontario Referral Network™• +80+ IMEs, Hospitals and Treatment Centres• +500,000 Cases• +3.5 million Medical Documents• +150,000/year HCAI Submissions
Insurance Adjuster Portal
Access all claim information from your intuitive secure portal
Query and Manage Claims and Workflows
Insurance Adjuster Portal
Drill Down to View Claim Related Services
Insurance Adjuster Portal
Instant Analytics for Meaningful Metrics
Insurance Adjuster Portal
Employer Services
Access all case information from your intuitive secure portal
Employer Services
All Case Information is Accessible from a Single Screen
Employer Services
Easily create and monitor case activities.
Employer Services
Query/Searchall cases by any criteria
Employer Services
Managing Care in Community
What are Community Care Access Centres?• Connectors to home care, long-term care destinations, and other services in
your community.• Funded and legislated by the Ontario Ministry of Health and Long-Term
Care.
All Case and Patient Information is Accessible from a Single Screen
Managing Care in Community
Employment Services
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 help workforce get sustainable employment.
Employment Services
Employment Services
Employment Services
Employment Services
Example of how various Plan items are tracked on the Case / Service Plan
Structured Settlements
What are Structured Settlements?• “A structured settlement is a financial or insurance
arrangement, defined by Internal Revenue Code as periodic payments; a claimant accepts to resolve a personal injury tort claim or to compromise a statutory periodic payment obligation.”
• The government of Canada exempted structured settlement income from taxation, subject to conditions.
Structured Settlements
Structured Settlements
What is the SmartSimple business solution?• A structured settlement is put together a number of
ways. • The variables contemplated in the formulation
process are as follows:1. Amount of lump sum payments;
2. Interest Rates
3. Frequency of payments (i.e., monthly, annual, etc.);
4. The life expectancy of the plaintiff.
Structured Settlements
SmartSimple Solution – Claim Details View
Structured Settlements
SmartSimple Solution – Detailed Annuity View with Products
• From the labs…
Data Exchange
Managing Statuses between Insurers and IME’s
-The Insurer contains statuses which indicate various milestones of the assessment. e.g Scheduled, Cancelled, Completed, Billed
-The IME Status list consists of both insurer related statuses and IME related internal statuses.
An Assessment is only sent back to an insurer once it has reached a certain point in the process.
E.g When it is first scheduledWhen it is awaiting additional medsWhen it is completed, cancelled, or there is a change in schedule
Data Exchange
Managing Statuses between Insurers and IME’s
Objective:
1) To increase efficiency, and streamline the process for exchanging assessments between IME and Insurer
2) Separate the statuses which are of interest to the Insurer and those of interest to the IME (IME internal statuses)
3) Reduce the number of data exchange-related statuses in SmartSimple
Data Exchange
Managing Statuses between Insurers and IME’s
Data Exchange
Managing Statuses between Insurers and IME’s
How do we accomplish this?
New Setting that allows defining which statuses are to be included in the export
Advantage:-Streamlines the status process by preventing new statuses from being created on each system via exchange.
-Ensures consistency among statuses when exchanging with various Insurers or IME’s
-Based on status, this ensures that the assessments are not sent back if the report is still being worked on.
Data Exchange
When Exporting, the checkbox is selectable only for those statuses that can be exported.
List of Services under a Case. In this list, Completed and Scheduled are set for export.
Open Discussions
Thank you for Attending!
SmartSimple Community Conference 2013Case Management Solutions