Self Insured Claims Data – Your TPA Has Many Helpful Options Online

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Self Insured Claims Data – Going Beyond A Loss Run

J&L examines loads of self insured claims data every month.  Some TPAs offer loads of information that go beyond just reviewing a loss run.

picture examining self insured claims data report
Wikimedia Commons – Aw58

Much of the self insured claims data can be reviewed using notifications as bells and whistles.   The ones I like that seem to work well can be set up as emails or notifications on the home or main screen.

If you do not have online access and are self insured, you need to obtain it to set up your own system.

Let us cover a few of the notifications.   Remember – you need to make the settings at a level you feel comfortable with without becoming the adjuster on the file.

Payments Over X$

One notification that you should have set up is a basic one for self insured claims data analysis.   When a payment is made over for instance $10,000, you should receive an email immediately.

Most systems have that in place.  If not an email, then at least have the payments over $10,000 or the largest 10 payments made over the last 60 days right on the home screen.

Remember, self insureds – the TPA is spending directly out of your bank account, so a large payment should be a notification to you to at least see what the payment entailed and on what file.

Risk managers – you do not want to justify to a C-level manager why you did not review a large subtraction out of your budget.

Reserves Over Y$

Rubber band with money self insured claims data and Card
Wikimedia Commons – Drew Friestedt

As with the payments, you need to know when the reserves have increased significantly on a certain file.  This is another one that when a certain amount is added to a file – for instance, and increase $25k in total, an email is sent to you immediately.

This is an important aspect of self insureds claims data.  Why?  Usually, reserves are fed into your Loss Development Factor and the reserves are being increased to make some type of large payment.

Litigation, Denial, Subrogation, Fines, Settlement, Hearings, Closing –  Flags

Any major development on the file should have a flag notification sent out or have it on your TPA’s home screen when you logon to see your self insureds claims data.

The subrogation flag is one of the more interesting ones.  You can know if the TPAs claims adjuster is looking into the subrogation on the file that has third party involvement.

The list of flags can be enormous.  The states a self insured operates in may dictate which one of these flags are more useful than others.

Vendor Assignment

This unique flag lets you know what vendor is being assigned by the TPA.  This cost-saving flag becomes very important when the TPA is using an internal company vendor such as a PBM or Rehab Nurses. 

Do Not Adjust The Files – Risk Manage Them

Computer Screen of self insured claims data Spreadsheet
Wikimedia Commons – Texas State Library and Archives Commission

Having too many flags set or having the reserve or paid values too low turns a Risk Manager into an adjuster.  You are paying your TPA to adjust the files – let them do their job.

Manage the risk by going beyond your loss run – adjusting the claims can be an exercise in frustration.

TPA Fees – All Should Be On A Self Insured Claims Data Cost Spreadsheet

Make sure you know every penny your TPA is charging you for their services including the internal vendor assignment flag from the above heading.

One can usually request a screen to be set up to show these or downloaded as an Excel (not CSV) Spreadsheet.  You need to know where the internal charges originate.  The TPA fees can be surprising yet informative self insured claims data.

 

 

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2 Responses

  1. Thanks for reading the article and commenting with a good question. Most TPA’s provide data access as part of their client package. Some may charge a fee (usually nominal) to access extra data or your basic data. The online access is usually worth the cost.

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James Moore

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

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  • Risk & Insurance Magazine
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