I've recently begun working with Medata, which pioneered automatic bill review in workers' compensation. Now they are the first to integrate medical and disability guidelines into the bill review system. Why is this important? Instead of having to get out of the bill review program, open a guidelines database and find the guidelines, the demographic/diagnostic-based guideline pops up on the screen just when the reviewer needs it. This encourages reviewers to check guidelines - should the patient take six weeks to recover? What is appropriate treatment for this injury for a guy this age? What if he has co-morbidities - like diabetes? How does that affect recovery time? Having this info at their fingertips can help claims managers identify the tough, potentially expensive claims faster - before they spiral out of control - and give them more attention. Guidelines can also be shared with physicians, many of whom are overworked and located in rural areas and unable to keep up with the nuances of every single injury and best- practice. For more info, see the release.
