Work Loss Data Institute (WLDI) announced release of the ODG Reserve Calculatoras part of the Official Disability Guidelines (ODG) product line.
The Reserve Calculator uses a proprietary statistical modeling program to help insurance claims adjusters forecast medical, indemnity and administrative costs at the claim level. This is based on a multitude of inputs including up to five ICD9 or ICD10 diagnosis codes, procedures, and patient demographics like claimant age or state. It highlights potential “Confounding Factors” to look for and record, which can each represent a high “Risk Severity Coefficient,” defined as significant probable increases in claim costs. These factors include the presence of depression, diabetes, hypertension, obesity, opioids, smoking, substance abuse, surgery or hospital stay, and legal representation.
Indemnity, medical, and administrative costs are modeled individually and in the aggregate, allowing for adjustments in each bucket for expenses paid-to-date, existing reserves and an “Adjustment Meter” for changes requested by adjusters based on their own expertise. High risk claims are flagged, with direction to refer for case and medical management using the evidence-based ODG guidelines. Finally, an ODG Reserve Worksheet is generated, to retain as documentation within the claim file.
“We set out to help adjusters, carriers and TPAs more accurately standardize, document, and substantiate reserve dollars,” said Phil LeFevre, director of business development for WLDI. “Our clients have wanted this for a long time, but the data collection, statistical modeling and testing were years in the making. Payers are particularly excited about interfacing the ODG Reserve Calculator right into internal claims systems.”
Modeled from WLDI’s proprietary insurance claims database of approximately 2,500,000 medical claims representing about $20,000,000,000 in paid costs, the ODG Reserve Calculator is available in the ODG Toolbox within the subscriber Web version of ODG. Integration and automation with existing claims systems is also available.
Source: Work Loss Data Institute
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