SAN DIEGO, CA--(Marketwire - April 26, 2010) - Mitchell International, Inc., a leading provider of information, workflow and performance management solutions to the Property & Casualty claims and Collision Repair industries, today announced the launch of the SmartAdvisor™ Utilization Review Decision Manager, its next generation medical bill review application that seamlessly integrates medical bill review and utilization review (UR) to deliver more accurate workers' compensation medical bill pricing adjustments. The solution provides clients the flexibility to apply a variety of state-mandated and nationally-accepted guidelines as well as acting as a tool to implement their own custom UR guidelines and treatment plans.
The Mitchell SmartAdvisor UR Decision Manager addresses a major source of financial leakage in the medical claims environment which occurs when there is inconsistent application of utilization review or treatment plan decisions within the bill review process. The flexibility, control, and accuracy that the SmartAdvisor UR Decision Manager offers will result in a vastly more efficient claims process that produces greater straight-through utilization review decisions, reduced staffing requirements, and ensuring that only approved treatment is allowed in the bill review process. The solution is powered by the Capstone® Business Decision Engine, a fully configurable business rules engine from SmartAdvisor that automates bill review and repricing decisions. The next generation SmartAdvisor UR Decision Manager will be available in July 2010.
Most methodologies employed by payers to apply utilization review to their workers' compensation medical bill review are inefficient, manual processes that fail to leverage the power of technology to apply those decisions automatically within the bill review workflow. Traditional approaches to this challenge use static, one-size fits all approaches to UR decisions that are hard-coded to one standard. The UR Decision Manager allows each client to tailor the criteria to meet state regulations, national standards or even custom developed criteria sets. The UR Decision Manager allows those decisions to be automatically applied to each bill processed in SmartAdvisor using a technique that aligns procedure codes into common treatment groups. Even Claims Examiner decisions can be incorporated into the process for automated application.
"With SmartAdvisor UR Decision Manager, we are adding to our suite of flexible, highly configurable medical bill review tools in order to respond to a clear and compelling business need for automating and seamlessly integrating the application of utilization review within the bill review process. It's common knowledge in the industry that unenforced medical utilization determinations create significant financial leakage in the claims operations," said Nina Smith, Senior Vice President and General Manager of the Mitchell International SmartAdvisor Solutions Division.
She added, "Traditional bill review applies negotiated rates along with legal and compliance requirements in each state to a provider's bill, but leaves too much on the table compared to the lower costs that can be obtained by integrating bill review with utilization review data. The UR Decision Manager will help plug expensive process and financial leakages in claims operations and ultimately deliver improved efficiency and lower costs."
SmartAdvisor is a comprehensive bill review solution for workers' compensation that leads the industry in its unique combination of performance software, client services, and best-in-class partnerships. SmartAdvisor's unique capabilities include customizable workflow modeling, Capstone business decision rules engine, SmartReports™ data analytics and reporting tools, Claims Examiner Portal for fast, secured, real-time access to bill data, and a proven technology platform that delivers on average 50-70% straight-through processing for improved efficiencies and lower costs. In addition to being a leading workers' compensation solution, SmartAdvisor provides the same capabilities and benefits to the auto and general liability markets and is ideal for servicing all bodily injury lines in a single platform. Visit www.mitchell.com/smartadvisor for more information or contact Mitchell SmartAdvisor Solutions directly at 1-800-421-6705 to schedule a demo of the SmartAdvisor bill review system.
Visit us as well at Booth #337 at the RIMS 2010 Annual Conference & Exhibition being held from April 25-29 at the Boston Convention and Exhibition Center in Boston, MA.
About Mitchell International, Inc.
Mitchell International (www.mitchell.com) is a leading provider of information and workflow solutions to the Property & Casualty claims and Automotive Collision Repair industries. The company's comprehensive solution portfolio streamlines the entire auto physical damage, bodily injury and workers' compensation claims processes. Mitchell enables millions of electronic transactions between more than 30,000 business partners each month to enhance partner productivity, profitability, and customer satisfaction.