Claim Reporting Comes Full Cycle

Claim intake is not a one-size-fits-all service. Actec starts with an in-depth analysis of your goals and current process to develop a custom workflow that is right for you. We'll use your business rules to ensure accuracy, minimize call times, and reduce follow-up calls.

• Roll out quickly with Actec’s best practices workflow for a complete, logically organized report.
• Give your customers any combination of reporting options: telephone, e-mail, fax, Internet, and even electronic file submission.
• Let Actec enter notices directly into your in-house claims management application, seamlessly launched from our contact tracking module, which allows us to offer additional reporting, tracking, forms management, and dissemination capabilities.
• Respond quickly to critical incidents. Your customized plan specifies the data collected, format of reports, detailed recipient notification, and escalation procedures.
• Ensure correct routing of claims – even verify coverage upfront – with rules-driven policy and claim office assignment.
• Increase accuracy, consistency, and efficiency by providing policyholder, location, distribution, carrier, and employee demographic data to populate notices at intake.
• Customize list options with job titles, department codes, medical coding, PPO providers, and more.
• Send data in any file layout, at any frequency - we handle the rest to minimize your IT resource needs.

Quickly and accurately capture complete information – the first time. With Actec, you are there for policyholders when they need you the most – the moment an incident occurs, day or night. Actec is your primary source for collecting and disseminating critical information, including commercial and personal lines claims, non-claim reports and inquiries, employee absences, fraud, and catastrophic events.

• Actec Intake Specialists are available 24/7, 365 days a year at the first notice of loss (FNOL) to handle worker's compensation, auto, property, general liability, non-occupational, short-term disability, and long-term disability claims, as well as non-claim reports and inquiries.
• E-mailed/faxed incident notices are distributed to dedicated Intake Specialists for quick turn-around. A paperless environment with RightFax server and document management system offers compliance with privacy and security regulations.
• Internet self-entry is totally secure and completely integrated with our back-end intake system so there is no loss of functionality.
• Claims may be submitted via electronic data interchange (EDI) for filing, dissemination and data consolidation .
• Actec’s best practices capture complete information the first time, reducing the need for follow-up.
• Customized, rules-driven workflows ensure accuracy and minimize call times.
• Step-by-step documentation gives you a complete audit trail for every type of contact received.

Full-Cycle Claim and Incident Reporting doesn’t end after intake. Actec helps you convert claim reports into actionable information so you can close claims quickly, track trends, and ultimately manage risk. Actec offers many essential services, including:

• Triage to ensure escalation of critical situations with full-service notification procedures that are automatically triggered based on defined criteria
• Medical Coding performed in accordance with the National Correct Coding Initiative (NCCI) and custom coding performed by Actec’s experienced staff
• Duplicate Checking to flag matches or possible matches to previous claims and handle them according to your business requirements
• Quality Assurance Reviews of all claims (or claims flagged by workflow rules) to check incident descriptions and validate data
• Follow-up Completion of any claims with missing or inconsistent information
• Vendor Referrals to connect policyholders with high-quality, in-network services
• Notice Pending to suspend distribution of notices until specific criteria are met
• Companion/Related Claim Links to identify associated notices across coverage lines or multiple-claimant incidents for more efficient administration
• Claim Number Assignment to track notices from the start, generated by Actec according to your rules or obtained directly from your CMS using web services

Expedite completed incident reports to an unlimited number of key recipients, including government agencies, in any format, such as electronic data interchange (EDI), mail, fax, phone, text message, or e-mail.

• Urgent reports are immediately escalated and flagged as high priority according to your business rules.
• Critical outbound contacts are personally handled by experienced staff, in addition to automated notifications.
• Actec maintains all current state first reports of injury (FROI) for worker’s compensation and performs all state filing procedures of FROI and subsequent reports of injury (SROI), as well as medical bills via EDI as mandated.
• Notice distributions may include personalized cover pages, jurisdictional FROIs, standard forms for all coverage lines, supplemental report summaries, custom forms, and regulatory documents.
• On-demand dissemination is available in compliance with your security policy.
• Contact center statistics, incident report summaries, state filing acknowledgments, and all dissemination logs are available as scheduled or ad-hoc reports.

Can you measure the impact of first notice of loss (FNOL) and incident reporting on your bottom line? Does your current service or in-house solution operate as efficiently as it should? Are follow-up calls, filings, and distributions eating up time and resources? Are your customers happy with your service? Do you have the data you need to monitor these performance indicators?

Complete, accurate, and timely incident reporting and management means reduced claims paid out, lower claim handling expenses, decreased administrative costs, decreased medical expenses, and reduced litigation costs. Integrating the actionable data from each report provides you with a complete overview of your organization to identify and manage risk more effectively.

• Injuries reported within two weeks are 18% more expensive than those reported within one week, while injuries reported between the fourth and fifth weeks are 45% more expensive (Glen-Roberts Pitruzzello).
• Only 22% of injuries reported within 10 days of an incident are litigated, but the number of incidents that are litigated jumps to 47% when incidents are reported more than 31 days after an injury (Glen-Roberts Pitruzzello).
• Insurers with longer than average cycle times of 14.8 days are rated in the bottom 50% in terms of customer satisfaction (J.D. Power and Associates).