Insurance Claim Dilution
Why it’s so Hard to get Treatment Authorized and Paid for
When the liability insurers introduced computer software claims management back in the mid 1980‘s, the software was intended to augment the adjusters role in determining the medical needs of an injured person in accordance with the policy limitations, with the purpose being to aid adjusters in determining what was necessary to help the injured experience a full recovery from their injuries.
That purpose is still there, yet payments for medical care are becoming increasingly difficult to get reimbursed for. The old methods that doctors and attorneys used in finding, reporting, treating and getting for reimbursed for services is out of date. Without ongoing training, you can’t keep up with changes being made by insurers that get you paid for medical or legal services. Doctors and attorneys need to update their understanding of the current protocols for injury discovery, validations, reporting and management requirements. You need to know how insurers are denying your services. You need irrefutable evidence to validate injury severity and use the latest in acceptable treatment forms, coding & documentation structure that will be accepted by the insurers new Artificial Intelligence tools that govern your reimbursements.
PRAGMA INTEL’S training courses help guide doctors and law firms to properly communicate with insurers about ALL of a person’s injuries and symptoms. Powerful communication tools have been developed to successfully convey traumatic injury and it’s effects on the victim. Use our proven methods to significantly influence the outcome of claims settlements for better medical reimbursements that provide greater financial relief for the injured.