The Modern Claims File – 5 Considerations When Selecting A Records Retrieval Partner

By 000983 – June 14, 2010

Are you still retrieving records the old fashioned way?

In the claims management process there are three constituencies that frequently need to retrieve records (medical, employment, etc) to do their job well: claims professionals, staff counsel, and outside law firms.  Generally, there are two ways to retrieve the records:   through subpoena or through an authorization obtained from the claimant or third-party.

While practices vary, many claims organizations still handle this process the traditional way,  using internal professionals or (more expensive) legal resources to create the authorization or subpoena, send it to the record-holder, and then begin the process of following-up on the request over and over to find out what the status is. When the records finally arrive, more resources are required to sort the records, index them, and put them in a format in which they can be utilized in a meaningful way.

Traditional records retrieval processes can be both inefficient and expensive. Furthermore, the old process consumes valuable time that could be better spent on actually analyzing and evaluating the claims and resolving cases.

New Technologies Mean New Options for Claim Executives

The expansion of national record retrieval companies, and the use of web-based delivery platforms, has resulted in new choices for claim executives. In short, claims organizations can now give these routine retrieval tasks to record-retrieval experts. These organizations do nothing but retrieve records, meaning that they can retrieve them faster, more efficiently, and often less expensively. And, these companies can deliver records in formats that reduce the time required for internal and legal staff to analyze and derive real value from them.

5 Key considerations when selecting a records retrieval partner

1. Nationwide Coverage and Subpoena Expertise.  Utilizing a company that has experience retrieving records across the US is very important to getting your records turned around quickly. Ensure that your partner has expertise not just in authorization work, but also in subpoena and legal document preparation. Subpoenas are a completely different animal from authorizations and require a much high level of service. Make sure that your partner has extensive experience and verify it! Your law firms or your staff counsel will thank you. Taking this process off their desk is not helpful if they have to re-do the work being prepared by your records retrieval partner.

2. A User-Friendly and Well-Organized Online Repository. The online web repository must be equally easy-to-use for claims professionals, staff counsel and outside law firms. Ideally, it should provide records-access to multiple parties (the claims professional and the outside attorney, for example). Users should be able to initiate requests quickly and easily, and with a few clicks be able to see or download the delivered records.

3. Records Organization and Indexing Options. Many providers will provide options around how records are delivered in the web repository. These range from simply being presented in the same (disorganized) order they are received from the provider, to being fully indexed and organized by record type. Make sure your partner provides multiple options and most importantly that it has the expertise to organize, index and bates label the records. You may find, for example, that paying a little more to have the records well-organized on the front-end means enormous efficiency and time-gains on the back-end. Some providers also offer full-blown nurse-reviews, chronologies and records analysis as well. Using a retrieval partner that offers those services as well can be a huge advantage in streamlining your operations.

4. Status and Turn-around Reports.  A major component to the value of these programs is being able to retrieve records more quickly, reducing the life-cycle of your claims. Similarly, you want your staff and attorneys to know where each record is in the process with just a few online clicks. You want no time-consuming phone calls and no e-mails back and forth. The whole point of this process is to give back more time to the claims or legal professional so they can do more valuable work. You also want to see how long it is taking your partner to turn your requests around so that you can gauge successfully the program is working. Your partner should be able to produce or create access to these reports easily and quickly.

5. Evaluate carefully the price to value ratio.  You truly get what you pay for in the records retrieval world. Remember that the retrieval partner is responsible for all the follow-up activity and phone calls required to get the records to you more quickly. Using a provider with a very low base price means can mean that they are not incented to make those necessary phone calls. You may be better off in the long run working with a provider that will provide a higher level of service to your team, since this may keep you from having to switch or substitute partners sooner than you would have liked.

What have you done in the records retrieval arena? Is it working? What would you add to this list?