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“With the new innovations in this release, our customers can deliver MSA submissions substantially faster than with traditional methods, while fully meeting CMS standards. We see this as a big step forward for workers’ compensation carriers.”
For over a decade, workers’ compensation insurers have used CLARA’s platform to lower medical costs and improve outcomes for injured employees. CLARA applies AI and machine learning to analyze structured and unstructured data, perform contextual analysis with natural language processing, and develop forecasts and recommendations for insurance professionals. CLARA has a proven track record of delivering rapid ROI to its customers; one nationwide claims administrator is saving 33% on its Medicare Secondary Payer (MSP) compliance costs using the CLARA product.
CLARA’s MSP Compliance module automates the process of developing treatment forecasts, first by ingesting case documents and treatment history, then applying in-depth expert logic to put past treatments in their full context in order to accurately predict future treatments. CLARA’s AI engine eliminates the tedious process of combing through mountains of records, filtering out duplicate information, recognizing errors and discrepancies amid related documents, and linking bills to medical records. CLARA’s AI platform applies the company’s deep expertise in workers’ compensation claims processing to assemble a clear, complete and accurate picture of each case. Using natural language processing with contextual analysis, for example, CLARA’s AI platform can identify the existence of an underlying medical condition based on a specific treatment, even in cases where a physician makes no specific mention of the condition itself.
CLARA automates pricing for treatments, surgeries and medications based on jurisdiction and Medicare pricing requirements, enabling a nurse or adjuster to price expensive treatments and forecast settlement scenarios. Carriers can run unlimited reports for different applications, including traditional MSAs, evidence-based MSAs, pre-MSA, or FMCE scenarios. Reports are fully validated by CLARA’s CMS expert nurses, enabling carriers to submit approval-ready MSAs to CMS in just a few days.
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MSP Compliance 2.0 incorporates enhanced collaboration tools, easing the flow of communication between carriers and CMS experts at CLARA, who are available to guide adjusters through the MSA submission process. The new software version provides additional flexibility in selecting which reports to run as well as improvements to automation and performance. Adjusters can run unlimited reports based on multiple scenarios — without incurring additional costs.
Version 2.0 of MSP Compliance also marks the introduction of CLARA’s Medical Record Explorer, which enables adjusters to easily view and search medical records, extract key information, and identify records by type. Medical Record Explorer places a wealth of information at an adjuster’s fingertips, giving them immediate access to the information they need for each case.
CLARA’s AI platform is built around a secure, HIPAA-compliant, SOC2-compliant foundation — always on, available anywhere, and fully auditable.
“MSP Compliance 2.0 will be a catalyst for even greater agility and efficiency for CLARA’s customers,” said Tom Warden, Chief Insurance and Science Officer at CLARA Analytics. “With the new innovations in this release, our customers can deliver MSA submissions substantially faster than with traditional methods, while fully meeting CMS standards. We see this as a big step forward for workers’ compensation carriers.”