Business Process Services

Utilizing Deduplication to Reduce Costs and Speed up Medical Record Reviews for Workers’ Compensation Insurance Claims

16 August 2023

Insurance companies serve as vital partners in managing workers’ compensation claims, ensuring that employees are provided with the necessary benefits and support when encountering work-related injuries or illnesses. They are responsible for verifying the legitimacy of claims, determining the extent of coverage, and providing timely financial assistance to claimants during their recovery process. To fulfil these responsibilities, insurers must meticulously examine and analyse extensive amounts of medical records, which form the foundation for understanding the nature and severity of the injuries sustained. The process of reviewing these voluminous records, however, incurs considerable expenses and requires a substantial amount of time to complete.

Medical record reviews are expensive

Indeed, medical record reviews come with a high price tag. Medical records are large voluminous documents that usually run into thousands of pages. Our research indicates that, in some states like California, IMEs and QMEs charges around $3 per page for their review services. As a result, insurers spend significant money reviewing medical records with IMEs and QMEs to determine workers’ compensation claims.

Page duplication in medical records—a common occurrence

A patient’s Medical records are usually retrieved from their healthcare providers. When verifying a workers compensation claims, the applicant and the defendant gather and submit these records to medical evaluators for assessment. Because these records are collected from the same healthcare providers and of the same patient, these records often contain duplicate pages, redundant information, and, sometimes, irrelevant reports.

American Health Information Management Association claims that 8%-12% of pages in electronic health record from a given facility or provider are insignificant to the process or claim.​ Furthermore, an official report highlighting duplicate pages in medical records reveals that nearly 40% to 100% of the pages submitted for review to medical evaluators are duplicates.

Insurers lose thousands of dollars in reviewing medical records with duplicate pages

Insurers often submit medical records for review without realizing they contain duplicate pages. IMEs and QMEs charge insurers on a per-page basis, including duplicates. This significantly increases review costs and leads to considerable financial losses for insurers—losses that could have been avoided. Additionally, duplicate pages not only inflate expenses but also prolongs the review process, as medical examiners spend extra time reviewing the same information repeatedly.

Deduplication: A cure for Reducing Costs and Streamlining Reviews

What is Deduplication?

Deduplication is the process of meticulously sifting through medical records to identify and remove duplicate pages and irrelevant reports from the records. Domain experts usually apply AI/ML technology to ensure efficiency and accuracy. Consequently, the medical records submitted for review are 100% duplicate-free, reducing insurers’ costs.

Our deduplication process has long been helping insurers cut down their review costs. Also, it relieves stress for the IMEs and QMEs as it dramatically reduces the amount of unorganized, cluttered, and vast pages of medical records.

Steps involved in the deduplication process

Our deduplication process utilizes a hybrid approach, combining the expertise of our reviewers with AI/ML technology to identify, locate, and remove duplicate and irrelevant pages from medical records. Here’s a step-by-step overview:

Indexing

After obtaining medical records from both parties, we upload the documents to a unique, HIPAA-compliant server space. Once the records are on the server, we index them according to the client’s requirements, such as the First report of injury, Medical report, Non-medical personnel, Utilization review, Miscellaneous, Duplicate, and Other patient reports.

Indexing makes it easy for non-medical professionals such as lawyers and insurers to comprehend the records easily.

Deduplication: Removal of duplicate pages

Our expert reviewers leverage AI/ML to meticulously examine each page of the record to accurately identify, locate, tag, and extract any duplicate pages present within the records. Invalid pages and irrelevant information are also removed during this process. Our hybrid approach helps us deliver 100% duplicate-free records quickly.

Formatting

After deduplicating the records, we optimize the documents by creating borders and hyperlinks for swift access to each category. The file is then available in various formats, including PDF, Word, XML, and HL7, ensuring easy downloading and exporting.

Furthermore, we provide a LOG sheet and Cover Letter to ensure compliance with the Labor Code and your state’s Code of Regulations. You will receive an email containing the total page count of records for QME review, including pages from both your and opposing sides. This page count allows you to verify that the QME does not overcharge for record reviews in their billing.

Benefits of our Deduplication process

Deduplication of medical records will help you to achieve the following:

  • Reduce unnecessary review expenses
  • Maximize operational efficiency
  • Expedite the review process
  • Save IMEs and QMEs from excess paperwork

PreludeSys as your deduplication partner

PreludeSys guarantees a streamlined and efficient process to manage medical records—including deduplication. Our hybrid approach combines domain experts with AI/ML technology to ensure accuracy while reducing costs. We provide optimized documents in various formats and adhere to strict compliance requirements. PreludeSys is the partner you can trust to deliver the highest level of service and support.

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