BPR Project Director Update April-June 2015

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BPR Project Director Update April through June 2015

Greetings! I hope that you’ll forgive the long interval between updates. This update will be a combination summary of the spring’s events with news about what is coming up. Going forward, the updates will be published on a quarterly basis. This will enable me to tell you about progress on the BPR initiatives and outreach events with less repetition and overlap. So welcome to the spring 2015 update! I have Medical Portal and Payor Compliance progress to report, as well as a summary of our spring outreach and information about upcoming webinars. Let’s get caught up!

As I reported back in March, the stakeholder requirements for the Medical Portal were submitted to our Information Technology Services (ITS) team for their analysis. The Medical Portal team narrowed down this broad list of wants and needs to a list of the top 10 most critical requirements that the medical portal must meet to be successful.

Treatment authorization requests (C-4 AUTHs, MG-1s, and MG-2s) make up five of these critical requirements. That so many requirements surrounding treatment authorizations rose to the critical list indicates how important it is that the Board keep working on getting this aspect of claim processing right. The five requirements are:

  • Creation of Treatment Authorization Request (TAR);
  • Search and query (claimant/Board case #) Claim case matching or new Claim case creation for TAR;
  • Validation of TAR requirements for complete Provider submission;
  • Payor Review and Response to TAR;
  • Request for Review of Payor Response to TAR from Provider or Claimant/Claimant Representative.

The other five requirements in the top 10 include features that are essential to the portal’s usability. These are:

  • User/Role preferences;
  • Access codes and lookup of Medical Treatment Guidelines;
  • TAR Notifications automatically generated to all Parties (portal/mail);
  • Ability of all Parties to obtain status of TARs in process;
  • User dashboard highlighting TAR-required actions and work queue.

I want to congratulate the Medical Portal team on their perseverance. It has taken a great deal of work to collect feedback on stakeholders’ wants and needs for the portal, and then synthesize that information into a concrete set of business requirements. The Medical Portal team is now at work to determine how many of these critical requirements will be implemented in the first release of the portal.  

Payor Compliance has also been making great progress. I’m happy to report that, to date, Payor Compliance has held three webinars on the new reports. These sessions have been going very well and have helped resolve many questions stakeholders have about their reporting responsibilities. Approximately 180 people participated in the first webinar held April 7th on timely first reports of injury and the new Timeliness of First Report Injury (FROI) report. A second webinar was also held on the 28th.

The third webinar, held on June 2nd, covered Timely SROI Showing Initial Payment and Timely Initial Payment. This webinar was not only very well attended, it also helped resolve a number of questions surrounding SROIs and timely first payment of benefits.

Both webinars are available on the Board’s website as a PowerPoint presentations. I encourage you to review them if you did not have an opportunity to attend the live sessions.

This is a perfect segue to my next piece of news. For those of you who do not know, Payor Compliance now has its own section on the Board’s website. You can access the page and the PowerPoint presentations of the webinars from this link: Monitoring and Compliance. To navigate to the page from the Board’s home page, choose Insurance Carriers>Monitoring and Compliance. Under Recent News, you can click on either the April Timely First Payment webinar or the June Timely SROI webinar.

Subsequent webinars on the other timeliness reports are being planned, and I will share details about these as plans are finalized. For more information about the reports and the Payor Compliance project, please see the Subject Number that was published on April 17th: Subject Number 046-760, Payor Compliance. If you would like to receive invitations to the webinars, please contact the Monitoring and Compliance unit at monitoring@wcb.ny.gov, to request that you be put on the list.

In outreach news, the second Advisory Council meeting took place on May 1, 2015 at the Board’s main office in Schenectady. Although the Advisory Council began with the BPR, it has expanded its scope to meet and discuss issues of importance to the Board and its stakeholders. These meetings enable the Board to understand first hand stakeholders’ perspective on workers’ compensation issues.  

The BPR team was on the road again in June and July with another series of roadshows. These sessions are always a great way for stakeholders to hear the latest news on BPR project initiatives directly from the BPR team and exchange questions and ideas with Board executives. As usual, the discussions were frank and came from a place of wanting to do what would best serve injured workers.

A document will be published to the BPR section of the Board’s website that summarizes the roadshow discussions. I hope this will provide a synthesis of the major topics and the feedback the Board received.  A webinar of the roadshow presentation is currently being scheduled for those of you who did not have an opportunity to attend one of the in-person sessions in the District Offices. I anticipate that both the summary document and the webinar will be ready in early August, but please monitor the BPR section of the Board’s website and the Outreach Calendar for new information.

Finally, please keep your feedback and questions coming to the BPR mailbox (BPR@wcb.ny.gov). Your thoughts and ideas are a very meaningful contribution to the BPR project. You have helped guide the project’s direction for the better, for which you have my sincere gratitude. Thank you!