Agenda

Introducing…

Case Management Solutions for Diverse Business Sectors

Arcadia Interface For Case Management

From the Labs

Discussions

• Introducing…Desjardins Insurance Company

• Coming Soon…Exacta

Insurer – IME Vendor Management

Insurer’s Access SmartSimple’s Ontario Referral Network™• +80+ IMEs, Hospitals and Treatment Centres• +500,000 Cases• +3.5 million Medical Documents• +150,000/year HCAI Submissions

Insurance Adjuster Portal

Access all claim information from your intuitive secure portal

Query and Manage Claims and Workflows

Insurance Adjuster Portal

Drill Down to View Claim Related Services

Insurance Adjuster Portal

Instant Analytics for Meaningful Metrics

Insurance Adjuster Portal

Employer Services

Access all case information from your intuitive secure portal

Employer Services

All Case Information is Accessible from a Single Screen

Employer Services

Easily create and monitor case activities.

Employer Services

Query/Searchall cases by any criteria

Employer Services

Managing Care in Community

What are Community Care Access Centres?• Connectors to home care, long-term care destinations, and other services in

your community.• Funded and legislated by the Ontario Ministry of Health and Long-Term

Care.

All Case and Patient Information is Accessible from a Single Screen

Managing Care in Community

Employment Services

Employment Services

What does the Employment Services solution offer?• Job Search assistance• Resume assistance and interview preparation• Workshops• Individual Assessment and case management• Labour Market Research and Job Development

• Ontario Ministry of Training, Colleges and Universities (MTCU) funds employment training and educational programs to help workforce get sustainable employment.

Employment Services

Employment Services

Employment Services

Employment Services

Example of how various Plan items are tracked on the Case / Service Plan

Structured Settlements

What are Structured Settlements?• “A structured settlement is a financial or insurance

arrangement, defined by Internal Revenue Code as periodic payments; a claimant accepts to resolve a personal injury tort claim or to compromise a statutory periodic payment obligation.”

• The government of Canada exempted structured settlement income from taxation, subject to conditions.

Structured Settlements

Structured Settlements

What is the SmartSimple business solution?• A structured settlement is put together a number of

ways. • The variables contemplated in the formulation

process are as follows:1. Amount of lump sum payments;

2. Interest Rates

3. Frequency of payments (i.e., monthly, annual, etc.);

4. The life expectancy of the plaintiff.

Structured Settlements

SmartSimple Solution – Claim Details View

Structured Settlements

SmartSimple Solution – Detailed Annuity View with Products

• From the labs…

Data Exchange

Managing Statuses between Insurers and IME’s

-The Insurer contains statuses which indicate various milestones of the assessment. e.g Scheduled, Cancelled, Completed, Billed

-The IME Status list consists of both insurer related statuses and IME related internal statuses.

An Assessment is only sent back to an insurer once it has reached a certain point in the process.

E.g When it is first scheduledWhen it is awaiting additional medsWhen it is completed, cancelled, or there is a change in schedule

Data Exchange

Managing Statuses between Insurers and IME’s

Objective:

1) To increase efficiency, and streamline the process for exchanging assessments between IME and Insurer

2) Separate the statuses which are of interest to the Insurer and those of interest to the IME (IME internal statuses)

3) Reduce the number of data exchange-related statuses in SmartSimple

Data Exchange

Managing Statuses between Insurers and IME’s

Data Exchange

Managing Statuses between Insurers and IME’s

How do we accomplish this?

New Setting that allows defining which statuses are to be included in the export

Advantage:-Streamlines the status process by preventing new statuses from being created on each system via exchange.

-Ensures consistency among statuses when exchanging with various Insurers or IME’s

-Based on status, this ensures that the assessments are not sent back if the report is still being worked on.

Data Exchange

When Exporting, the checkbox is selectable only for those statuses that can be exported.

List of Services under a Case. In this list, Completed and Scheduled are set for export.

Open Discussions

Thank you for Attending!

SmartSimple Community Conference 2013Case Management Solutions