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New System For Acc ? Colossus ,is ACC using this system now ?

#1 Guest_Buddy_*

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Posted 07 December 2003 - 04:01 PM

Check this out guys
www.acc.org.nzacc-news-22---apr-2000
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newsA Newsletter for Health Care ProfessionalsaccIssue 22April 2000
Here at Healthwise, we’ve been pretty busy withtransitioning back to ACC. However, the process hasgone very smoothly, and we’re confident that the finalstage (on 1 July) will be as trouble-free as we canpossibly make it.Indeed we expect our processes in general to beincreasingly streamlined as we adopt the advantagesof new technology. If you haven’t visited our web sitealready (www.healthwise.co.nz) please do, as we’verecently updated it.The main benefit of this technology has to be on-linetransactions which are currently being tested, pilotedor rolled out across the country. Providers can nowregister on-line and, using a unique password (enclosedwith this newsletter), view their current provider profile.You can also order publications, view ACC News andupdate yourself on news from ACC Healthwise.Many providers have linked with ACC to billelectronically and have benefited from quick paymentsand reduced paperwork. This approach is now beingextended to include on-line claims lodgement and willculminate in an “electronic message gateway” later inthe year. You’ll be able to lodge claims, bill and downloadinformation relevant to your patient’s casefrom one central “page” on the site. Andto save you typing patient details adnauseam, the site will eventually linkdirectly to your Practice ManagementSystem (PMS).ACC has made excellent progress withelectronic claims lodgement in a pilot inthe Waikato run by Houston Medical andHealthLink. Providers can submit ACC 45s andM40/47s directly from their PMS software. If you’relinked to Houston and not running with the new claimslodgement system, contact Houston and the systemcan be very easily set up.For providers with another PMS, electronic lodgementis not far away. You’ll hear from either ACC or yourPMS provider in the near future.This is great technology – let’s make the most of it.Dr David RankinGenral Manager ACC [email protected] results from WCAPA recent report on ACC’s Work Capacity Assessment Programme (WCAP) hasidentified some encouraging statistics.Claimants exiting from the WCAP from 1 July 1998 to September 1999 werematched with Work and Income New Zealand data to investigate to whatextent they then began receiving benefits. The main findings of the research(which compared 3,887 claimants) were:• 79 percent did not go on to a benefit within three months of leaving theWCAP• only 9 percent received health-related benefits within three months ofleaving the WCAP• the remaining 12 percent received a work-tested benefit of some kind.We can infer that the 79 percent who did not receive a benefit re-entered theworkforce for at least three months. These are great results for ACC and thework we’re doing through the WCAP.Physio Treatment Profiles imminentThe new Physiotherapy Treatment Profiles are currently in production and weexpect to be distributing them in May.The Profiles were developed by the New Zealand Society of Physiotherapistsas a joint initiative with ACC, and are a consensus of opinion on what isconsidered appropriate and common current practice for 91 of the mostcommon musculoskeletal conditions treated by physiotherapists today.Like the GP Treatment Profiles, this resource should prove highly useful forphysiotherapists throughout the country. If you’re a physiotherapist, look outfor your copy soon!Meanwhile, the GP Treatment Profiles are currently being updated. All commentsand contributions are welcome – please send them to David Rankin, GeneralManager ACC Healthwise, PO Box 242, Wellington, email [email protected]
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April – July PracticeBy now you’ll have received the ACC News special edition that explained the changes to the ACC schemeeffective from 1 April this year. More change will happen from 1 July, but until then please remember thatthe same principle you’ve used to lodge claims since 1 July 1999 still applies:• complete the ACC 45 form for non-work injuries (and for ACC self-employed people)• complete the AITC form for work injuries, including ACC-covered work injuries (and self-employedpeople who have private accident insurance).This means if it’s a work injury, you still need to find out who your patient’s employer is insured with. If itis ACC, write “ACC” in the insurer box and send the AITC form to ACC. We’ll then determine cover andsend the form to Medical Fees for payment.After 1 July, cover for all personal injuries incurred after 1 July reverts to ACC. We’ll be sending youall the information you need before then, about the claims process, the ACC Partnership Programme,the billing process, forms to use and any ongoing management of claims covered by private insurers.Elective Surgery Purchasing ForumACC Healthwise is hosting a forum on Wednesday 3 May to discuss industry views on elective surgerypurchasing.About 150 people are expected to attend the forum at the WestpacTrust Stadium, which will cover subjectssuch as:• co-operation between public and private providers and the efficient use of resources to get the most outof providing good health care• the positive and negative perceptions of elective surgery purchasing• the significant variance in performance figures between regions in New Zealand• pricing of health services, and streamlining them to achieve competitive pricing.The forum will include panel discussions and interactive workshops. ACC Healthwise will also take theopportunity to present its purchasing strategy for elective surgery for the next four years.Speakers at the forum include representatives from key healthcare organisations (Hutt Valley Health, CapitalCoast Health, Boulcott Clinic, Taranaki Healthcare, Southern Cross Healthcare and St George’s Hospital inChristchurch), orthopaedic surgeons John Tonkin, John Calder and Grahame Inglis, and key managers fromACC Healthwise.The ACC Partnership Programme – What is it?The ACC Partnership Programme is being introduced under the new legislation that took effect from 1 April.Briefly, the programme provides the opportunity for employers to take responsibility within their ownworkplace for employee health and safety. They must qualify under a range of criteria and provide all statutoryentitlements in relation to work-related personal injuries suffered by their employees. They must also payall costs in relation to their employees’ claims.The ACC Partnership Programme will affect the processes you use for your patients’ injury-related claims.We’ll be in touch before the programme is implemented to advise you exactly what to do.
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newsaccRehabilitationAssessment ServiceIf you’ve heard about our Rehabilitation Assessment Service (RAS), but are not sure exactly what it’s about,here’s a quick rundown...What is it?RAS is a second-opinion service available to GPs and physiotherapists throughout New Zealand. A network of rehabilitationassessors, with recognised expertise, provide assessments, clinical advice and peer support services.RAS comprises:• an assessment of a patient’s needs and diagnosis• a review of certification, treatment, rehabilitation and entitlement services• a report containing a recommended Treatment and Rehabilitation Plan.When would you use it?RAS is used for patients who have been continuing to receive GP or physiotherapy treatment beyond their expected recoverytimes and for patients with complex needs that providers would appreciate a second opinion for.RAS may be used for any injury but is particularly useful for high-risk types of injury, such as back and occupational overuseinjuries. Rehabilitation assessors can offer an alternate opinion on diagnosis and optimal rehabilitation to assist the patientto recover more quickly.GPs and physiotherapists can use the RAS to:• obtain advice from someone who has the expertise appropriate for the injury and patient diagnosis (eg, for back injury)• obtain a comprehensive assessment of an injury to help in planning an appropriate return to work or rehabilitationprogramme• help a patient gain early access to rehabilitation planning services and employer liaison• obtain a second opinion where there is a discrepancy between a patient’s expectations and the GP’s or physiotherapist’sadvice.RAS encourages early and effective communication between the GP/physiotherapist, the patient, the rehabilitation assessor,the case manager and the employer.GPs and physiotherapists can recommend a patient for referral to a rehabilitation assessor at any time. The referral can bemade by contacting your local branch to arrange for the referral to take place. RAS may also be instigated by an ACC casemanager when they are reviewing individual cases. The RAS report will be sent to you for your information and to assist youwith the continued rehabilitation programme with the patient.
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ACC Corporate OfficePO Box 242, WellingtonNew ZealandTelephone 0-4-918 7700Facsimile 0-4-918 7701www.acc.co.nzA quick check...Part of ACC’s job involves reviewing clinicalrecords to ensure health providers are providingnecessary and appropriate services for their patients.Unfortunately however, we often do not receiveenough or adequate documentation to do thiseffectively. Examples include:• no entries for some services claimed• no treatment plans or recorded progress againstplans (for example, only the symptoms recorded)• patients being treated every two days for longperiods of time without peer review or referral• the cause of injury not being clear• providers treating and then claiming from ACC foran underlying medical condition• providers claiming and receiving payment forservices given by another provider (such as a doctorclaiming for a service provided by a nurse)• clinical records being written retrospectively afterbeing requested• inadequate documentation of the justification fortime off work certification• patient co-morbidites (for example, treating andclaiming on ACC for underlying medical problemsadditional to the injury).For your information, the criteria we use for reviewingclinical records are:• Is there a clinical record for the treatment claimed?• Do the clinical records meet the professionalstandard of documentation?• Is there an appropriate clinical reason to justify thevisit or ongoing treatment?• Is the treatment in line with current acceptabletreatment numbers/frequency?Remember, in cases where there is insufficientsupporting documentation to show that the treatmentis necessary and appropriate, we are obliged to recoverany payments we have made. If the information is falseor misleading, cases are referred to the Fraud Unit.Important material on safetycoming your wayA new system designed to communicate safety concernsbetween providers and ACC is being introduced.ACC has liaised closely with the NZMA to develop a systemthat is workable and acceptable. It will be critical providersunderstand the system and follow the guidelines.We have always placed the utmost importance on health andsafety yet were moved to thoroughly review our systems afterthe murder of a staff member in Auckland last year. This ledto the introduction of still more safety measures and our staffwork to strict rules at all times. We are also concerned for thesafety of our partners (providers, rehabilitation providers, etc)and this is why an extra system to help us all keep safe isbeing introduced.The system will involve providers helping to identify claimantswho may pose a risk to themselves or others by placing a smallsticker on forms sent to ACC or other providers. Detailedinformation and instructions will be sent to you with your firstsupply of stickers shortly.newsacc

Its a bit long winded ,but I have read just about word for word the same from the software system called' Colussus 'that CSC sold to many Health Providers in the States UNUM Provident being one ?!
Me thinks after reading up on the system it fits in exactly with ACCs policies
Mmmmmmmmmmmmm I wonder !!
Did ACC get theres from CSC??
What do you think !?
Have a read of this

Colossus

CSC’s Colossus® is the insurance industry’s leading expert system for assisting adjusters in the evaluation of bodily injury claims. Colossus provides adjusters access to your company’s claims data within a defined Business Process Management framework for evaluating injuries, treatment, resolution, impairment and general damage settlements. Colossus helps adjusters reduce variance in payouts on similar bodily injury claims.

With Colossus, adjusters quickly interpret medical reports and look up definitions of injuries, treatments, complications and permanent impairments using AMA 5th edition data. Through a series of interactive questions, Colossus guides the adjuster through an objective evaluation of medical treatment options, degree of pain and suffering, degree of permanent impairment to the claimant’s body, and the impact of the injury on the claimant’s lifestyle.

Equally effective for personal or commercial lines, Colossus is used by 13 of the top 20 US Property & Casualty Insurers to minimize pay out variance on similar bodily injury claims. CSC's Claim Evaluation Solutions:
Increase fairness to all customers by ensuring consistent company-wide best practices
Increase the adjuster's confidence in the negotiation process
Improve the adjuster's investigative questioning skills (at all levels from new adjusters to the most experienced)
Help adjusters ensure reserves are set accurately
Colossus guides claims professionals through the evaluation of the degree of pain and suffering experienced, the effect of the injury on permanent impairment to the claimant's body and the impact on the claimant's lifestyle. At the conclusion of a Colossus consultation, a summary of the claim is provided, including a recommended settlement range. Colossus ensures consistency in how bodily injury claims are evaluated across the entire claims organization, thereby reducing pay out variance.

Or is this possibly a system that ACC might be looking at using ?

Regards Buddy :ph34r:

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#2 Guest_flowers_*

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Posted 07 December 2003 - 04:58 PM

WONDER HOW MANY OF OUR G.P'S HAVE BEEN CONNED INTO USING THIS TO THEIR PATIENT'S DETRIMENT BOTH SHORT AND LONG TERM

"newsaccRehabilitationAssessment ServiceIf you’ve heard about our Rehabilitation Assessment Service (RAS), but are not sure exactly what it’s about,here’s a quick rundown...What is it?RAS is a second-opinion service available to GPs and physiotherapists throughout New Zealand. A network of rehabilitationassessors, with recognised expertise, provide assessments, clinical advice and peer support services.RAS comprises:• an assessment of a patient’s needs and diagnosis• a review of certification, treatment, rehabilitation and entitlement services• a report containing a recommended Treatment and Rehabilitation Plan.When would you use it?RAS is used for patients who have been continuing to receive GP or physiotherapy treatment beyond their expected recoverytimes and for patients with complex needs that providers would appreciate a second opinion for.RAS may be used for any injury but is particularly useful for high-risk types of injury, such as back and occupational overuseinjuries. Rehabilitation assessors can offer an alternate opinion on diagnosis and optimal rehabilitation to assist the patientto recover more quickly.GPs and physiotherapists can use the RAS to:• obtain advice from someone who has the expertise appropriate for the injury and patient diagnosis (eg, for back injury)• obtain a comprehensive assessment of an injury to help in planning an appropriate return to work or rehabilitationprogramme• help a patient gain early access to rehabilitation planning services and employer liaison• obtain a second opinion where there is a discrepancy between a patient’s expectations and the GP’s or physiotherapist’sadvice.RAS encourages early and effective communication between the GP/physiotherapist, the patient, the rehabilitation assessor,the case manager and the employer.GPs and physiotherapists can recommend a patient for referral to a rehabilitation assessor at any time. The referral can bemade by contacting your local branch to arrange for the referral to take place. RAS may also be instigated by an ACC casemanager when they are reviewing individual cases. The RAS report will be sent to you for your information and to assist youwith the continued rehabilitation programme with the patient."

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#3 User is offline   twostickswalking 

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Posted 07 December 2003 - 05:29 PM

I think that the systems are similar for child agencies, they call these
res risk estimination service, which you complete in pairs etc.

I am sure if you know about the systems and how they work, then
you can arrange your own assessments to counteract theirs,
you will need a copy of the system they use, then make you own
system, taking to your own health service provider.
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#4 Guest_IDB_*

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Posted 25 June 2004 - 09:53 PM

there was an article in recent times that said ACC was to spend lots more $$$ on another claims management system, not sure where from, one does wonder how much of a waste of $$$$ it will be when the millions ACC spent on the "INFORME" program only to tell claimants it is not available in electronic form. so where does the $$$ go if you can access what your levies paid for?
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#5 User is offline   hukildaspida 

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Posted 13 December 2012 - 09:50 PM

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#6 User is offline   hukildaspida 

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Posted 22 July 2014 - 04:30 PM

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