Snapsheet and TempusDirect Partner to Streamline the Injury Cost Containment Process for P&C Carriers

Check out our Partnership Story on PropertyCasualty360

Combining Snapsheet’s workflow automation engine and rapidly growing API ecosystem with TempusDirect’s cost containment solutions, carriers and service providers reap the benefits of speed, transparency, and payment accuracy.

CHICAGO AND ARIZONA – July 4, 2022 – Snapsheet, the pioneer of virtual appraisals and an emerging leader in claims management technology, and TempusDirect, a leading provider of medical cost containment solutions for the Property and Casualty (P&C) insurance market, today announced a strategic partnership and integration that utilizes technology to further simplify the cost containment process for Tempus customers.

The new partnership and process optimization efforts from Tempus directly through Snapsheet’s Vendor Integration, streamline the cost containment process for both providers and claimants.

“Through our partnership with TempusDirect, we are leveraging our cutting-edge, insurance claims management platform to increase speed, transparency, and payment accuracy for all parties involved,” said Andy Cohen, President and COO at Snapsheet. “We align with TempusDirect’s mission of removing the obstacles that can get in the way of quality and speed of patient recovery and look forward to combining our efforts to amplify this shared goal.”

“We are excited to work with Snapsheet to further our mission of focusing on quality and patient care while cutting costs,” said Josh Dickerson, COO and co-founder at TempusDirect. “Our solutions coupled with Snapsheet’s integration will simplify the work for adjusters and ensure a smooth process for all.”

About Snapsheet

Snapsheet is the pioneer in virtual appraisals and a leader in cloud-native claims management software, enabling the most innovative claims organizations to deliver the best experiences for customers. With a focus on engagement, digitization, and intelligent automation, Snapsheet provides unmatched software and processes to improve customer experience, drive greater organizational agility, and deliver transformational benefits through its Snapsheet Cloud software suite and Appraisal Services offerings.

Snapsheet leads the industry in claims innovation including the deployment of the fastest digital auto insurance claims process in the United States. As a trusted innovation partner, Snapsheet works with more than 125 clients, including many of the largest insurance carriers, third-party administrators, MGAs, insurtechs, and sharing economy disruptors. For more information, visit snapsheetclaims.com.

About TempusDirect

TempusDirect is built upon the foundation of user inspired innovation, and a promise to listen and serve with a sense of urgency. We create our solutions for insurers, TPAs and self-administered employers across all insurance lines where medical providers are paid directly by P&C payers.

We eliminate the burdensome obstacles around provider reimbursement by partnering with patients, health care providers and insurers in a collaborative way that builds strong relationships and a better, more streamlined reimbursement process and faster patient recovery. Our Tempus suite of services establishes full transparency for cost containment and solves a unique industry need. For more information visit www.tempusdirect.com.

Lawyers, Leverage & Leakage: Negotiating Attorney Demand Packages

by: Greg Gaughan, Co-founder & CEO of TempusDirect , January 2022

Liability coverage is based in tort, which means the successful adjuster requires leverage in the absence of the certainty that contract coverages and fee schedules provide. When negotiating with both unrepresented and represented claimants, it is critical to provide adjusters with the data, rules, and process to use leverage effectively on a scaled basis.

Unrepresented claimant bodily injury (URBI) early settlements are typically consensual, emphasize speed, service, and customer experience. They set up well for the direct to provider (DTP) payment model, allowing carriers to use Tempus’ scaled leverage with providers to reduce specials reimbursement and eliminate “lump sum” leakage. Moving the specials negotiation from individual claimants to providers allowed the introduction of time and certainty leverage, while maintaining the efficiency and consensual nature of the lump sum model. This shift and application of leverage in URBI ended a 30+ year run of lump sum payments at 100% and made DTP an industry best practice.

Attorney represented claimant bodily injury (ARBI) is less consensual and more complex, due to the attorney-client relationship which prohibits most of the benefits of the DTP model found in URBI. ARBI lacks the single transaction efficiency of URBI, and involves a staged negotiation of demand and offer, followed by a series of counteroffers. Negotiation training for adjusters on settling attorney demands seems simple enough as the mechanics of the attorney - adjuster negotiation have not changed in many years. The question then is why does leakage remain so prevalent in demand package specials, and where exactly does the leakage occur?

ARBI leakage occurs when adjusters lack the data and leverage to reduce hospital and other emergency service bills that contain public to private cost shifting, and inflated retail pricing. Unlike professional service bills, there is not a widely available UCR benchmark to apply to hospital bills. Carriers do apply healthcare reference pricing, and many have adopted a public Medicare reference benchmark (multiplier adjusted) as a negotiation leverage standard. While helpful, these benchmarks alone fail to address the leverage requirements of a multi-stage attorney negotiation. Adjusters need data and leverage for each stage of a negotiation because few if any negotiations are one and done, and you cannot use the same leverage twice.

Here are three examples with the same 100K bill that demonstrate the current & future use of negotiation leverage:   

No Leverage

Litigation adjuster negotiates a 100K hospital bill, the treatment is not attorney directed care and is related to the mechanics of the injury. The adjuster has no specific data or leverage to support their arguments and relies on claims and venue experience to establish value and negotiation strategy. This adjuster may be 100% right in their evaluation of a bill as inflated, but claims do not settle because an adjuster is right. Claims settle because an adjuster is prepared with persuasive arguments backed by strong leverage. Without any data or reference, the adjuster must concede large increments of money in the counteroffers to settle the claim and avoid costs of suit, which is not a feasible option for LAE or inventory management.

Not Enough Leverage

Same scenario, and now adjuster uses a public Medicare rate benchmark, set at 150% to adjust for the private auto market. The Medicare rate creates a good negotiation “anchor” or floor for negotiations but loses impact and utility when the attorney counters and negotiations move to a round 2 or 3. Adjusters may resort to other healthcare benchmarks, but most hospitals do not share pricing data on the numerous healthcare, state specific websites. Adjusters must apply a non-formulaic method of “chunk” negotiating to get the bill settled, often to “split the difference” – a key indicator of a failed or no negotiation strategy and leakage. In sum, Medicare provides a good anchor, but the adjuster lacks a ceiling, formula, or data to calculate amounts to incrementally adjust counteroffers if necessary. This counteroffer leakage is the ARBI cost containment blind spot for many carriers.

Staged Leverage

This time the adjuster validates the 100K hospital bill for collateral source and/or fraud (10-15% frequency) to be sure they are not paying on something they do not owe (Tempus Claims Validation - TCV). Next, they create a staged negotiation strategy that sets both a floor and ceiling, or a bracketed value for the claim supported by data at both ends. The Medicare rate is the floor, and the Tempus Live Benchmark (TLB) is the ceiling creating a narrow, bracketed value range to negotiate within and to set counteroffer increments in advance.

TLB represents the actual, accepted rate from this provider for these charge types in Auto. It is not an oblique reference to healthcare rates, it is direct - what this hospital accepts based on thousands of previous negotiations with Tempus. After Tempus validates the bill and eliminates any possible preliminary leakage before the negotiation starts, they provide the adjuster with a proprietary accepted auto rate ceiling and powerful leverage to support final settlement, up to and including adjuster offering to take fiscal responsibility at the low TLB rate. Adjuster has staged leverage, and they will not run out of leverage or back into a corner as the ceiling is the strike price in the market.

About Tempus: Our Innovation

Tempus is the first and only company to offer 3rd party liability medical bill validation and a proprietary data benchmark solution. Importantly, these solutions solve real problems that no one else can. While ubiquitous, demand package bill review software still cannot see and validate what the attorney does not put on the bill. Moreover, no other company has Tempus’ provider history, relationships, and agreements to create national accepted auto rate benchmarks. Finally, our URBI and ARBI innovation has attracted strategic integration partners enabling us to take this solution into a streamlined claims system and bill review rules based workflow. Fast, efficient, low priced, high ROI.

Why 3rd Party is Different, Why Tempus is Different

A major reason 3rd party is different from 1st/PIP or WC is it involves tort, and the resolution of claims often lacks the speed and certainty of most contract coverages and fee schedules. Moreover, adjusters, attorneys and medical providers have competing interests, and the best negotiators have strong data and leverage. For these reasons, 3rd party cost containment is not a simple extension of PIP or WC competencies, and requires several "must have" competencies which also serve as a competitive advantage for Tempus: (1) We understand negligence and solve for how ambiguity impacts process. It's more complicated than reducing a medical bill, because attorneys reject offers and adjusters need to consider general damages, limits and LAE when addressing medical specials inflation. Our solutions, process and service are designed for these "real world" dependencies. (2) We know the state laws and regulations. We know where our solutions work best, and knowing the state environment enables us to create new solutions at a single state and national level, which supports our client base of national and regional carriers. When we ask for feedback (user inspired innovation) it is to create and improve, not to learn the business from you. (3) We have experience working in claims litigation and negotiations. It's easier to innovate and serve if you've actually done the job. We have deep SME in claims, provider negotiations and attorney/claimant negotiations including both special and general damages. That doesn't mean we have all of the answers, but we do ask good questions.

For Tempus, these competencies are the price of admission. The next step was defining our differentiation areas: unique solutions and superb execution.

Competitive advantage is doing different activities than your competitors and capturing value from them. We built TempusDirect by creating one unique solution after the next, with different activities within each of them. No one else has the “what we do” or “how we do it” inside of Claims Validation or Live Benchmarks, and we leverage the symbiotic relationship of our solutions to create new ones with shared data and best practices. This user inspired innovation model is fueled by our passion for the business, or the “why we do it,” which is also a competitive advantage.

Operational excellence is doing the same activities as your competitors but executing better on those same activities. 3rd party claims adjusters deal with unique negotiation scenarios every day, and they should have quick access to a highly skilled service organization that knows 3rd party and can provide support. We excel at service with our team of “claims smart” associates who partner with adjusters to identify errors, fraud, or customize our approach to the special circumstances of a claim. Importantly, we build strong relationships with every provider and adjuster using our solutions, which is key to a sustainable 3rd party model.

Finally, with unique solutions and excellent service, we aspired to make our scalable solutions easily accessible by adjusters. We’re launching our adjuster centric portal in October and recently announced our Guidewire partnership which allows us to deliver our solutions via ClaimCenter. These are important strategic initiatives for us as workflow and process will be critical as we continue to deliver new solutions. 

Thanks to everyone for your support. We'd love to hear your feedback and ideas, so please reach out to me and follow us on Linked In.

Tempus Announces Strategic Partnership with Healthcare Technology Partner Prime Health Services

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TempusDirect, a leading cost containment solution in the P&C market, announced a new network integration with Prime Health Services, Inc. (PHS) within the workers’ compensation, auto liability, first party auto, and healthcare markets. PHS is a nationally recognized PPO network used by insurance carriers, third party administrators, self-insured employers, and governmental entities. PHS network clients will now have improved access to specialized network savings through a robust and seamless integration with Tempus.

Effective second quarter 2020, this partnership offers a unique and fresh approach to historical cost containment within our industry through increased workflow optimization and enhanced outcome solutions. “This is an important partnership for our industry because of the effectiveness and efficiency of the power behind our combined solutions.” states Josh Dickerson, COO and co-founder of Tempus. “Strategic partnerships that align across multiple markets are rare and we could not be more excited for this partnership with PHS and what it means for current product utilization and future product development.”

 “It’s a win-win relationship: our network of medical providers will benefit from seeing Tempus patients as much as the patients will benefit from receiving their quality health care,” states Jennifer Ryon, Chief Revenue Officer for Prime Health Services. “We are delighted to welcome a new client that creates value by removing obstacles in the medical reimbursement process while remaining focused on the quality and speed of patient recovery. PRIMErenovo finds the common ground in claims payment, integrating robust web-based tools and analytics for sub-second response time.”

ABOUT TEMPUSDIRECT

TempusDirect is built upon the foundation of user inspired innovation, and a promise to listen and serve with a sense of urgency. We create our solutions for insurers, TPAs and self-administered employers across all insurance lines where medical providers are paid directly by P&C payers. We eliminate the burdensome obstacles around provider reimbursement by partnering with patients, health care providers and insurers in a collaborative way that builds strong relationships and a better, more streamlined reimbursement process and faster patient recovery. Our Tempus suite of services establishes full transparency for cost containment and solves a unique industry need. For more information visit www.tempusdirect.com and www.interortho.net.

ABOUT PRIME HEALTH SERVICES, INC.

Prime Health Services is a strategic healthcare technology partner, here for you when you need a vast network of medical providers at reasonable rates. Prime Health’s national PPO Network is a workers’ compensation, auto, and group health comprehensive, turn-key solution for insurance carriers, TPAs, self-insureds, and governmental entities. Our team offers valuable, personalized service and solutions that stay on-pace with the ever-changing needs of the industry.

Prime Health is perfectly sized to create customized preferred provider networks to maximize value for our clients and our network of medical providers. We are nimble, client-centric, and offer a good dose of Southern hospitality. More information is available at www.primehealthservices.com.

TempusDirect Coronavirus (COVID-19) Business Continuity Plans

TempusDirect (Tempus) Coronavirus (COVID-19) Business Continuity Plans 

As novel coronavirus (COVID-19) diagnoses continue to increase around the world, Tempus is committed to providing a safe environment for our employees and ensuring business continuity, to the best of our abilities, in service to you, our customers and partners. We are confident that coronavirus will not significantly impact Tempus' platform and service. Thank you for your continued trust in us. 

With the rise in diagnoses, we are taking increased measures to maintain business continuity and protect the health of our employees. 

We are currently taking the following measures of precaution: 

  • We have canceled all business travel and recommended that our team avoids non-urgent personal travel as well. 

  • We are only accepting the minimum number of visitors to our offices and have canceled all planned events, parties, meet-ups, and conferences. 

  • We have shared best practice health tips with our team and continue to keep them updated daily. 

  • We have placed extra hand sanitizing stations around our offices and increased the frequency of office cleaning. 

  • We have reduced on-site interviews to a minimum, proceeding with video interviews instead. 

  • While we continue our work as usual, we are preparing for different scenarios, including the possibility of our entire team working remotely if required. As a private cloud-based Service company with an extremely strong infrastructure, we are prepared to manage business continuity challenges virtually. We anticipate no impact to our service and believe in our ability to keep services running and expanding as usual, with no interruption. We have ensured that our team members have whatever they need to work remotely if needed and to continue doing their jobs securely. We have increased channels of internal communication, and as always, prioritize communication with you, our customers, so you can remain focused on your business challenges and goals. 

  • We will continue to meticulously monitor news from WHO/CDC, among other sources and guidelines, and are committed to reassessing the situation and adjust our plans accordingly. 

We wish you all good health and thank you for continuing to place your trust in us. Please do not hesitate to reach out with any questions or inquiries.  

A New Era in Bodily Injury Claims Handling:

Capturing Effectiveness and Efficiency

What seemed impossible a few years ago has now grown into a best  practice for most auto carriers – the direct to provider (DTP)  settlement model for unrepresented bodily injury claimants. The once revered “lump sum” model is rapidly being replaced by DTP. The number and scale of the carriers making the shift is significant in an industry where core claim handling models rarely change. In fact, until recently, most early settlement units were operating the same today as they were thirty years ago. So why and how has DTP replaced the lump sum settlement model we used for so many years?  

The “why” is easy – DTP achieves the desired “trifecta” in cost containment: happy claimant, happy provider, happy adjuster. Carriers learned that the key to improving the claimant experience is making the process easier for the claimant, which includes handling the task of paying the providers. In addition to the customer experience, carriers can benefit from a discount off billed charges from many providers, previously unavailable under lump sum. Providers are open to discounting  the billed charges for a quicker, certain reimbursement from an institutional payer (carrier) as opposed to a claimant who may take longer or not pay at all forcing costly collections. The adjuster is happy after creating a positive claimant experience, a settled claim with the same cycle time, and reduced specials severity with no conflict. 

The “how” was always the challenge for carriers. For years adjusters have used some form of “do it yourself” approach with DTP, particularly on the larger hospital bills. But this situational use of DTP was difficult to scale because of the inefficiency of higher paid, professional adjusters making multiple calls to providers, in addition to their normal workload. Consequently, programs lacked penetration on most bill types and never moved the needle on medical specials severity or pure loss ratio. Some carriers opted for a hybrid model approach and used DTP without negotiating discounts with providers. This improved the claimant experience and kept adjusters off the phone with providers, but did nothing to reduce severity.     

At Tempus we saw an opportunity to solve the scalability challenge by creating a solution that has the severity reduction benefits of DTP with the efficiency of the lump sum model. The result is our TempusDirect solution. 

TempusDirect solves the scalability problem because it is effective on facility and professional service bills. While professional bills can be challenging, reducing them is critical to a successful program as they make up the majority of a claimant’s specials. TempusDirect differentiates by outperforming on the entire range of bill types, from ER Physicians and chiropractors to large hospital bills. 

Our goal was to make TempusDirect as efficient as the lump sum model it replaced. Importantly, we wanted to align our product innovation efforts with what we observed the most innovative carriers doing with claims models and segmentation. Carriers continue to split the process v. professional components of the adjuster’s role. This optimizes the time and talents of adjusters to evaluate, negotiate and settle with the claimant, and removes process-oriented work by sending the medical bills to a central repository for review, provider negotiation and payment. TempusDirect aligns with the process v. professional task split, and for the many carriers that aspire to achieve that segmentation now, TempusDirect is capable of retrieving, discounting and paying the provider directly, leaving the adjuster free to handle core claims work. 

Our Tempus Promise is “always listening, innovating and serving with a sense of urgency.” We recognize that cost containment is dynamic and  that state regulations and the behaviors of providers and attorneys are always changing. Our solutions are built to last because they are built to evolve. We never stop innovating and stay one step ahead because this business is our passion and we live this Promise every day.