Insurers use Colossus to make unfair settlement valuations, now ZEUSclaim is on your side!
The guidelines for processing private health insurance and Medicare claims differ drastically from personal injury and auto accident claims. In fact, the data required is so different that medical experts need two different electronic health records.
Insurers hired consultants who created “Business Process Improvement” which included the development of “Colossus”, the first software program that insurance companies use today to evaluate bodily claims. Unfortunately for the injured, the software is based on their own set of guidelines.which is not the same as the private insurance or Medicare guidelines that physicians use, and has this has led to lower settlement valuation.
Doctors, lawyers and injured parties are at a severe disadvantage as standard medical record and documentation systems based on private insurance and Medicare guides are not designed to exchange full data for valuation into Colossus.
The Consumer Federation Of America published a recent report stating: insurance companies make broad-scale “lowball” claims’ payments to injured consumers that are less than what they should receive under their insurance policies. http://www.consumerfed.org/pdfs/Studies.ComputerClaims06-04-12.pdf
An 18-month targeted National Association of Insurance Commissioners (NAIC) multi-state market conduct examination of Allstate’s claims handling practices, found the insurer software is “BIASED” and such “Tuning Bias” de-values injury claims.
This investigation was part of what resulted in Allstate agreeing to pay a TEN MILLION DOLLAR ($10,000,000.00) Regulatory Settlement.
These Decision Point codes are used by auto insurers but are not part of private insurance or Medicare guides:
- 10,720 “Decision Points”
- 14,357 “Value Drivers”
- 27,125 “Severity Drivers”
- 26,350 “Standard Multipliers”
- 33 “Liability Drivers”
- 15 “Additional Increase Multipliers
- “Case Maximizers”“
- “Injury Severity Points”
- “Prolonged Modifiers”
The formula used by insurers to determine settlement valuation is called: “The Point To Dollar Translation Percentage Multiplier”.
This is a process of determining the settlement value of claims by translating the Decision Points into settlement dollars based on each insurers rate and formula.
Furthermore, the insurance companies’ software assigns different codes and values in the following categories:
- Injury Severity Types & Effects (26 codes)
- % Whole Person Impairment (represents high value)
- Duties Under Duress (60 codes)
- Loss of Enjoyment (60 codes)
- Administrative Codes
- Legal Codes
- Liability Drivers (33 Drivers)
- Economic Codes
To incorporate these codes in BOTH the doctors records as well as mirror them in the attorney demand letter, we have created the ZEUS System so when doctors and lawyers use ZEUS, they are able to present the insurer codes in the correct terminology, format and sequence to interface and input value into a Colossus claim.
Zeus assembles the insurer codes in both the medical and legal records on injury claims.
Physicians should refrain from using record systems based on government “Center For Medicare Services” guidelines on their injury patients as they are not able to provide a sufficient exchange of insurer Decision Points to convey and input data into an injury claim.
Data is missing or interpreted differently, collaboration is limited; it takes longer to communicate with insurers and is not efficient. Exchanging data can be a challenge due to the difference between private and Medicare insurance guides and Colossus guides, language barriers, different specifications of formats, sequencing and varieties of categorizations that differ from the private and Medicare systems.
ZEUS should be used in injury cases to counter Colossus by identifying the Decision Point and ‘Value Driver’ Codes in both the doctor’s documentation and lawyer’s demand letter to assemble the points in the correct terminology, format and sequence to exchange information, interface and input added valuation into a Colossus claim.
Simply stated; if the attorney or physician do not incorporate these codes and factors, the ‘windows’ of the insurers’ software’s do not open and compensation associated with these injuries and factors is lost.
Zeusclaim is a physician record system for patients injured in auto accidents and Zeusdemand is the legal system for the plaintiff attorney. When used, the Zeus injury claim system will assemble the maximum amount of decision point codes to open the value (dollar) windows and increase the settlement valuation.
We have created Zeusclaim medical and Zeusdemand record systems for both physicians and attorneys to document the complex medical, administrative, legal and economic factors of a Colossus claim and assemble them to exchange the factors and input added valuation into a Colossus injury claim.
GET THE HIGHEST, FAIREST SETTLEMENT VALUATION WITH ZEUS.
Use Zeusclaim electronic medical record (EMR) system on your personal injury cases. It works on any computer or iPAD application and is cloud based. Upload the VALUE DRIVER CODES, Decision, Validity & Severity Points to your computer and backup on our our server which stores the electronic file in a paperless application and converts your input notes into the medical documentation containing the value driver codes. Data is accessible at any time.
Use Zeusdemand CLAIM FINALIZATION AND DEMAND PRODUCER to assemble the administrative, legal and economic code factors of the claim and then the Zeus functionality will automatically bring the medical codes in to the demand to generate added valuation.
The Zeus system interprets the data, incorporates the codes, uses the correct phrases & terminology and formats the medical report and demand letter to exchange the data in the manner required to sequence with the insurance companies’ software and input the full code settlement valuation.
Zeusclaim and Zeusdemand have averaged an increase in settlement valuation by 4.5 times!
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