CLARA Analytics, the leading provider of artificial intelligence (AI) technology in the commercial insurance industry, announced the release of CLARA Optics, which uses AI and machine learning to scan, sort and analyze bills and medical documents to create a claim-based medical record. CLARA Optics not only lowers claims operating expenses but also drives better medical outcomes for commercial claims with deep insights and alerts. CLARA Optics is the latest generation of CLARA’s medical record product, formerly called Treatment Summary. Optics automates medical records transcription, extracts and organizes important details about each claim, and makes that information available to adjusters and nurse case managers (NCMs). This enhanced version adds intelligent alerts and analytics to better equip claims personnel to respond proactively to changes in each case.
“Claims managers have to grapple with a mountain of details,” said Tom Warden, Chief Insurance and Science Officer at CLARA Analytics. “It’s virtually impossible to keep tabs on every bit of new information that comes along. Our AI technology separates the signal from the noise and discerns what’s actually meaningful. With the new alerts and analytics added to Optics, it is a whole lot easier for overburdened adjusters and NCMs to stay on top of things.”
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CLARA Optics combs through case records and applies advanced algorithms to discern the most relevant information. It then compiles case summaries for adjusters and NCMs, empowering these claims professionals to come up to speed very rapidly on each case. Summaries are constantly updated and revised to reflect the most recent events, eliminating the need to pore over thousands of pages of detailed records. CLARA Optics reduces risk by ensuring that important case details are not overlooked.
CLARA’s Optics module continuously scans cases for changes that could materially impact each claim. It then alerts adjusters and NCMs whenever a predetermined risk threshold has been exceeded or when important new details emerge. If an injured worker makes multiple visits to an emergency room or urgent care facility within a short period of time, for example, that might be an indication of significant complications in their case. Optics can raise an alert to the claims manager, notifying them of the situation so they can respond proactively.
A Wide Range of Alerts
CLARA Optics now includes a wide range of pre-configured alerts, including the use of a new ICD code in a patient’s case, new visits pertaining to a claim, gaps in treatment, the use of catastrophic ICD codes, or the application of unusually high-cost treatments.
Alerts are also provided whenever new information about a worker’s claim indicates a possible change in status. When an injured employee has improved to the point where they meet or exceed ODG guidelines for returning to work, for example, a notification is sent to the case manager.
CLARA Optics enables claims professionals to get straight to the facts, quickly understand each case that comes before them, and rapidly respond to new information. As each case progresses, it empowers adjusters and NCMs to address any relevant changes in the claimant’s condition promptly and effectively.
Optics is built on CLARA’s award-winning AI platform, which offers a comprehensive set of tools to help workers’ compensation insurers reduce medical costs and improve outcomes for injured employees. CLARA applies AI and machine learning to analyze both structured and unstructured data, perform contextual analysis with natural language processing, and develop forecasts and recommendations for claims managers. CLARA has a strong record of proven ROI, aiming to achieve positive returns for their customers within just six months of go-live.
“One of our company’s stated commitments is that we always go the extra mile for our customers,” said CLARA CEO Heather H. Wilson. “With Optics, we’ve stepped up our game with new alerts and analytics that make a very real difference in the effectiveness of claims adjusters and a real difference in the lives of injured claimants. Our customers have better visibility into claims than ever before. They’re getting more accurate information, and it’s showing up faster. We pride ourselves in the fact that we combine AI technology leadership with deep expertise in insurance claims. That combination enables us to deliver outstanding ROI for our customers.”
CLARA’s Optics module is priced on a per-page basis, allowing adjusters and NCMs to revisit case details as often as they like, without incurring additional costs for new reports. As additional information becomes available, pertinent case details are automatically captured and updated, giving claims management professionals vastly improved visibility to important changes as soon as they happen.
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