To help insurance carriers keep up with the millions of medical bills processed each year, CCC continues to enhance first- and third-party casualty rule capabilities. The CCC Casualty Rules Engine is a big part of those enhancements, delivering faster bill processing for automotive casualty claims.
With a deep catalogue of data sources, codes and rules, CCC’s new rules engine helps insurance carriers further enable straight-through processing (STP) decisions through more robust analytics.
How the CCC Casualty Rules Engine Works
The CCC Casualty Rules Engine combines a strong foundation of content with a configurable rule set, enabling different simulations, outcomes, dedicated monitoring, and robust data and analytics. Together, this information is helping deliver greater transparency and informed decision making to insurance carriers.
Robust Rule Catalog
CCC’s configurable rule catalog incorporates regulatory rules, business rules, and customer data, providing insurance carriers with greater visibility into their chosen rule logic and outcomes.
Insurers can work with CCC’s implementation specialists to review, understand, and elect all available rule configurations, which will be systematically applied and returned to adjusters as the final reimbursement recommendation.
Carriers can configure CCC’s first- and third-party solutions to their specific needs. But, what if they also want to see “what-if” scenarios to understand all potential outcomes associated with an instance of a rule’s execution?
CCC’s data-driven rules will enable insurance carriers to adapt and test rule outcomes in parallel to production. They can set or exclude rules to streamline casualty billing review while taking advantage of regulatory and pricing guidance for additional recommendations.
Data & Analytics
CCC’s first- and third-party casualty solutions provide insurance carriers with a dashboard view of the carrier’s rules to better understand frequency, variance, ranking, dollar impact and other trends. These rule analytics help insurance carriers make informed decisions on whether to implement a rule as an edit (automatically applied), as a flag (alerting the adjuster), or not at all.
When it comes to applying pricing methodologies, some states have laws mandating certain reimbursement requirements. CCC Casualty monitors relevant rules and regulations by jurisdiction, updating values and rules based on customer input.
For example, in states that apply fee schedule pricing, reimbursements are recommended based on the state or jurisdiction’s specific fee schedule and the customer’s input.
For the non-fee schedule states, additional configurable options are available for reimbursement recommendations, including Preferred Provider Organizations, Out-of-Network Negotiations, Usual, Customary and Reasonable (UCR) pricing, Medicare benchmarking, Average Wholesale Price (AWP), Provider’s Billed Amount, and more.
Getting to STP
The CCC Casualty Rules Engine, paired with best-in-class analytics, is helping insurance carriers create an end-to-end data-driven process. The goal is to assist carriers in determining when manual intervention is needed, and to enable straight-through casualty claims processing when possible.
For first-party casualty claims, analytics can be used to evaluate if there is an opportunity for straight-through processing, based on customer configurations. For third-party casualty claims, visible edits and flags can let the adjuster know when manual modifications may be appropriate.
To learn more about the CCC Casualty Rules Engine, reach out to a member of the CCC Casualty team.