Risk Predictive Early Referral Application (RPERA)

For customers seeking a more scientific and non-traditional approach to the identification of high-risk claims that might benefit from targeted case management, GENEX offers a Risk Predictive Early Referral Application (RPERA). The goal of the Early Referral is to identify high risk claimants for early contact and targeted case management intervention to reduce lost work time.

RPERA runs the First Reports of Injury (FROI) through a proprietary referral process. The FROI is checked against two years of historical claims data. The result is that each claim is assigned a Risk Score, based on a referral algorithm and criteria.

Claim Risk Scores are a GENEX proprietary analytic methodology that was formulated based on the characteristics of past benefit use that best predict future benefit use and cost risk. Claim Risk Scores are not based on total cost alone. They are also based on the frequency, duration, and types of employee benefits used, as well as the nature of the medical conditions for which workers received treatments. The Claim Risk Score methodology therefore accounts for both the severity and complexity of a workers’ medical and lost time benefit use.