Over the last few years, New York has been implemented new reforms to increase the speed and efficiency of its claims process. In today’s Inside Workers' Comp, Dr. Lisa O'Connor, Genex's Associate Clinical Director, Utilization Review, tells us about one of them, OnBoard, New York’s new online web portal for processing workers’ comp claims.
Tom Kerr (TK): Lisa, thanks for joining us.
Lisa O’Conner (LO): It's my pleasure, Tom.
TK: So, first things first, why is New York developing this new OnBoard system?
LO: So, New York is really looking to modernize the work comp system, and they're looking to replace their traditional paper‑based claim system with a single web‑based platform. And they're doing that because they want to give the adjusters, physicians and claimants access to real‑time data. They want them to be able to use some self‑service features. They want to improve the overall system's responsiveness, so they're centralizing the process into one web‑based platform that everyone can access, no matter where they are.
TK: And how long has New York been developing the system?
LO: New York started the planning process in the summer of 2019. They have been slowly releasing information to us over the last year. They're really expecting three phases to this process, so the limited release of OnBoard is coming up in the spring-early summer. And then, they're going to be upgrading their entire e‑claim system later in 2021, and they expect the OnBoard system to be fully operational, fully released by 2023. So, it's quite a big undertaking.
TK: And what do these changes mean to how utilization review claims will be handled in New York?
LO: So once OnBoard is fully operational, everything is going to go through this platform, so we won't be receiving any requests from outside parties. All people involved in the work comp system are going to have to log into this OnBoard portal and do the work within the portal itself. So, we won't be getting forms and then faxing back to providers as we’ve done in the past. The board has developed several new online forms. They renamed all their forms, that are going to be more specific to the treatments being requested.
So, the system allows us to be an active piece of this as far as logging in and completing our work within the portal, and not outside of it.
TK: Does this mean there will be a significant difference in how New York handles claims as opposed to other states?
LO: Yeah, it's pretty different given that this is going to be just a singular portal. We have a lot of other states where we deal electronically with them — form submissions and that sort of thing — but there's not a centralized system like this where everybody involved is going to be accessing it. So, this is pretty unique right now.
TK: How is Genex preparing to be compliant with the new OnBoard system?
LO: Genex is attending all the seminars and instructional sessions that the board is hosting, and there’s been several so far. We've gotten a sneak peek of what it's going to look like and, based on that, we are crafting some materials for our account managers, clinical reviewers, and operational staff. And, as we learn more about the system, we'll be sending updates as the board continuously provides us with new information.
But the biggest advantage that Genex has is that we've been processing New York formulary work for a large number of clients, and this is already being done through a web‑based portal. And when OnBoard is fully fleshed out, the formulary piece is going to be rolled into the OnBoard system. So, we're already very familiar with how the board operates with the current formulary portal, and we think it's going to be very similar. So, we have an advantage since we've been exposed to how New York is thinking about web‑based care.
We also have a very large and diverse group of clients, and we've been doing formulary work since it began. This has allowed us to develop a good relationship with the board. They know us.
TK: And do you think the OnBoard system will offer significant improvements to the way claims are handled?
LO: I think that having a centralized location, especially a web‑based portal, to access information is great. I think it's going to reduce frustration among staff involved, whether that's physicians, claimants, claims examiners, or UR staff. And I think it's certainly a test that other states are going to be watching, because I think that moving towards these centralized systems is certainly very appealing. I think reducing the physical forms is very appealing as well,
The downside I can see is that if the portal crashes or is unavailable, which we've seen a couple of times with the formulary portal, that no work can be done. We're sort of at the mercy of the internet, which can be tricky when there's regulatory timeframes. But I think that the board takes this all into account. We work through these aches and pains with them. We give them feedback, and I think over time, it's going to evolve into something that really benefits everybody that's involved in the work comp system. But I think that's why they're starting with a limited release, to sort of ease all of us into this process and deal with those little aches and pains that are going to come up so that it can be tweaked for preparation for that full rollout taking place in a couple years' time.
TK: Do you see OnBoard as something that will help Genex speed up claims processing in New York?
LO: Yeah, I think it's going to be interesting because, similar to how the formulary works now, when we receive a notification that a review has been assigned, we'll contact our reviewer immediately, which will allow the reviewer to immediately jump on the portal and complete it. This helps as far as responsiveness on our end, because it simplifies things. Everything is already populated, so reviewers are just going to go in, complete their reviews in the portal, and they're done. So, it's definitely a nice process as far as that goes, because the system is doing all the intake work for us. All our records will be there to access, which will make our reviewers happy because it will allow them to just focus on making the decision. Once that decision is made, the adjuster will then get that notification on their own dashboard that the review has been processed, and that's it. So, I think it's going to really streamline the communication between all parties. The board is also trying to develop a chat system, giving users availability to chat with other people involved in this process. So, it's going to be interesting, for sure.
But yeah, I think it's going to really help us improve communication with everything being in that one location. There will be no dropped faxes or letters going to the wrong place.
Learn more on how Genex Utilization Review can accelerate delivery of appropriate care for your organization here.