The County of Los Angeles Expands Use of PCIS’ ClaimsVISION 

In Production Since 2015, the County Signs New Agreement for Claims Management and No Touch FROI/SROI Reporting, and Adds PCIS’ Vision Legal Module and E Compliance.

(Photo credit:BDS2006.)

The County of Los Angeles has signed a new contract expanding its relationship with PCIS (New York), according to the vendor. The County has been in production since 2015 with PCIS’ claims management suite ClaimsVISION. The County’s Chief Executive Office (CEO) Risk Management Branch uses the PCIS system to manage and oversee workers’ compensation claims for all employees of Los Angeles County, the largest county (by population) in the United States.

The mission of the County’s CEO Risk Management Branch is to evaluate significant Countywide risks, hazards and exposures; develop and implement risk management methodologies to fund, minimize or eliminate loss; and, advise the Board of Supervisors and Departments of risk control strategies to mitigate unanticipated financial losses.

The new contract expands the County’s use of ClaimsVISION’s automated E Compliance infrastructure with a new Financial Approval Hub, featuring auto-trigger integration to the County’s audit control system, a new Vision Legal module, the addition of County Counsel users, and EFT integration.  Key to the County’s utilization of ClaimsVISION is PCIS’ ability to achieve the County’s goal of 80 percent touchless payment transaction processing, driven by a complex network of business rules and auto-triggers.

Single, Centralized Workers’ Compensation System

PCIS’ ClaimsVISION currently serves as the County’s single, centralized workers’ compensation claims system to provide what the vendor describes as efficient, highly automated, and streamlined claims processing. ClaimsVISION centralizes the County’s claims administration operation, hosting over 900 users across four TPAs, interacting with more than a dozen third parties, and processing an average 27,000 open claims and 2,000 payments per day, PCIS reports. The PCIS system also acts as the hub for collaboration and coordination of data between the County, partner TPAs, PBMs, and MMCCs; requiring a unique infrastructure that allows for complex assignment, validations and approval rules, and affords the County the ability to rotate its roster of partners seamlessly.

Benefits that the County anticipates benefits from its expanded use of PCIS’ ClaimsVISION include the following, as described by the vendor:

  • Fully automated “No Touch FROI/SROI Reporting” to the State of California;
  • Direct CMS Medicare reporting;
  • Surpassing the 80 percent touchless payment transaction processing objective;
  • Deployment of Vision Legal, legal case management, adding County Counsel users;
  • A financial approval hub for enhanced payment and a vendor compliance audit control system.

“Our goal is to continually find ways and leverage the best technologies to improve our claims and compliance handling,” comments Steve Robles, Assistant CEO, Risk Management Branch, Los Angeles County. “We have been extremely pleased with PCIS and the system’s ability to provide touchless FROI/SROI reporting and to meet our gauntlet of financial reporting requirements in order to reach 80 percent touchless payment processing. When it came time to expand our case management capabilities and enhance our interface to Audit Control, PCIS was the obvious choice.”

“Our expanding partnership demonstrates the County’s success with and confidence in ClaimsVISION,” comments Georgette Loizou, Executive VP, PCIS.  “Through our joint efforts we continue to set the bar in the public sector with technological advances that leverage claims and risk management best practices.  Since its go live with ClaimsVISION, the County leads the state in No Touch FROI/SROI automation. With our latest modules, the Financial Approval Hub and Vision Legal, we are able to provide the next innovations in compliance and litigation management.”

Los Angeles County Consolidates Workers’ Comp on PCIS ClaimsVISION

Anthony R. O’Donnell // Anthony O'Donnell is Executive Editor of Insurance Innovation Reporter. For over a decade he has been an observer and commentator on the use of information technology in the insurance industry, following industry trends and writing about the use of IT across all sectors of the insurance industry. He can be reached at AnthODonnell@IIReporter.com or (503) 936-2803.

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