The Workplace Safety and Insurance Board of Ontario (WSIB) Tuesday said it will outsource its health claims and approval and payment system to BCE Emergis Inc. The amount of the five-year agreement was not disclosed.
Montreal-based BCE Emergis will develop a Web-based claims and payment system to process the about 300,000 workplace health claims the province generates annually. The back end of the system is scheduled to go live towards the end of the first quarter of 2002 and the Web portal will follow in July.
It will replace the 30-year-old processing system the WSIB currently uses where all claims are processed by hand, said Rob Timlin, project director for the provider bill approval project for the WSIB.
“We have a fairly poor record of turning around payments to providers and workers. What we’ve focused on here is trying to improve that service by trying to automate the process,” he said. With the current system outgoing payments may take 60 days or more, but the new system will adjudicate claims automatically and could turn around payment for the next day, he said.
BCE Emergis will manage the Web interface with the province’s 27,000 health and medical providers on behalf of the WSIB and also manage help desk and support functions. The WSIB will still manage about 20 per cent of claims manually — those that are too complex to be managed by the automatic adjudication engine and will have to be assessed individually, said Timlin.
The Web-based system will be able to generate detailed reports claims and recognize claim patterns, which may help cut down on abuse of the workmans’ compensation system, said Ron Loucks, executive vice-president of e-health solutions for BCE Emergis.
“We’ll be able to monitor that through some very sophisticated software,” he said. “These kind of anomalies will jump out in a reporting system that we’ve designed on behalf of the payers so they can look at situations that need attention.”
BCE Emergis has designed systems for two other compensation boards in Quebec and B.C., said Loucks, though not as detailed as the new arrangement it has with Ontario. BCE is aiming to sell the Ontario model to other provinces and in the U.S.
A similar model was deployed for insurance company customers like Clarica earlier this year to provide online solutions for the drug and dental market. BCE is making now headway in the extended health care arena like pharmaceuticals, chiropractors, physiotherapy, added Loucks.
