The workers' compensation marketplace is faced with unique and complex challenges when it comes to claim processing. Keeping up with regulatory requirements, CPT codes, and changing fee schedules can cause even the most experienced claim adjuster to become overwhelmed.

To further complicate matters, the workers' comp arena is no stranger to consolidation. In recent years, the marketplace has seen many mergers, including Coventry's acquisitions of Focus and First Health. Mergers, combined with rising medical costs, have led to an increased interest in specialty managed care companies. This creates mosaic-like workflows with multiple PPOs, specialty networks, and managed care companies each handling a piece of the workers' comp puzzle. For claim adjusters, this means increasingly complex vendor management responsibilities on top of existing challenges.

In addition to this list of moving parts and parties, insurance companies, third-party administrators (TPAs), and employers are dealing with antiquated legacy systems. Companies continue to rely on claim adjusters' manual assessments to accurately process claims and to compensate for the limitations of their current systems. This includes confirming the accuracy of CPT codes in relationship to the approved, compensable injury, adhering to the appropriate state regulations, and providing the correct documentation to each involved party. The result is a tedious, time-consuming process.