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  • Claims Management

    High Performing Claim Managers    American Excess Insurance Exchange, RRG (AEIX) membership is comprised of sophisticated, not-for-profit healthcare systems with capable, highly qualified claims managers handling their portfolio of pending claims within a self-insured retention (SIR).

    AEIX Claims Scorecard Benchmarking    To help ensure consistent claims management practices across the RRG, members participate in a comprehensive review process conducted by professionals from Premier Insurance Management Services, Inc. (PIMS), utilizing a proprietary claims scorecard tool. The scorecard, developed jointly by AEIX members and PIMS staff, analyzes 31 different claims metrics and ensures that AEIX members maintain high reliability processes in the critical areas of communications, reserving, financial documentation, claims controls and technical management. The AEIX Subscriber’s Advisory Committee receives a summary scorecard report annually to discover any poor scores and to help PIMS develop action plans to improve performance. These plans may include on site consultation engagements by PIMS personnel to build out processes and provide education. To share best practices and enhance capabilities, PIMS provides in-depth discussions of each audit category during governance meetings.

    Results from the scorecard process demonstrate that all AEIX systems are meeting or exceeding expectations and have been improving steadily over the past five years.

    Mitigating AEIX Loss Exposure    AEIX members lead the governance committees, providing member-owned direction for the RRG. PIMS manages AEIX with specific emphasis on giving members a voice in operations of the company. Member collaboration has led to innovations in the audit protocol, policy language trigger, and multiple patient safety initiatives. In the latter area, AEIX and PIMS partnered to create and implement three highly successful and recognized improvement collaboratives focusing on emergency department and perinatal safety. For more information on these initiatives, visit our Promoting Patient Safety page.

    Management of AEIX by PIMS    Adverse claim developments at the hospital level can financially drain a healthcare system of capital not easily replaced in today’s competitive environment. In the face of rising costs of defense and higher losses paid nationally, hospitals cannot overlook the importance of evaluating their claims performance to ensure they are efficiently achieving the best possible outcomes. To assist you, PIMS employs attorneys and healthcare professionals with significant experience in managing professional liability (medical malpractice) claims.

    The PIMS professional team provides a wide variety of services:

    • Claim management of excess exposures above a members’ SIR, as well as providing assistance and advice on cases within members’ SIRs.
    • Claim department audits measuring capabilities across five important technical and financial competencies, providing metrics which may be benchmarked against peer hospitals.
    • Full management of claims and lawsuits from investigation of incidents to mediation, settlement, trial, and post-trial activities.
    • Consulting in the development of claim management systems and protocols for healthcare entities.
    • Providing education seminars and newsletters to help drive member performance improvement and adoption of best claims and litigation practices.

    For more about PIMS click here