GOAL #2 Expeditious and Accurate Claims Processing
Goal: To process applications as expeditiously, accurately, and efficiently as possible so
that eligible victims may receive financial assistance promptly and in accordance with the
program's mandates and requirements.
Objectives
2. To train and manage staff to ensure high quality in processing applications.
3. To ensure that applications are processed consistently and in accordance with applicable statutes and rules.
STRATEGIES
Objective 1: To establish and improve processes that ensure the highest efficiency and productivity in processing
applications.
Basic Strategies
b. Study work flow and analyze how process can be improved by
eliminating wasteful actions and enhancing productive steps.
c. Assess procedures on a regular basis to maintain productivity.
Be sure to seek input from claims-processing staff on which
procedures are working and which should be changed.
d. Take advantage of available technology (computers and
automated application-tracking system) to the extent possible to
speed and facilitate processing.
e. Acknowledge receipt of each application with a letter to the
applicant as soon after receiving the application as possible.
Acknowledgement within 10 working days is recommended.
f. Make prompt requests of law enforcement, medical and mental
health providers, employers, and others for information necessary
to analyzing the application. Ask for responses by a certain date
or at least as soon as possible. Develop procedures for following
up with procrastinators.
g. Develop management tools and reports to measure accurately
how quickly applications are being processed by individual staff
and the program as a whole. A "monthly claims activity" report
showing total claims received and determined, with a breakdown
on each staff member's progress on assigned applications, is one
recommended monitoring tool.
h. Set and achieve a goal of processing the same number of
applications in a 12-month period as are received during that
period. In other words, if a program receives 1,000 applications
in one year, it should try to process at least 1,000 applications
during that same year. Status should be monitored monthly.
i. If facing a backlog, develop a strategy to reduce and eliminate
the backlog within a reasonable time frame. One recommended
strategy is to define the backlog as all applications currently
pending, and to process and eliminate those backlogged applications at the same time as new applications are processed. By this
means, the program establishes a definite and non-increasing
number of backlogged claims that can gradually be reduced, at the
same time that current applications are being handled at the rate
they are being received.
Advanced Strategies
b. Develop ways to expedite the processing of applications
involving emergency needs. If feasible, make use of law enforcement or prosecutor-based advocates to "certify" emergency need.
c. Develop ways to expedite applications requiring preauthorization for services.
d. Develop ways to expedite the processing of applications that
require little analysis.
e. Set and achieve a goal of less than 90 calendar days for making
a decision on the eligibility of each applicant and the expenses that
should be paid that applicant, counting from the time that an
application is received until the decision is made to deny or pay the
first expenses.
f. Set a goal for the time within which an application should be
analyzed fully and a recommendation of eligibility is made,
counting from the day the police or crime report is received. This
is a goal separate and in addition to the goal for processing an
application from the time the application is received; it focuses on
that portion of processing that involves the analysis of all the
information once it has been received, rather than the overall time
it may take to process an application.
g. Develop expertise among some staff members to handle specific
types of victims, such as seniors, non-English speakers, and child
victims.
h. Use an outside consultant to evaluate processes and productivity.
i. Seek direct linkages with police departments and state agencies,
such as Medicaid administrators, Social Security, and employment
services, to obtain on-line access to necessary information.
j. If calls from applicants and service providers regarding status of applications and payments is interfering significantly with processing efficiency, develop procedures to limit interruptions, such as assigning one staff person (or a small group in larger programs) to respond to calls; responding to status calls only between certain designated hours; or developing a means for service providers to gain on-line access to status information.
Basic Strategies
b. Orient and train staff to ensure understanding of the following:
o Program mission, mandates, and goals
o Eligibility requirements
o Benefits
o Process for analyzing applications
o Collateral resources
o Basic concepts and terms used by medical and mental health providers
o Basic issues relating to victimization, and service programs available to assist victims
o Criminal justice process
c. Train staff to communicate with and interact with victims and
service providers in a sensitive, professional way that facilitates
information exchange and promotes the purposes and image of the
program.
d. Conduct annual staff performance evaluations.
e. Recognize and reward superior achievement of individual staff
members.
f. Send staff to state conferences relating to victim issues, and to
regional and national conferences relating specifically to compensation, as resources allow.
Advanced Strategies
b. Consider rotating staff through different jobs to maintain
motivation and promote personal development of staff.
c. Establish performance measures for all processing activities, and
provide data to encourage staff to conduct self-examination of
performance and compare productivity to that of fellow employees.
d. Provide management training to managers to assist in managing
staff and directing program.
e. Develop written training materials for each staff person to aid in
orientation and training.
Basic Strategies
b. Establish ways that staff members can consult with each other
and management when they face problems in processing applications.
c. Convene regular meetings of staff to discuss changes in policies
and procedures, or problems in performing work.
d. Develop a checklist of work that needs to be accomplished in
evaluating each application, such as evaluating eligibility requirements and checking collateral resources.
e. Develop a method for reviewing and monitoring staff work in
processing applications, such as a quality review list.
Advanced Strategies
b. Develop process of peer review to allow staff the opportunity to review decision making of other investigators.