Medical Canvass Investigator
A MedTrac medical canvass is a survey of medical facilities in a specific geographical area to uncover WHERE & WHEN a claimant may have received treatment. The starting point is usually the claimant’s home address, but it can be equally helpful to search the area around the work address or even a prior address of the injured person.
Medical canvassing is designed to uncover pre-existing conditions and unreported medical treatment. This analysis can help determine if a claimant’s history of medical treatments is accurate, as well as help to uncover incidents of attempted fraud. Medical canvassing helps determine if the claimant received treatment prior to the accident, pinpoint whether injuries occurred outside of the workplace/incident, see if the claimant has a history of injury claims, and assess if the injury is actually related to the claim. Medical canvassing also helps determine whether the claimant has a history of injury claims and allows both claim handlers and attorneys to discover information to help verify legitimate claims/cases and uncover potentially fraudulent claims.
Canvassing assists all lines of insurance associated with any bodily injury claim. No matter the line of insurance involved, the key point of consideration is that at any time a claimant and/or their attorney may knowingly withhold information pertaining to a claimant’s medical treatment history. Often, claimants pick and choose what medical information is being shared. The ability to further validate or discover other medical providers involved in treating the claimant is always critical in evaluating the claim.
Once your request is reviewed and confirmed, our proprietary software will identify all medical facilities matching the criteria of your selected medical facility types, thus, building a list of medical facilities to be contacted and eliminating all “bad facilities” and duplicate listings. Then, our expertly trained medical canvassing analyst will begin the initial contacts of all medical facilities listed. Upon the completion of the initial canvass, additional QC protocols trigger additional calls or follow-ups for additional results. Finally, the completed canvass is reviewed and a final report is generated.
Getting effective, efficient, data-rich medical canvass reports with a fast turn-around time can make all the difference in a claim and help your claims team:
- Establish whether the claimant received treatment prior to the accident
- Reveal a possible history of injuries
- Determine whether the injuries were related to pre-existing injuries
- Confirm whether injuries occurred outside of the workplace
- Uncover undisclosed medical treatment
- Detect a pattern of drug-seeking behavior
- Substantiate a claimant’s statements
- Expose possible claim misrepresentations
- Provide specific information about treatments received for pre-existing conditions
What’s included in a MedTrac Medical Canvass?
- Demographic database pre-check to validate relevant information about the claimant
- Automatic workflow actions for critical canvassing events
- Provider identification that match the requested type and scope
- Radial maps and hyperlinks of data points
- Tools to assist with analysis & interpretation of information contained in the canvass report