Technology & Tools Flashcards

Liability insurers paying settlements to Medicare beneficiaries use electronic reporting to CMS primarily to comply with:

Answer: Section 111 Mandatory Insurer Reporting under the Medicare Secondary Payer Act

Section 111 requires insurers to electronically report settlements and payments involving Medicare beneficiaries.

Which technology creates a shared, tamper-resistant ledger that could let multiple insurers verify claim transactions, such as subrogation payments?

Answer: Blockchain

Blockchain records transactions in a distributed ledger that participants can trust without a central intermediary.

An application programming interface (API) helps a claims organization by:

Answer: Allowing different systems, such as a vendor repair network and the claims platform, to exchange data automatically

APIs connect separate software systems so data flows between them without manual re-entry.

Text mining of adjuster notes is especially useful for:

Answer: Detecting words or phrases like 'attorney' or 'surgery' that signal rising severity

Text mining scans unstructured notes for indicators that a claim may escalate, supporting early intervention.

Which practice best protects claimant personal information when adjusters work remotely on laptops?

Answer: Using encryption, multifactor authentication, and secure company networks

Encryption and multifactor authentication reduce the risk of unauthorized access to sensitive claim data.

In workers compensation claims, wearable devices are increasingly used to:

Answer: Monitor injured workers' activity and support return-to-work and rehabilitation progress

Wearables can track movement and rehab compliance, helping manage recovery and return to work.

Before relying on a vendor's AI model to recommend claim settlement values, an insurer should most importantly:

Answer: Validate the model's accuracy, understand its key inputs, and keep human oversight of decisions

Insurers remain responsible for vendor tools, so models need validation, explainability, and human review.