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Property and Liability Claims Management
Now your brokers, agents and clients at remote locations can have instantaneous access to property and liability claim information.
Claims Advantage™ is the first web-based application to manage all aspects of property and liability claims processing. Online, real-time connectivity allows agents, brokers and users to review policy information and access claim data instantaneously. The P&L module is fully integrated into the Claims Advantage™ product suite allowing for the processing of claims across all lines of insurance.
The P&L module is a fully integrated property and casualty claims management and payment system that is securely accessed over the Internet. Operating our own network of data centers, powered by IBM, the P&L module enables insurance companies, TPAs, and self-insured, self-administered companies to access injury reports and bills, view their EOBs and post treatment plans for claimants on-line.
The P&L module streamlines all of your data transfer and review processes while providing connectivity from anywhere in the world. The system makes claim reports instantly available for claims management personnel, including medical case managers, at any location. Depending on company protocol, the first report of loss or injury can be initiated on-line and authenticated by required supervisors.
Key Features To Consider
- Flexible master files to adjudicate any type of property and liability claim
- Fully integrated to the Workers Comp and Group Health modules
- Manage individual claims associated with a general occurrence
- Track claims by claim number, occurrence number, insured, accident location, claims adjuster, claims rep and more.
- Generate data by claim or all claims associated with an occurrence
- Adjudicate claims against policy data, verify coverage, deductibles, copays, and policy type
- Track witnesses, attorneys, and legal data
- Integrated electronic documents indexed to claim
- Medical bills re-priced
- Electronic banking, check writing
- ISO reporting and NCCI reporting
- Reserving, subrogation, litigation, schedule of autos and properties
- Easy reporting
- Integrated electronic forms, fax and email
Additional System-Wide Features
| Web-Based: |
Our web-based technology empowers your Workers Compensation
bill review process with up-to-the-minute information on claims,
providers, payments, databases, tables and schedules ensures
your bill re-pricing will net the absolute maximum savings
allowable. |
| Compensation: |
Single or automatic payments, expense payments, administrative
payments, claim summary reports, forms by jurisdiction, garnishments,
debit/credits. |
| Bill Re-Pricing & Review, Clinical Edits |
Extensive, customized and MCCI clinical edits. Case management
authorizations automatically adjudicate bill line items, state
fee schedules, PPO’s, build a table of protocols and
authorizations by Dx, CPT Dx group codes. Auto build any UCR
fee schedule by percent of state Medicare/Region. |
| PPO's: |
30 PPO's Loaded On System plus a National Pharmacy PPO |
| Case Management/ URAC Accreditation: |
Authorizations, utilization review, procedure tracking, cost
savings tracking for all aspects of care, notes by type, work
queue diary & calendar, fax & email from system, forms
generation, letter generation and auto entry to notes. Can
be used for Group Health claims management. |
| Plan of Care: |
Multiple plans by Dx with begin & end dates, customized
assessments, 30 day return to work, RAW medical plan, etc...
Conforms to URAC data collection. |
| Utilization Review: |
Tracks outcomes and savings by admissions, automatic review
for cases flagged. Can also be used for Group Health claims
management. |
| Reporting: |
Hundreds of reports may be run by many sorts, customized
reporting. |
| Data Downloads |
Run presorted data downloads to use with any report writer,
auto downloads encrypted files and selected data to your local
drive for import. |
| Forms Management: |
Any form printed on plain paper at any printer with system
data merged on to form. Date and time of form generation captured
to notes file. |
| Check Printing: |
Select pay from account by parent, group, employer, or by
type of payment. Medical checks batched by provider by employer
with EOB attached or additional forms printed, collated forms
on printer using several paper draws, copies of checks, no
preprinted checks used, use most any existing printer,
secure, any number of accounts and checks, outsource and more... |
| Document Imaging, Email & Fax Fully
Integrated Into Applications & Work Queue |
Work flow, audit trail, routing, notes, stamps, email & fax.
Fax images, forms, and reports in text or PDF format, directly
from system. Capture fax and email transactions into notes
file automatically. Internet email from the Claims Advantage™ System has
your company reply to email address. |
| MODM (Measure Of Disability Management): |
Return to work benchmarks by Dx code, work class code, gender & age;
reports, on screen queries and automatic work queue notification
when close to well managed RTW benchmark. Helps you measure
case management effectiveness. |
| Pharmacy Benefit Manager: |
Saves 15 - 40% off of state fee schedule, no effort on customer
part, all pharmacy data captured on Claims Advantage™ system
for approval, authorizations faxed directly out of system to
Pharmacy. You pay only if you save. |
| Electronic Banking: |
MCO centralized claim form & FROI input center, cuts
your costs; HIPPA and URAC certification staff to help you
obtain approval. |
| EDI to States: |
FROI, SROI, Bills IAIABC format. |
| Insurance Reporting EDI: |
NCCI, INSCorp, others. |
| Policy Administration: |
Policy issuance, rating, and premium billing & collections.
Financial trust reporting and administrative payments |
| Case Management: |
Case Management Time Billing and Collection |
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