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Claims Advantage™ Product Suite

Claims Advantage™ is the most experienced and comprehensive, web based system to manage all aspects of illness or injury bills and claims management for insurance companies, TPA's, MCO's, self-insured and state fund employers, providers, and government agencies. No month end closes are required. All data is "as of date." So, reports can be run at any time to get an accurate picture of a claim at any time in the past. Always web based now for over 18 years. Large mirrored data storage. Uptime 99.999% over 18 years. IBM business partner.

Claims Advantage is designed for multiple lines of insurance including: workers' compensation, general liability, property, auto, professional liability, disability and more. In addition to the base features, Claims Advantage™ supports EDI (IAIABC) for State Reporting Requirements, document imaging, bill re-pricing, forms and letter generation for all jurisdictions as well as client defined. Our software is highly configurable and can be customized to meet any organization's needs. You can connect anyone any time, including providers and employers. If you are a TPA the employer connection can be branded to your logo and colors.

Our software empowers risk managers, claims managers, adjusters, insurance managers, attorneys, third-party administrators (TPAs), safety managers and other risk management professionals with comprehensive solutions that link their key risk, claims and policy data.

Features and Benefits to consider:
Web-Based: Our web-based technology empowers you to connect anyone at anytime securely allowing a completely paperless transaction between payor and provider, including payments. Providers can enter bills and see EOBs in real time. Employers and Providers can enter FROIs online. Providers can see authorizations, medical case management plans and attach any document to a claim via the web. MCM is done in real time and is paperless. Bills are repriced, clinically edited and adjudicated instantly as they are keyed in by a provider online.
Compensation: Single or automatic payments, expense payments, administrative payments, claim summary reports, forms by jurisdiction, garnishments, debit/credits. Automatic reserves, subreserves, electronic payments and much more.
Bill Re-Pricing & Review, Clinical Edits Extensive, customized and MCCI clinical edits. Case management authorizations automatically adjudicate bill line items, state fee schedules loaded, PPO’s, build a table of protocols and authorizations by Dx, CPT, Dx group codes. Auto build any UCR fee schedule by percent of Medicare fee schedule by region. Bills are input direct via the web, by hard copy through our data input center or via electronic file upload.
PPO's: 30 PPO's Loaded On System means instant bill re-pricing 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. Integrated imaging is so easy to use.
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.
Work Flow Rules & Job Queue: Set and design work flow rules with automatic reminders. Set triggers to automatically perform work flow processes. Manager overview of others workflow. Direct work flow to other employees
Reporting: Hundreds of reports may be run by many sorts, customized reporting and automatic data downloads. Reports emailed in PDF to clients or clients on line can run their own set of reports.
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 created and 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. Electronic payments and banking. Data file feeds to your ERP system or outsourced check printer.
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.
Data Input Center & Electronic Banking: Claim form & FROI hardcopy input center, cuts your costs dramaticily; HIPPA and URAC certification staff to help you obtain approval. Complete electronic banking, direct deposit and positive pay.
EDI to States: FROI, SROI, Bills IAIABC latest and other formats.
Insurance Reporting EDI: NCCI, INSCorp, others.
Policy Administration: Policy tracking, issuance, rating, and premium billing & collections. Financial trust reporting and administrative payments
Case Management: Case Management Time Billing and Collection. Customized medical case management plan formats. Connect to Case Managers within the cloud.