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Client Server Software: Medical Care Management
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| General Information |
Record necessary claimant demographic data, in addition to claim numbers, type, status and representatives. This Section also contains a claim contact “rolodex” and claim file organizer, automatically linking the user to all Office and imaging documents related to the claim. |
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| Accident Information |
Document general injury &/or illness data, in addition to cause, nature, body part, w/c claim and medical history, and key reporting information. |
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| Employment Information |
Includes vital wage, benefit, employer, occupation, employment history and job duties, in addition to a robust RTW tracking module. Track each disability by projected, guideline and actual RTW dates, describe restrictions, record date and RTW types, and calculate full or restricted duty days automatically. |
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| Insurance Information |
Links critical carrier, policy and coverage details to individual claims. |
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| Financial Information |
Retrieve bank and account defaults, set and edit reserves, issue single and recurring payments, record subrogation and recovery transactions. |
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| Settlement Information |
Document demands, evaluations, authorizations and agreements between all parties to the claim, including primary and excess insurers. |
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| Controvert Information |
Record benefit entitlement, denial dates and rationale, and rescind reasons. |
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| MMI & PIR Information |
Track Maximum Medical Improvement and Permanent Impairment Rating details including dates, body parts, guidelines and provider. |
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| Litigation Information |
Facilitate litigation management by tracking applicant and defense attorneys, filings, depositions, mediations and hearing outcomes. |
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| Medical Providers |
Whether directing care or authorizing treatment, this powerful feature quickly and accurately delivers meaningful medical provider information to the case manager. Conduct effective searches based on pertinent search criteria such as location, specialty, provider network affiliation and more. |
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| Medical Authorizations |
This flexible feature empowers case managers to authorize and track the treatment process at many levels; Providers and facilities, inpatient and outpatient, CPT codes and characteristics, frequencies and durations, lengths-of-stay and dates-of-service, initial and follow-up appointments. |
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| Medical Guidelines |
This feature places medical knowledge resources at the service of case managers at the time they are needed most. Utilize leading commercial guidelines and / or implement your own best practices in an easy-to-use automated fashion. |
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| Notepad and Diary |
Configure notepad topics and categories to increase time management effectiveness by integrating task, diary and Email functionality. |
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| Letters and Forms |
Database merge fields interface with user definable templates automating critical claim management correspondence and forms. |
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| Billing and Invoices |
The Billing Gateway enables organizations to establish product specific billing arrangements for each employer or insured, including global fees for service, flat fee per claim or claim type, milestone billing, in addition to time and expense capturing. The system also accommodates state sales tax, automated claim expense allocations, and the ability to generate and reconcile client invoices. |
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