CLAIMExpert

CLAIMExpert is an automated claims processing platform offered by APS (Adaptive Processing Solutions), designed to streamline the claims management process for workers' compensation and auto casualty claims. This solution is suitable for a range of companies, including national and regional insurance carriers, self-insured/self-administered organizations, third-party administrators (TPAs), and managed care companies. Professionals and industries in the insurance sector, including insurance carriers, self-insured companies, TPAs, and managed care companies, can benefit from CLAIMExpert's advanced features and tools.

Key Features

Automate the Entire Medical Bill Cycle: According to the vendor, CLAIMExpert offers a fully integrated paper-to-electronic and eBill solution for automating the entire medical bill cycle. It combines end-to-end solutions and innovative technology to enhance workflow and potentially save costs.

Reduce Medical Spend by 21%: CLAIMExpert provides flexible and effective claims processing solutions that the vendor claims can help reduce medical spend by 21%. By automating the medical bill cycle, CLAIMExpert aims to optimize adjuster effectiveness and maximize network coverage and vendor transparency.

Maximize Adjuster Effectiveness: CLAIMExpert aims to automate routine tasks, freeing up adjusters to focus on complex decisions. According to the vendor, adjusters using CLAIMExpert can potentially close medical claims over 50% faster, resulting in improved adjuster effectiveness.

Close Claims 10% Faster: CLAIMExpert's automation and workflow management features aim to enable adjusters to close claims 10% faster. The system aims to streamline the claims management process, ensuring that claims stay on track and are resolved efficiently.

Dashboard: CLAIMExpert offers a customized dashboard that allows users to monitor data and generate reports. According to the vendor, the dashboard provides real-time insights into claim-related information, helping users make informed decisions.

ODG Integration: CLAIMExpert integrates with MCG Health's Official Disability Guidelines (ODG) to provide evidence-based guidelines for claims monitoring. According to the vendor, leveraging ODG integration can help adjusters achieve better outcomes on their claims by applying best practice guidelines.

Rarity and Relatedness Ruleset: CLAIMExpert includes a rarity and relatedness ruleset to generate efficiencies and potentially reduce medical spend. The ruleset aims to identify bills that are not appropriate for payment, potentially saving time and money.

Reporting and Analytics: CLAIMExpert provides comprehensive reporting and analytics features to help users make informed business decisions. According to the vendor, real-time reporting allows users to monitor key metrics and track performance.