Solutions for:




ClaimsExpert™
The PTS Workers Compensation ClaimsExpert™ module includes all of the configurability, workflow, document management and other features of our Commercial Lines Platform.

Claims Administration & Management

  • Includes configurable case management rules, workflow and task scheduling
  • Automated prompts, alerts and diary functions
  • Forms library includes regulatory letters and a correspondence management module
  • Customer portal
  • Vendor management tools
  • TPA and Self-Insured modules include tailored features and functions
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Claims Processing

  • Rate calculator handles benefit/indemnity rate per jurisdiction
  • Dynamic Reserves management; reserve calculator maintains multiple reserves types, including temporary, permanent partial, permanent total, medical and other expense
  • Calendar and diary functions maintain status and claim file notes
  • Maintains vendor authorization, drug & medicine authorizations, disability & rulings, litigation, and subrogation
  • Supports EDI transmission of FNOL/FROI and subsequent transactions to jurisdictions/states
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Claims Benefits and Expense Payment Processing

  • Supports both manual key entry and electronic payment processing
  • Auto Pay – enables automatic payment schedules for different payment types (i.e., TTD, PPD, etc)
  • Medical bills re-pricing using data feeds from medical bill re-pricing vendors or state specific fee schedule tables
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Data Exchange (XML Web Services, EDI)

  • Data mapping via web interface and the EDI transaction utility
  • EDI transactions to States and regulators
  • XML Web Services
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