Solutions for:




Solutions for MGAs/MGUs
PTS Workers Compensation Software for Insurance Carriers, MGUs and MGAs is a secure, scalable and highly configurable solution supporting the full Workers Compensation value chain; from application processing, underwriting, policy administration, premium billing, accounting, statutory compliance, reserving and financial reporting. Transactions in all 50 states are supported, leveraging the robust features of the Commercial Lines Platform.


  • Supports voluntary and residual markets
  • Rating plans generated from configurable and easy to modify rating tables
  • Facilitates rating across different states, rate sets, rating tiers and rating algorithms
  • Allows multiple ‘exposure units’
  • Generates multiple rates per application based on different guaranteed cost or deductible plans
  • Supports accompanying coverage including USL&H, Maritime, Voluntary Compensation, FELA and others
  • Fully supports NCCI rates and all state-specific taxes and surcharges

The PTS solution is designed to handle the business of regional, national or niche carriers. Features include workflow, document management, task calendaring and a full set of business analytics and other state-of-the-art tools.

Underwriting

  • Generates multiple rates per application based on different WC plans such as guaranteed cost, deductible
  • Supports accompanying coverage such as USL&H, Maritime, Voluntary Compensation, FELA and other
  • Handles underwriting for:
    • Multiple or multi-state locations
    • job classifications
    • Payroll
    • Loss history
    • Additional coverage
    • Other pertinent data (e.g., including or excluding coverage for officers, owners)
  • Supports taxes and surcharges
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Policy Administration and Management

  • Policy issuance and endorsement
  • Policy renewals
  • Policy cancellation and reinstatement
  • Payroll management
  • Agency information management
  • Supports WCPOLS, WCSTAT, URE, DCI reporting
  • Alerts and notification groups
  • Customer portal
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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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Service Billing

  • Maintains service billing customers
  • Maintains billing service codes and rules
  • Maintains billing structure, including billing company details, service codes and rules
  • Generates line item extracts for review and final adjustments
  • Prints final invoices and automatically updates AR system
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Forms & Regulatory Correspondence

  • Generates claim related correspondence letters and required forms using a dynamic forms engine
  • Maintains full correspondence and form history for each claim
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Customer Portal

  • Supports customer submission of First Notice of Loss/First Report of Injury over the web
  • Enables customer access to on-line claim status view and enterprise reports (loss runs, injury list, claim status reports, more)
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Vendor Management

  • Maintains vendor database including claimant dependents and attorneys
  • Generates vendor 1099s
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Audit Processing

  • Supports multiple audit types, i.e., renewal, final and cancellation
  • Allows assignment of audits to internal or external auditors
  • ‘Remote auditing’ feature allows external auditors to receive audit assignments, schedule audit visits, enter detailed audit information and transmit audit information for processing
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Statutory Compliance & Financial Reporting

  • Increases business productivity and ensures compliance with the latest US regulations
  • Supports EDI transactions to States and insurance regulators
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