Solutions for:




Solutions for Self-Insured
PTS provides the industry leading solution for Self-Insured Workers Compensation programs, supporting the entire claims processing cycle and other key functions, including:
  • Claims administration
  • Medical case management
  • Unemployment Claims
  • Benefit and expense payment processing
  • Customer service
  • Service Billing
  • Statutory compliance and financial reporting

Claims Processing

  • Rate calculator handles benefit/indemnity rates 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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