Capabilities and Features

The following is a list of some of the features and capabilities of ProClaim:

» Web-based system, requires zero deployment. Interfaces with all processing systems including PowerMHS and Facets.
» Queue based distribution. First in, first out.
» Grouping of queues into "goals", user-configurable, to meet check run deadlines. Goals are assigned to examiners systematically.
» Assignment of claims to examiners based on skill sets.
» Assigned goals crossed with skill sets present the mathematically optimal claim to an examiner's desktop to minimize interest penalties.
» Real-time feedback of examiner performance and inventory changes every five minutes.
» Quickly make changes to your entire claims department with the click of a button when an emergency arises.
» Provides complete audit trail of all activity within the system, everything time stamped with the users who operated on the claim.
» Sharing of work across departments, or geographic locations at the touch of a button. Multiple departments can share the same queue.
» View inventory and performance with "Tree-based" reports, in the context of your organization's hierarchy. Monitor subordinates progress.
» Processing alerts attach to qualifying claims so that important alerts are presented to examiner alongside the claim. Lessens examiner burden.
» Every aspect of ProClaim is configurable, from the ground-up. The unique SQL based configuration model eliminates the need for expensive programmers.
» ProClaim performs its daily inventorying and distribution activities automatically. Relieves this burden traditionally performed by supervisor.
» Deliver desk procedures to the desktop for the suspension codes that exist on the claim.
» ProClaim works with multiple processing systems. Provides a single, consolidated view to monitor suspended claims activity across the enterprise.
» Ability to view claim activity in "non-claims" areas such as Enrollment or Provider services
» Easily segregate claims out of claim population when necessary to prevent examiners from receiving them.

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