Healthcare Advisor Series Product Suite

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Claims Advisor: Comprehensive Claims Management

The Claims Advisor™ module provides a comprehensive claims management tool for the effective and efficient processing of claims data.

Cloud + Onsite versions

In today’s litigious setting, proactive management of claims is crucial in controlling risk factors, and ultimately, cost. The Claims Manager must effectively identify all potentially compensable events, track details of the allegations, identify the various risk and financial consequences, actively manage the litigation process, identify and analyze high-risk/cost events, and implement ongoing measures for future risk prevention.

Claims Advisor ™ provides a comprehensive claims management tool for the effective and efficient processing of claims data, from the initial notice of a claim, through the adjusting and investigation stage, posting of reserves and payments, management of diaries and notes, to the final disposition and closing of the claim. It is integrated with DataTrk™ for the quick entry of initial claims setup data.

Powerful features include:

  • Hospital Professional, Physician Professional, General, Auto, Property and various other lines
  • Claim types/sub types/causes/location/injuries/severity levels/outcomes
  • Policy management for primary/excess/reinsurance layers built in
  • Location/Department/Service/Division/Specialties involved
  • Adjuster, plaintiff, defense attorneys, litigation details
  • Co-defendants, practitioners/personnel involved tracking
  • Record Requests, Interviews, Depositions, Expert Reviews
  • Transactional audit trail of claim financials for Valued As Of Reporting
  • Comprehensive Notes and Diary tool for ongoing claims investigation
  • Integration with MS Word for mail merging of standard letters/documents
  • Integration with MS Outlook for direct emailing of claim notes/follow up
  • File and/or scanned image attachments for paperless claims activity management
  • Detailed reporting via “point and click” screens and prompts
  • Analytical and Graphical reporting built in and integrated with MS Excel
  • Browse tool for “on-demand” browsing of claims data and exporting to MS Excel
  • On-Demand Data valuation – “As Of” claim reporting
  • Built In CMS Section 111 Data Capture & Full Reporting to CMS
  • Direct integration with Risk Advisor and Patient Relations Advisor

"We have used the RiskQual HAS™ system to successfully manage claims for our large multi-hospital health system and insured physicians for over 10 years. Their support services have always been excellent as well"

Health System, RI (Client since 1994)