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Intake Process
The intake process supports Web, Telephonic, Fax and Paper intake, this process
requires many different types of paper and/or electronic forms. ClaimVantage provide
sample intake electronic forms for customers who have the option to design their
own form types. Initial eligibility can also be completed during intake process
depending on the claim type defined by the customer.
Assignment
When the intake process is completed the claim can be forwarded automatically
by the rules engine or the claim can be assigned to an Un-assigned Claims queue.
Claim Item
ClaimVantage has defined a Claim Type that supports multiple types of
data needed to support the claim process. A Claim Type could be an Image,
Correspondence, Notes and/or Case Plans. The claim types are stored in
chronological order to support the review process.
Case Management
ClaimVantage provides a generic Case Management tool together with To Do Activities
and Assigned Claim queue to manage data required to process the claim. Case
Management also includes the File Plan, this can be one or multiple plans supported
by the Claim Type. The File Plan can be designed by you to meet your specific
requirements, multiple plans are supported.
Claim Triage
The system can be shared by various resources that need to triage a claim and
make decisions when looking at the same data. This makes the decision making
process very effective as all parties can view the same data simultaneously.
File View
At any time during the claim process, the Claim Analyst can review a summary
of the claim. This view of the claim summarizes the current status of the claim
that can be viewed by various parties. An example of how this can be used is
when a Customer Service Representative (CSR) needs to provide information on
the status of a claim to a claimant over the phone or via Web access.
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