ClaimsAssistant for Windows - Features

ClaimsAssitant Main Work Space

ClaimsAssistant Intake
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Claims/Case Intake

Streamline your claims process with ClaimsAssistant. It is a comprehensive system with the following features:

  • Claims Data

    Captures full details of the claimant information and all relevant details about the claim
  • Automatic Benefits Calculations

    Automatically calculates benefits for medical and dental expenses, counseling costs, funeral or burial expenses, personal property damage, and lost wages or support based on a state’s maximum award -- Providing consistent calculations across the organization.
  • Automatic FT/PT Case Assignments

    Automatically assigns claims according to each staff member’s workload, thereby optimizing productivity levels and keeping knowledge workers happy.
  • Duplicate Alerts

    Detect duplicate claims.
  • Fraud Alerts

    Built-in detection alerts about possible fraud activity.
  • Link Cases

    Track linked and related cases.
  • Case Notes

    Collaborate using case notes.
  • Case Summaries

    Generate case summaries to present to the Board or other approval entities.
  • Checklist

    Manage case quality by having knowledge workers complete a checklist before moving a case in the workflow.
  • Multiple Claims

    Respond to a claims inquiry without having to stop and close a current claim.
  • File Attachments

    Attach any file such as image, audio, or .pdf to support a claim.
  • Tasks

    Flexible task engine allows knowledge workers to easily manage their daily tasks.
  • Bar Code Scanning Support

    Scan and store all documents in a central database.
  • Search a Claim

    Locate claims by case number, staffed assigned, case status, date of incident, name, birth date, and SSN of victim, or claimant, or offender.


Easily generate notification letters using ClaimsAssistant through its seamless integration with Microsoft Word

  • Create letters by type such as claimant, service provider, agency or awards. Letters can be scheduled for batch printing.
  • Letters are customizable with your organization’s logo & address information.
  • Generate reminder letters to providers, agencies, and claimants about missing information.
  • Track letters sent and received in a log, and track overdue letters.
  • Choose from 200 plus letter templates built-in.

ClaimsAssitant Letters

ClaimsAssitant Admin and Security

Admin Management/Control & Security

Administrators can simply manage ClaimsAssistant claims software without any customized programming.

  • Group Editor

    Manage users and groups with defined privileges and permissions. Hide/Show fields according to permissions.
  • Auditing/Logging

    Detect and prevent fraudulent claims with detailed logging and alerts.
  • Calculation Rate Editor

    Allows you to maintain benefits caps for the fiscal year. Different caps can be maintained by separate fiscal years.
  • Code Editor

    Provide flexibility to add codes and change descriptions as needed.
  • Re-Assign Case Status

    Change case status for a series of case files or certain number of files.
  • File location

    Change file locations for a series of case files or certain number of files.
  • Branding

    Customize letters and reports using your organization’s logo and brand.

Finance Integration

ClaimsAssistant can integrate with an in-house accounting system, and generate award payments on a claim. Payment data are in XML format.

  • Stand alone finance module for secured access only for finance users.
  • Allows for seamless integration, making payments to claimants and providers much faster.
  • Track funds and cost centers associated with paying certain expenses.
  • Pay loss of earnings or wages monthly through the protracted payment process.
  • Currently interfaces with PeopleSoft and SAP. Automated process to reconcile checks, saving time from manual entry.

ClaimsAssistant - Finance module

ClaimsAssistant Document Imaging Powershell

Document Management and Imaging

Documents such as provider bills and police reports can be scanned into ClaimsAssistant so the entire staff can share the documents and go paperless.

  • Store all documents electronically in one central database.
  • Allow your IT department to develop business rules in Microsoft Powershell for greatest flexibility.
  • Link scanned documents such as bills directly to an expense.

Medical Exam Reimbursement Management

Track claims payments submitted by medical providers and agencies for sexual abuse examinations.

  • Allows for seamless integration, making payments to claimants much faster.
  • Track and manage the CPT codes for tracking exams.

ClaimsAssistant Exam Reimbursement Management

ClaimsAssistant Restitution

Restitution & Recovery

Track offenders and documents such as provider bills, police reports, etc.

  • Track checks paid and balances in the system.
  • Track offender status

Legal and Supplemental Management

Process claims appeals, decisions and supplemental payment for awarded decision.

ClaimsAssitant Legal

ClaimsAssitant Reports

Federal Compliance Reports

Powerful and professional reports that meet federal compliance reporting guidelines

  • Use Crystal Reports or any reporting tool to create custom reports.
  • Choose from 40 plus standard reports included.

ClaimsAssistant Web API

Empower your Information Technology group to integrate with ClaimsAssistant using its Web Services API

  • Accept on-line applications and submit it directly into the ClaimsAssitant database.
  • Through an on-line portal, allows users to upload files directly and attach it to the case.
  • Allow your IT department to develop using their tool of choice, whether it be Java or .Net.

ClaimsAssistant Web API

See what ClaimsAssistant can do for you.