The AdjusterPortal is a suite of client-configurable modules built for quick and efficient adjudication of medical bills by claims adjusters. With the portal, claims adjusters are empowered to quickly review, edit, approve, or deny medical bills using a well organized and intuitive interface. Utilization Review (UR) decisions are enhanced through evidenced-based medicine (EBM) tools that measure disability duration and benchmarking data covering every reportable condition for workers’ compensation cases. The combination of these features along with accurate, high-volume bill adjudication capabilities makes the AdjusterPortal an ideal cost containment solution for medical bill payers.
AdjusterPortal also provides clients with the tools they need to create automated workflows that support their unique business objectives. Tightly integrated into the bill review process, a broad range of business rules can be implemented in real-time to identify and capture bills that require examination by adjusters. Workflow configuration options allow clients to choose when and how to apply the business rules throughout the bill review life cycle.
AdjusterPortal
™ features and benefits include:
- My To-Do List – Bills that require manual adjudication are loaded into the adjuster’s My To-Do List work queue. Bills are listed in spreadsheet format so the adjuster can quickly browse the queue and adjudicate bills with ease. Interactive controls allow adjusters to deny or approve bills one at time or in groups, view claim data and bill images, add bill notes, or reassign bills to other adjusters when deemed appropriate. Search filters and column configuration options are also available.
- Bill Editor – Bill editing is performed in the Bill Editor where adjusters can approve or deny bills at either the summary or service line levels. Limited changes to the service lines, such as forced payment recommendations can be made with sufficient security privileges. If a bill requires further action, an adjuster can add special handling notes to the bill and redirect it back to bill reviewers. When required, the adjuster can also generate notes and letters using a pool of configurable correspondence items.
- Business Rules Engine - A powerful reactive rules engine allows clients to configure a set of rules to be executed against a bill at one or more points in the bill processing workflow. These rules identify business situations that should be reviewed by adjusters. The workflow defines what bill types are affected and when the rules are applied in the bill review process. For example, rules can be triggered before or after (or both) the bill review process. Rules can be edited and saved in real-time with immediate impact. All rule modifications are recorded and tracked in a rule’s history log.
- Support UR Decisions - The Official Disability Guidelines (ODG) Treatment is a value-added resource integrated into the decision making process for bills and individual service lines. This premier cost-containment tool enhances UR decisions by providing comprehensive diagnosis and treatment recommendations based on the ICD-9/CPT code correlation. Automated functions include analyzing bill data and assigning color codes to denote levels of compliance for a bill, and links to information on specific evidenced-based ODG recommendations for the injury. Additionally, adjusters and Nurse Case Managers have instant online access to the complete ODG resource guide.
