CaseExpert
Claim adjudication is a complex process involving information, people, schedules and security to name a few but important aspects. Information must be obtained in a secure manner from people who are geographically diverse.
Case adjudication (or case management) is an increasingly demanding and complex responsibility for both the public and private sectors. To gain a complete and accurate picture, the adjudicator must review evidence from several parties to validate information about a case. Inaccurate information can lead to faulty decisions and lengthy, expensive appeals.
CaseExpert software increases the effectiveness of case adjudicators and enhances the ability of administrators to improve their case management process.
- It is a robust case management software which has evolved from over 20 years of experience with state disability determination agencies
- It is engineered to operate on the powerful IBM iSeries platform
- It integrates the power of MS Word and Adobe to produce letters and electronic forms.
CaseExpert allows you to:
- Gain a "technology assistant" for adjudicators with user-defined logic providing electronic to-do lists and automated claims assignment
- Reduce processing time by using a full-featured e-business component that enables evidence collection, appointment scheduling, automatic follow-ups, etc.
- Control security at any level with advanced security components
- Manage activities and caseworker performance using CaseExpert reporting and statistical tools
- Reduce data entry errors with an auto-code function that eliminates the need to memorize codes
- Have an extensive storage capability with optical records storage to house user created letters and electronic forms
- Customizable process to automatically capture financial data to send to existing billing systems
- Meet your capacity needs with a turn-key, scalable solution.
CaseExpert Facilitating Disability Determination
Recent Achievement
Some of the Disability Determination (DDS) agencies in the public sector are significant users of the CaseExpert product. CaseExpert has been instrumental in supporting the paper intensive workflow at each DDS based on its highly customizable To-Do List and Letter Generation capabilities. As adjudication of claims concludes and decisions are made by the Disability Examiners, claim information is electronically communicated to the Social Security Administration (SSA) via interfaces.
In recent years, CaseExpert has been significantly enhanced to do the above (and more) without paper. Workflows are now managed through electronic means via the enhanced To-Do List function. Letters to the service providers (hospitals, copy services, etc.) are sent electronically via email, fax or uploaded to a website as applicable. Extensive interfacing between CaseExpert and SSA applications has resulted in real-time exchange of information and access to centralized tools available to the Disability Examiner. Integration with an electronic forms application has allowed the DDS user to create a fully edited form electronically (previously a paper exercise) and have it uploaded to the SSA central document repository as and when required.
CaseExpert has helped materialize the service improvement goals of its DDS clients by reducing the overall case processing time.
Close to 50% of the SSA's eligible disability cases are managed by CaseExpert with over 4,000 combined users, at 17 state agencies processing on average 100,000 letters per day and over 1,100,000 cases per year.
