CCMI RMIS Systems At a Glance:
CS PRISM for Windows™
Spectrum For Clients®
PRISM FOR WINDOWS™ - (IBM AS/400 Client /Server)
Corporate Claims Management’s Claims Administration System, a component of CS PRISM for WindowsTM , provides a sophisticated Windows TM based claims and risk management tool which can be used to effectively administer and track claims for Workers’ Compensation, Auto Liability, General Liability, and other user-defined lines of coverage. CS PRISM for WindowsTM allows our Client Services Team to set up and customize the database to meet the specific needs of each Corporate Claims Management client. All client-defined criteria such as coverage, location or cost-center hierarchy structures, nature of injury codes, body part injured codes, etc. are set up in user-created tables. Clients can create any number of user-defined fields to track and analyze data that is unique to its exposures, in terms that are easy to understand and meaningful to the end user.
CLAIM FILE MANAGEMENT
The user can display a variety of claim, payment and reserve transaction details. Online searches can be executed for claims meeting different criteria with the option to print or download (Excel, Word, PDF, Access formats) the information retrieved.
DIARY NARRATIVE FUNCTIONS
The Diary Narrative Module is a powerful tool which facilitates electronic recording of adjuster notes, reminders for action on claims, allows electronic messaging between areas, and ensures effective claims supervision and management. The diary records are stored in the AS/400 System which provides permanent storage and retrieval capabilities for all information related to a claim and its administration.
Employing the electronic tool increases adjuster efficiency by eliminating the need to produce, maintain, and reference these records in a manual filing system. Permanent storage of data within the computer system also eliminates the risk of loss.
The Diary Module can be utilized to record notations related to phone calls, information from doctors, lawyers and witnesses, and establish reminders for follow-up action. Unlimited diary information can be maintained on an individual claim record. The Diary Module includes coding to designate who entered the note or to whom the reminder is addressed, the date of the diary, and the type of action required. It promotes efficient recording of information through the entry of a four (4) digit narrative code. Through use of this code, the adjuster is not required to type in recurring narrative descriptions. The system automatically translates the code into the detailed description when the record is created. Organizations can also utilize Diary as an electronic messaging system to facilitate communication from one division/plant to another.
AUTOMATIC DIARY SYSTEM
The Automatic Diary system creates automatic diary record reminders on a claim each time a designated event occurs. Use of this system is beneficial by promoting consistency in the claims administration process and providing an efficient means of establishing adjuster reminders without manual entry. The Automatic Diary System can be used to generate adjuster reminders to complete reviews at the appropriate intervals, review reserves, etc.
The events that can generate creation of suspense diaries include: non-payment, reserve value change, payment, status change, opening or re-opening of a claim, changes in Workers’ Compensation Generator dates, rates, payment type code, or creation of a completed document in the Word Processing Module. Diary reminders can be established for the administrator or his/her manager.
CLAIM WORK FLOW FUNCTION
The Claim Work Flow feature in conjunction with the Diary Narrative and Automatic Diary systems provide a daily “to do” list for individuals involved in the claims administration process. It is an efficient way to notify the claims administrator that he/she has follow-up activities to perform on designated claims.
The Claim Work Flow List appears on the user’s screen the first time he/she signs into the Claims Administration system for the day. It can also be activated by accessing a routine in the Diary Module. Use of the Claim work Flow feature eliminates the need to perform periodic searches within the Diary Module to identify reminder records.
VOCATIONAL REHABILITATION TRACKING SYSTEM
The Vocational Rehabilitation Tracking System is a series of routines used to input, store, and access Vocational Rehabilitation information. This system is also used to print vocational rehabilitation abstracts and calendars, to search, display and print rehabilitation diary information, to provide code and diary maintenance routines, and to organize rehabilitation information in a self-contained unit.
Vocational Rehabilitation plans are developed by employers to reduce the cost of claims for injuries occurring in the work place. A sensible approach to managing disability includes consistent steps, taken from the beginning, to help the disabled employee return to work. Vocational Rehabilitation can aid the employer and the injured worker by:
Reducing the level of severity of the disability
Re-training the worker for a different kind of job, if necessary
Getting the employee back to work faster and
Using physical therapy to reduce the percentage of disability
Disability management programs can help employees return to work through early identification of problems and assessment of the disabled persons’ needs. Action planning and the support of supervisors can be instrumental in the successful maintenance of a program. Good communication and quality vocational rehabilitation plans are also necessary.
CHECK WRITING PROCESS
Checkwriting allows for the production of claim checks for payables entered in the Claim File Management Module. Once payables/checks are entered, the user can void or cancel checks, record manual checks to the check register, print the check register, maintain vendors, payment narratives, and state benefit files. Types of payables that can be processed are:
Invoice Payables produces checks for one-time payments on a cliam.
Recurring Payables produces checks for regularly scheduled payments that do not access the State Benefit file to calculate payments such as child support payments.
WC Generator Record Payables produces checks for recurring Workers' Compensation benefit payments calculated using guidelines stored in the State Benefit File.
SPECTRUM FOR CLIENTS
Introduced in the Summer of 2010, this new and exciting module to Corporate Claims Management’s Risk Information System combines a flexible and powerful ad hoc report writer with dozens of easy to view and understand charts, graphs, and pre-formatted reports in a web-based, dashboard application designed to allow for an efficient and comprehensive, real-time overview of your claims history in the manner you prefer! SPECTRUM FOR CLIENTS provides “point and click drilldown” features to let you see “the data behind the numbers” for an in-depth understanding of the claims and dollars incurred in seconds! Users simply select their dashboard preferences from our easy to navigate menu options to view and print a wide variety of management reports designed to facilitate immediate understanding and knowledge of your complete claims history and allow for the reporting and vital risk management decision support throughout the organization. Unlike other report writers, SPECTRUM FOR CLIENTS utilizes the strength of the CS database to analyze all aspects of your claim program from incidents to detailed legal and medical data.
SPECTRUM FOR CLIENTS provides complete access to detailed claim information and links directly to CS PRISM FOR WINDOWS. Multiple manipulations, reports, charts, and graphs are possible from a single query. Queries can be saved or defined for repeated use. Technical information, such as the relationships between the different database paths, does not have to be specified.
SPECTRUM FOR CLIENTS provides users true reporting independence with a full range of formatting features. Also available is the ability to share reports via email and the option of saving the data in PDF or spreadsheet formats for formatting at a later time.