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The following is a selfpaced, PowerPoint based
demonstration of the
QISS’ Claims
Management System
using screen shots of our
system.
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This demonstration is
intended to cover the
major aspects of our
system, and is not a
comprehensive
demonstration.
We will be glad to
address any questions not
answered in this
demonstration.
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The Diary tab on the Home screen is the first screen seen by a
user after logging into the system.
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Past items are marked in red, Today items are in green, and
future items are in black.
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Diary entries can
be sent to yourself
or to other users.
They can be post
dated for use as a
future reminder.
Entries can also be
classified as to
type (medical,
legal) and grouped
in separate
diary/note reports
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The Claims tab on the Home Screen lists all claims of interest to the specific
The Claims
tab onby
the
Home
Screen
listscustomization,
all claims of interest
to thesecurity
specific user, as
user,
as defined
their
own
screen
and their
defined by their screen customization, and their security access.
access.
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Lay out for claim id is:
(Location code).(claim number).(client number).(claim type)
10.34.1.AL is office 10’s 34th claim, from client 1 (Sample School District) and is an
Auto Liability Claim.
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Each user can determine which claims are shown, and what columns are displayed,
based on their entries in the Claim Tab Layout Manager.
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Clicking on the Claim ID will retrieve that claim file
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Clicking on the Claim Info tab will display claim information
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Clicking on the Client/Insured tab will display information related to the
client, including a client-specific hierarchy. Use of hierarchies help specify
where claims are occurring, and is very useful for risk analysis.
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Parties tab displays information on any party related to the claim
Status tab displays current status of the claim
Links tab provides links to often repeated tasks/reports
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Claimant tab displays a variety of the claimant’s personal information.
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On the claimant tab, Cause of Injury codes, Nature of Injury Codes, and
Part of Body Codes are tracked, as defined by the IAIABC (International
Association of Industrial Accident Boards and Commissions)
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The Claim type tab, labeled with the claim type (AL, WC, GL, PD), will display
information related to the claim type. In this AL example, vehicle information
is tracked. A WC example would track employment and pay information.
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QISS handles the new MSP Section 111 reporting laws, by electronically
reporting claims out of our system directly to CMS (Center for Medicare
and Medicaid Services. No third party is required.
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Clicking on the Reserve button will bring up the reserves for the claim.
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Reserves are separated into several coverage types (or ‘buckets’) as
defined by the our clients. Each bill is assigned to a ‘bucket’.
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By clicking on the plus sign in front of each bucket, the history of any
transactions related to that bucket is displayed, along with historical running
totals for Total Paid and Total Open.
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Clicking on the Bills button will produce a list of all bills, posted or
paid, related to the claim.
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Clicking on the plus sign for any bill will show the detailed information related
to that bill, and date paid, if it has been paid. Non-paid bill will show as
‘posted’ but not ‘paid’.
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All transactions are run based on the parameters set by the policy.
Searching Policy will bring up policy information for all clients (not all
users will have security to allow this)
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Policies for all
clients are listed.
Clicking on the plus
sign will bring up
the policy detail.
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Policy information
including policy
limits, excess
policies,
aggregate policies
and other policy
restrictions are all
tracked.
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Clicking on the Documents button will bring up the Documents screen where any
digital document (jpg, pdf, word doc, mp3) can be stored.
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Use ‘drag and drop’ feature to move
documents from desktop into the claim
file.
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Use drop down to choose one of several major categories of reports to be
generated.
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Within each major category of reports are several more specific report
selections. We will choose a summary loss run for this example.
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Selection parameters determine which data is retrieved
Formatting parameters determine how that data is
displayed on the screen.
Click ‘Run report’ to generate the report.
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Report is generated. Click on ‘Switch to Fullscreen
View’ to hide reporting parameters.
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This ‘Summary’ Loss
Run displays one line of
information per claim,
including the
summarized financials
on each claim. Claims
are listed in order of
client id (10.1, 10.2,
etc.) but could be
sorted on claimant
name, loss date, or
even by total incurred.
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Let’s group this report by Client Hierarchy 1 (which is
defined as ‘campus’ for this client)
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The same Summary
Loss Run is now
displayed, grouped by
individual campus.
Risk managers can
easily identify which
campus is responsible
for the most claims.
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Further group by Client Hierarchy 2 (defined as
‘department’ for this client)
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The Summary Loss Run
is now grouped by
campus, and then
departments within
each campus.
Subtotals for each are
also displayed.
This information can
then be used to make
recommendations to
your client, like more
safety training at a
particular location.
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When users create a report using
just the selection criteria and
formatting criteria they want, they
can then save the parameters of
the report and name it as they
wish. Individual saved reports are
then listed under the general
category of ‘All saved reports’.
Choose from one of the saved
reports, and your previous report
parameters are retrieved. Let’s
choose the saved report “Loss by
Part of Body”
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The parameters previously saved are retrieved.
Make any changes necessary (new date range,
different client) and run the report.
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This saved report lists
losses for the Sample
School District by part
of body.
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Glance down the list of saved
reports to see some of the many
reports generated out of our
system.
Claims in Litigation
Legal Expense by Type
Loss Run by Type of Coverage
Medical Expense by Type
Multiple Claims/Claimant
Subrogation Claims
And each of these can be modified
in almost endless ways by the user.
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Our goal is to provide the
most complete Claims
Management System
available on the market.
We welcome any
comments or questions
you may have.