General Claims Management Functionality
Lines of Business Modules
Optional Modules and Interfaces
Hardware/Software Requirements

General Claims Management Functionality

FileHandler incorporates as part of the base product dynamic universal claims functionality that provides a powerful tool to administer and close claims:

• FileHandler Security
  JW incorporates FileHandler Security, a fully integrated security component specifically designed for HIPAA-compliant security administration in FileHandler.
  
  FileHandler Security allows for individual-user, role-based accounts with multiple users leveraging the same roles. Permissions at the most granular level (by page, drop-down menu, data field, etc.) may also be customized on a user-by-user basis to further define the role designation for that particular user. This approach benefits system administrators by not requiring special roles for specific individual users when variance from another established role is minor. Each user also has a unique user id and HIPAA-compliant password.
  
  All authority limits are set in FileHandler Security and based on a per claim limit as well as a per payment limit broken down by reserve group. Both payment and reserving authority along with the corresponding workflow is client-defined through FileHandler Security and the FileHandler Business Automation Tools. For example, when a user exceeds their authority level (defined in FileHandler Security) a diary, email or note can automatically be generated to the user’s supervisor requesting approval.
  
  FileHandler Security is a powerful yet intuitive tool that both simplifies and streamlines security administration while maintaining the highest level of standards for data security and integrity.

• Policy Maintenance
  The FileHandler Policy Module is made up of a Master Policy table, Coverage Table, Location Table and Class Code Table. The Master Policy and Coverage tables track basic policy data such as Policy Holder, Effective Dates, Limits, Excess Retention, and Deductibles, etc. Each reserve type is tied to a coverage code, which enables FileHandler to track losses by policy, and by coverage. In addition, FileHandler supports the configuration of coverages with multiple layers of insurance (including self-insurance). The Policy Maintenance module also includes an “On-Call Notice Percent” user-defined column that tracks when a Self-Insured Retention limit has been exceeded. Users can be automatically notified of SIR erosion via diary and/or e-mail via a user-defined business rule configured through the FileHandler Business Automation module.

• Notes
  Users have the ability to notate the entire claim file via FileHandler’s Notes functionality. The system allows for unlimited numbers of notes to be entered on each individual claim with each individual note virtually limitless as it relates to the amount of the text that can be entered into each specific note. Data in the note can either be manually keyed in or cut and pasted from other documents, notes, e-mails, etc.
  
  Each note that is entered into the system is date and time stamped with the user login ID attached to the note entry. Data entered in the note can be checked for spelling via FileHandler’s integrated spell-checker and user-defined note types are attached to each note. Note types are a tool that can be used as a data point for sorting, filtering and/or reporting.
  
  Notes are displayed in a two-box scrolling format: note text is displayed in the bottom box with the top box providing the header information of the specific note text displayed. Information in the header box can be sorted, filtered and in the event the user would prefer a printed copy of the note or notes, the note report button provides a quick report in a .pdf format. The notes function also allows for a keyword search of the note text as well as filtering functions by user, date range, claim party and handler.
  
  Security is configurable on the notes screen to allow for a variety of access configurations. For example, security is configurable to only allow access to certain note types for specific users, or notes can only be editable for ‘x’ number of days after entry.
  
  FileHandler Mail is accessible from the Note Page enabling users to attach diaries to an e-mail and forward to any applicable parties.

• Diaries
  FileHandler’s integrated diary functionality provides a comprehensive tool that allows both adjusters and supervisors to track and monitor claim activities. The FileHandler diary system is segregated into two key components: the Diary Audit Page and the Claim Diary page.
  
  
  1. Diary Audit Page – The Diary Audit Page is designed to provide users a snapshot of all diaries that are due across all the affiliated claim files. This page also serves as comprehensive auditing tool for supervisors, providing them a real-time view of their adjuster’s workloads.
     
     The page is configured to provide a list of all the diaries that have either been manually or automatically generated for that particular adjuster with the page defaulting to display the newest diary first. The page displays the user, diary date, diary status, diary text and other applicable information.
     
     The page is configured to allow for sorting and filtering against a variety of data components, for example: diary type, diary status, line of business, handler, supervisor, etc. For those users who desire a paper-based report, the system will generate a quick report of the displayed diaries via the report button on the Diary Audit Page.
     
     To access the second component of FileHandler’s diary system, the actual Claim Diary page, users can either select the diary individually and pull open the claim on the workbench or select a host of claims and pull several claims to the workbench.
     
     
  2. Claim Diary Page – The Claim Diary Page displays all the diaries that relate to that specific claim. Diaries are displayed similar to the Notes page: two boxes with the diary header information above and the diary text below.
     
     The Claim Diary Page is the key repository of all claim activity and therefore may contain diaries from a variety of stakeholders on the claim. Users have the ability to sort, filter and report on individual claim diaries. In addition, electronic files can be attached to individual diary entries from the Claim Diary Page.
     
     When entering a diary, the system provides a real-time diary audit for the specified diary date. This allows for users to appropriately schedule diaries and not overload specific days.
     
     FileHandler Mail is accessible from the Claim Diary Page enabling users to attach diaries to an e-mail and forward to any applicable parties.

• FileHandler Mail
  FileHandler Mail is a fully integrated function for sending and receiving Email from within the FileHandler claim file. E-mails that are generated from FileHandler have the claim ID imbedded in the e-mail so that any replies are automatically routed through the FileHandler windows service application and entered into the File.
  
  Emailing capabilities are available throughout the entire system. For example, notes, diaries, letters, special handling instructions, etc., can all be e-mailed however all e-mail sent and received are centrally tracked on the claim e-mail page. From within the e-mail page users have the ability to sort and filter on incoming, outgoing and/or deleted e-mails for that particular claims, view attachments from each individual e-mail or forward to another e-mail address.

• FileHandler Reporting
  FileHandler’s reporting capabilities are divided between four key components:
  • FH Reporter
  • FH Risk Analysis Reporting Engine
  • FH File Audit
  • FH Business Intelligence Engine
  
  The FH reporter includes over 60 standardized reports such as loss runs, claim list reports, 1099 reports, and safety analysis reports. Reports may be generated in a variety of formats including .PDF, .xls or.doc file types. Security is configurable so that clients can grant access by role or group including report-only access. Reports may be scheduled to run on any interval, i.e., daily, weekly, monthly, quarterly, etc.
  
  FileHandler also integrates the FH Risk Analysis Reporting Engine, a fully integrated reporting tool that allows for real-time ad-hoc query’s of the database based an a virtually unlimited set of criteria, defined by the user from a set of pick-list menus.
  
  Data that is displayed is also available in both a graph format as well as a result table. For further analysis, the tool provides a ‘drill down option’ based on specific data elements defined by the user. The user may export the captured data into Microsoft Excel so as to save the results and apply additional MS Excel functionality, i.e., Pivot Tables, etc. In addition, “drill-down” results are displayed in the same screen as opposed to opening up a separate results screen. This dynamic tool provides a simple mechanism for quick analysis tailored to the specific needs of the user.
  
  In response to demand for real-time ad hoc reporting capabilities, FileHandler fully integrates the FH File Audit tool, a user-friendly, front-end reporting tool designed to create customized queries. Specific functionality includes:
  
  
  • Ability to pull from every data field in the database
  • Client specific/Client defined
  • Allow for filtering and group-by options
  
  
  Results are displayed the data in a row-like workbench within FileHandler with hyperlinks for each claim allowing the user to place the file directly to the workbench. The query results may also be saved within FileHandler to re-run at a later date and/or exported to Microsoft Excel
  
  FileHandler’s reporting tools are intuitive and extremely flexible. All four tools were designed with the user in mind while being cognizant that each client has unique needs and differing data requirements. We feel this design approach has greatly benefited our clients, providing them powerful reporting tools to meet the most stringent reporting requirements.
  
  Fully integrated into the product is the FH Dashboard, a user-customized tool which provides a centralized repository of customized reports automatically updated based on user-defined specifications. Claim lists, loss runs, workload reports, etc., are updated daily, weekly, monthly, etc., depending on user requirements with a red numerical indicator on the main claim page notifying users with each login the number of new dashboard reports created.
  
  Seamlessly integrated into the suite of FileHandler reporting tools is the FH Business Intelligence Engine, a reporting tool that offers claim management organizations a dynamic “snapshot” into their claims operations for immediate and real-time analysis of critical claims data.
  
  The FH Business Intelligence Engine organizes claims and performance information, translates the data into a graphical display and presents the real-time results in a user-friendly dashboard format. Reports are grouped by Claim Information (Claim counts, etc.), Financials (Reserve, Paid and Exposures) and Workload (Diary) with users having complete control to create dashboard views by the individual user or a specific group of users.
  
  In addition to the real-time graphical dashboard interface, the FH Business Intelligence Engine incorporates an automated alert system which allows organizations to define, track and benchmark quantifiable measurements or key performance indicators (KPIs) with notifications of KPI breaches

• FileHandler Reporter Scheduler
  As a supplemental component to the FH Reporter, the system integrates an automated report scheduling tool within the application that is configurable to both automatically generate reports per a user-defined schedule and distribute those reports via e-mail, ftp, or to a website.
  
  In an effort to provide clients the greatest level of reporting flexibility, it is important to note that FileHandler is an open system, therefore any commercial-grade reporting engine, i.e., Crystal, etc., could be used to create customized reports.

• FileHandler Business Automation Module
  Completely integrated as part of the base product, FileHandler incorporates the FileHandler Business Automation Module, a tool that allows your organization to custom design workflow through a series of automated business rules designed to drive specific actions.
  
  The system currently offers over 40 unique business rule ‘templates’ that can be customized to automate workflow in variety of client environments. Based on a qualifying action in the system, each business rule triggers either one or a combination of pre-defined actions, specifically:
  
  
  1. E-mail – a specific person or group of people are notified of via e-mail with appropriate attachments (see correspondence)
  2. Diary notification – a specific person or group of people are notified via diary
  3. Note entry – a pre-defined note is entered into the claim file
  4. Correspondence – a piece of customized or standardized correspondence is generated and either attached to an e-mail, attached to the claim file or both.
  5. Automated Reserve – a client-defined reserve type and amount are set based on a qualifying action
  
  
  Users are notified via a pop-up screen when a qualifying event has occurred and the results of the business rules triggered by the qualifying event. Users also have the ability to configure a ‘prompt’ prior to an action occurring so as to override. For example, a business rule may be configured to automatically create a reserve upon new claim entry however the business rule can be configured so when the business rule is executed, the user has the option each time to approve or disapprove the automated reserve.
  
  This engine serves as a powerful tool to automate many processes and improve productivity in your claims organization.

• FileHandler Check Printing Module
  Fully integrated into the base system, The FileHandler Check Printing Module allows for checks to be printed on one of 6 pre-defined check stock types. Checks are printed by checking account, and each checking account can have one of the six unique check stock types associated with. The module is configured so that the checks are printed on pre-printed, MICR-coded check stock. Additional check stocks and/or customization of existing check stock is invoiced on a time and expense basis. Destroy, alignment and test printing is allowed and accounted for in the end accounting process.

• FileHandler Correspondence Module
  The FileHandler Correspondence Module is an integrated tool for the generation of claim-related documentation. The module leverages MS Word and merges data fields from within the database into one of several available document formats* in the FileHandler forms library. The benefits of this module are numerous, including:
  
  
  • Insertion of Letter Head information (graphics, etc.)
  • Customization of Headers and Footers
  • Elimination of redundant data entry
  
  
  Any correspondence that has been generated is tracked in the database and stored at the claim level. Security can be applied to the module to allow view-only access for those documents that have been sent. In addition, documents can also be automatically generated and populated as part of the FileHandler Business Automation Module.
  
  *FileHandler supports all jurisdictionally required forms and letters for workers compensation.

• FileHandler Billing Module
  FileHandler incorporates a fully integrated billing module within in the application. This module provides clients the ability to bill their files either via a flat fee or time and expense and subsequently track receivables in the system.
  
  Flat Fee – User Defined Billing Schedules may be set up allowing files to be billed on a flat rate basis on a schedule and rate that are defined by the client.
  
  Time & Expense – FileHandler allows for clients to configure user-defined billing codes and billing services for itemized service billing. The T&E billing component provides for the adjuster the power to post their own time directly into the system. Client and user specific billing rates can be set up affording our clients enormous flexibility when billing files.
  
  Invoices are printed directly from FileHandler and cash receipt maintenance is integrated in the system.
  
  FileHandler integrates a variety of billing reports, which allow our clients to see outstanding invoices and cash receipt maintenance. Some examples:
  
  
  • Invoice Register
  • Cash Receipts Register
  • Client Aging
  • Interim Billing

• FileHandler Vendor Database
  FileHandler fully integrates a vendor database that is designed to track all pertinent vendor information including contact information, vendor notes and 1099 information. User-defined vendor-type coding may be leveraged for reporting purposes.
  
  Vendor information is sub-categorized into four distinct components:
  
  
  • Detail/Main information - Vendor's name, address, phone, fax, tax ID number, and 1099 type is captured. This page serves as the main contact and mailing address for a particular vendor.
  • Locations - A vendor can have multiple locations and mailing addresses all tied back to a central 1099 type and tax ID.
  • Contacts - Multiple contacts may be tied to vendors.
  • Notes - Vendor notes may be entered into the system and tied to specific vendors.

• FileHandler Litigation
  FileHandler integrates a litigation-tracking component within the system that is designed to capture litigation information relative to the individual claim file, specifically:
  
  
  • - Court, Judge and Jury Notes
  • - Plaintiff and Defendant (including associated parties) information
  • - Anecdotal Liability Analysis (including plaintiff and defendant) negligence %
  • - Litigation Cost Tracking
    • Demand Amount
    • Offer Amount
    • Low Cost to Defend
    • High Cost to Defend, etc.
  • - Anecdotal Evaluation Analysis
  • - Litigation date status tracking (motion, petition, discovery dates, etc.)
  • - Deposition date tracking
  • - Litigation Note tracking
  
  
  In addition to the data mentioned above, users also leverage the other tools in the system (FileHandler Mail, FileHandler Correspondence, FileHandler Document Imaging, FileHandler Notes/Diaries, FileHandler Reporter, etc.) to provide a fully comprehensive litigation tracking mechanism that can be used by attorneys and claims handlers alike, with all claim stakeholders sharing data in real time for immediate access to pertinent litigation and claim information.