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Third Party Administrators
Clavib provides web-enabled solutions addressing HIPAA requirements for the front-end data entry or direct connection transfer of medical information for the provider, and other constituencies of TPA’s. Clavib had developed software applications which enables secure login and authentication of providers and other pre-authorized parties into a website interface for inquiry and transfer tasks. The solutions / applications developed by Clavib can be accessed through the corporate website of TPA’s and any redirect will be transparent to the end user. Clavib develops applications keeping in view ease of portability into the TPA’s Data Center or another third-party database. Database updates will be provided utilizing the current TPA data extracts and batch processes. TPA’s would port data to the server on a periodic basis to update the server. The application will have the ability to auto-load the data extracts.

Third Party Administrators – [TPA]: The job of a Third Party Administrator is to maintain databases of policyholders and issue them unique identification numbers and handle all the post policy issues including claim settlements. Third party administrators will have access to the following information:

Claim payment information

  • Accident fund payment history.
  • Bill totals paid to date for claim.
  • Claim related payment information.
  • Permanent disability payment information.
  • Provider billing information.

Claim review information

  • Basic L & I account information.
  • Review experience factor summary.
  • Review policy information.
  • Review rate history.
  • Review risk class.
  • Summary of premium reporting period.

Claim document information:

  • List of document received on claim.
  • Review list of claim automated orders.
  • Review list of letters sent by claim manager.

Employer account information

  • Case reserve information.
  • Claim activity information.
  • Claim/employer relationship detail.
  • Information from the report accident.
  • Labor and Industries staff information.
  • Listing of log entries for the particular claim.
  • Name and address information.
  • Overview of activity on the claim.
  • Recovery factor calculation.
  • Review claim diagnosis allowance information.
  • Vocational recommendation.

Case Studies:

 

 
 
 
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