Claims Advantage™
for Workers Compensation

The first comprehensive, secure online system to manage all aspects of workers' compensation claims — from first report of injury through final settlement. Trusted by MCOs, TPAs, self-insured employers, and government agencies for over 27 years with 99.999% uptime.

Complete Workers' Comp Solution

Empowers risk managers, claims managers, adjusters, attorneys, TPAs, and MCOs with comprehensive solutions that link key risk, claims, and policy data — all phases from FROI through final settlement.

FROI/SROI & State EDI

Complete IAIABC-format electronic reporting to all 50 states with automatic compliance tracking.

  • First Report of Injury (FROI)
  • Subsequent Reports (SROI)
  • IAIABC & State Formats
  • NCCI & INSCorp Reporting
  • Real-time State Submissions

Bill Review & Clinical Edits

Three-tier bill adjudication with MCCI clinical edits, automatic repricing to lowest of billed, state fee, or PPO amount.

  • 30+ PPO Networks Loaded
  • MCCI Clinical Edits
  • State Fee Schedules
  • Duplicate & Special Edits
  • UCR Auto-Build by Medicare %

Compensation & Payments

Complete payment processing with ACH, check printing, garnishments, and automatic reserves management.

  • ACH & Direct Deposit
  • Check Printing with EOB
  • Garnishments & Debit/Credits
  • Automatic Reserves
  • Multi-Account Support

Case Management / URAC

URAC-accredited utilization review with complete medical case management, authorizations, and plan of care.

  • URAC Accreditation Support
  • Utilization Review Tracking
  • Authorizations & UR/MCM
  • Multiple Plans by Dx
  • Cost Savings Tracking

MODM Return to Work

The ONLY software with Return to Work (RTW) and MODM standards built in — predicting costs and guiding Pay for Performance.

  • RTW Benchmarks by Dx Code
  • Work Class & Age Factors
  • Automatic Work Queue Alerts
  • Case Manager Effectiveness
  • 30-Day RTW Metrics

Pharmacy Benefit Manager

Integrated pharmacy management saves 15-40% off state fee schedules with national PPO network.

  • 15-40% Savings
  • National Pharmacy PPO
  • Auto Authorizations
  • Direct Fax to Pharmacy
  • You Pay Only If You Save

Document Imaging & Workflow

Integrated document management with My E-Docs™ — work flow, audit trail, routing, and stamps.

  • Remote Scanning
  • Fax & Email Integration
  • Auto Entry to Notes
  • Work Queue & Diary
  • Forms & Letter Generation

Legal & Compliance

Complete legal review workflows with jurisdiction-specific forms and regulatory compliance built in.

  • Legal Review Module
  • Forms by Jurisdiction
  • Notes & Letters
  • Attorney Connectivity
  • HIPAA Compliant

Why Choose Claims Advantage™

The industry's most trusted workers' compensation platform.

99.999% Uptime

18+ years of continuous web-based operations with industry-leading reliability.

50 State Coverage

Complete workers' compensation processing for all 50 states with state-specific compliance.

IBM Business Partner

Enterprise-grade technology backed by IBM partnership and infrastructure.

URAC Accredited

Industry-recognized accreditation for utilization review and case management.

Ready to Transform Your Claims Operations?

Join employers, TPAs, and MCOs nationwide who trust Claims Advantage™ for their workers' compensation claims management.

Schedule Your Demo Today