Abstract: In accordance with one or more embodiments, an apparatus for facilitating insurance claims provides for receiving a medical report from a treating physician, the medical report indicating an evaluation of an injury of an injured worker; determining whether a report of a claim for the injury has previously been received from a medical liaison; and authorizing, prior to a report of the claim by either an employer of the injured worker or the injured worker when a report of the claim has previously been received from the medical liaison, a progression of an investigation of the claim by a claim professional based on the medical report.

Abstract: In accordance with one or more embodiments, a method of operating an insurance claim management system provides for receiving, in a claim reporting system, information related to a report of a injury claim, the information being provided by an insurance medical liaison located at a location at which the injured worker's injury has been evaluated. The information may also be indicative of an evaluation, by the insurance medical liaison, of at least one of a work-related injury and an injured worker. The method further provides for establishing a record in the claim reporting system for the claim based at least in part on the information received from the insurance medical liaison.

Abstract: Exemplary embodiments provide systems and methods that automatically gather, organize, present, and communicate data and information that aid a claim handler in making an accurate, informed decision regarding whether or not to allow or approve an authorization request, payment, claim, or action associated with a pharmacy insurance claim. Exemplary embodiments include a software application that reduces the effort required and increases the speed and effectiveness of claim handlers by providing organized, immediate access to claim summary and detailed pharmacy information, which streamlines reviews and the request approval process, including payment requests and prior authorization requests. Various embodiments also activate real-time alerts and reminders to claim handlers for various pharmacy claim management tasks.

Abstract: In accordance with one or more embodiments, a method of operating an insurance claim management system provides for receiving, in a claim reporting system, information related to a report of a injury claim, the information being provided by an insurance medical liaison located at a location at which the injured worker's injury has been evaluated. The information may also be indicative of an evaluation, by the insurance medical liaison, of at least one of a work-related injury and an injured worker. The method further provides for establishing a record in the claim reporting system for the claim based at least in part on the information received from the insurance medical liaison.