inHEALTH | Medical & Disability Claim Approval with consistent claim decisions and faster results Login Contact Us Home

inHEALTH Claims Intelligence
Solution Overview


inTAKEinFORMinKNOWLEDGE


inHEALTH’s unique Claims Intelligence Solution is a value added service solution for the case management and resolution of Accident Benefit (AB) claims. The solution is enhanced by sophisticated and powerful decision support software that was developed and honed over decades of expertise in medical and disability claims management.

inHEALTH differentiates itself through best practice methodologies and a sophisticated, evolved rules engine to optimize medical and disability case management, while enriching an organization’s claims data and knowledgebase for future AB/BI claims management.

  • Best Practice Protocols including clinical analysis, using scientific guidelines to capture recommendations for approval on proposed goods and services;
  • Advanced Data Collection providing a consistent mechanism for the collection and storage of data, and the ability to recall specific information to support current and future decisions around claims;
  • Consistent Outcomes utilizing the results of claim form data collected for approval processing; and
  • Continuous Quality Improvement enabling concurrent and retrospective analysis of data, based on the results of a closed feedback loop that captures and mines data at a granular level.


inHEALTH’s proprietary Decision Support Workflow solution for validation, straight through processing and guidance of the AB claims management process consists of three modular components.


inHEALTH inTake comprises of claim assignment and contact management capabilities. inTAKE components are configurable, enabling an organization to customize workflow messages to meet their unique service environment.

inTake’s claim assignment is a modifiable scorecard that enables claim organizations to prescreen claim data and streamline the claim assignment process. Additionally it enables a claim organization to align and prioritize their resources, based on the complexity of the claims.

inTake Claim Assignment


Click Image to Zoom

inTake’s contact management leverages inHEALTH’s core expertise to gather rich data while simplifying the application for AB claims for claimants. The data is stored and utilized for straight through approvals and medical and disability management.

inHEALTH inForm is the core component of inHEALTH Decision that creates value across the entire AB processing chain. inForms rich rule sets and knowledgebase supports the multitude of data points contained within claim forms and injury claim intake.

The claim form complexity is scored based on multiple input factors and is further segmented based on a score that either approves the claim form that meets minimum criteria or flags exceptions which are then directed to the claims teams for further resolution.

inForms Decision Support Workflow


Click Image to Zoom

inForm Decision Support Workflow enables a shift from process based management to risk based analysis and approval management. Medical and disability approval decisions can be based on individual claimant recovery and rehabilitation needs, making it easier to take a more pro-active approach with healthcare providers and a more timely use of third party involvement (IE’s).

Developed using industry specific claim data and health care practitioners’ recommendations,
inHEALTH inKnowledge provides adjusters with a benchmarking solution to help negotiate and adjudicate the forms approval process, while capturing essential data that can be leveraged for analysis and reporting.