Compliance Solutions

Simplify your claims reporting

Struggling to keep up with claims compliance?

Compliance is a complex, ever-changing area of claims management—and if you don’t handle it properly—it can end up costing you time and money.

Achieve accurate, timely claims reporting

Respond to specific state and federal claims reporting requirements automatically in your workflow and help reduce your exposure with an extensive suite of leading solutions and expert services.

Get the latest news and insights on claims innovation

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CMS releases new NGHP Section 111 User Guide (Version 6.2, January 11, 2021)

CMS has released an updated Section 111 NGHP User Guide (Version 6.2, January 11, 2021) regarding non-group health plans (liability, no-fault, and workers’ compensation).…

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The PAID Act is now law

In a major development on the Medicare Secondary Payer (MSP) compliance front, on December 11th, President Trump signed into law the Provide Accurate Information Directly…

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LMSA update: CMS’s “future medicals” proposals now scheduled for release in March 2021 | New LMSA case decision highlights continuing claims challenges

LMSA update: OIRA has issued an updated noticing indicating CMS’s “future medical” proposals are delayed again and projected for release in March 2021.

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The PAID Act is now law

On 12/11, the PAID Act became law. It requires CMS expand its Section 111 Query Process to identify whether a claimant is currently entitled to, or during the preceding…

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Get empowered to fulfill Medicare compliance

Satisfy requirements, avoid penalties

Section 111 Reporting

Satisfy requirements, avoid penalties

Identify and report Medicare recipients in your claims quickly and easily and address Section 111 reporting requirements with our Medicare Secondary Payer solutions.

Learn about Section 111 Reporting >

Mitigate risk, help prevent overpayment

Lien Services

Mitigate risk, help prevent overpayment

Getting hit with costly Medicare conditional payment liens or Medicare recovery claims? Our expert services can help reduce payments by challenging unwarranted Medicare demands.

  • Helps prevent overpayment of conditional payment liens
  • Reduces risk of Treasury collections

Learn about Lien Services >

Strategies to reduce costs, optimize settlements

Medicare Future Allocations

Strategies to reduce costs, optimize settlements

Medicare future medical allocations compliance for injury claims can be extremely complex. Our team of experts makes it easy. Get strategies to reduce costs, optimize settlements, and achieve compliance.

  • Support from a large team of experts dedicated to CMS compliance
  • Expert analysis from nurse practitioners that develop future medical claims costs

Learn about Medicare Future Allocations >

Streamline workers’ compensation reporting

Accurate, on-time compliance reporting

Wcprism

Accurate, on-time compliance reporting

Save time and help improve workers’ comp policy and claims reporting accuracy and timeliness with leading solutions that help simplify data reporting.

  • Get automated required report outputs, including FROI/SROI, Unit Stat, DCI, policy, medical, indemnity data calls
  • Manage Release 3.1 requirements and the NCCI indemnity call

Learn about wcPrism >

Get valuable industry trends and insights

Wcanalyzer

Get valuable industry trends and insights

Enhance your EDI compliance with a workers’ comp analytics solution that turns untapped claims and medical reporting data into actionable insights that provide industry trends and metrics.

  • Monitors state data reporting and compliance trends
  • Provides insights into claims and business trends
  • Helps insurers avoid non-compliance fines

Learn about wcAnalyzer >

States: Collect data more efficiently

Wccapture

States: Collect data more efficiently

We provide precise, cost-effective data intake for workers’ comp claims and medical data for states seeking to initiate EDI reporting or transition to a new IAIABC release.

  • Helps collect FROI and SROI from insurers with greater efficiency
  • Gathers medical data needed to help set fee schedules, identify fraud, and implement cost containment strategies

Learn about wcCapture >

Fulfill claims compliance in your workflow

Fullfill Compliance

Fulfill claims compliance in your workflow

Respond to a range of compliance and reporting requirements through our solutions. When authorized, we report your claims to regulatory agencies on your behalf and automatically check your claims against federal and state databases and criminal watch lists. Our solutions include:

  • Child support intercept matching
  • MAIS reporting
  • Property claims reporting
  • Auto claims reporting
  • Casualty reporting
  • Questionable claims reporting
  • OFAC screening

Learn about ISO ClaimSearch Compliance Solutions >

Contact Us to Learn More

Other Ways to Connect

We are available Monday through Friday, 7 a.m. — 9 p.m. US Eastern Time:

  • Chat Now

    Note that password resets and user information are not available through Live Chat or Email. Instead, please call the main toll-free number below.

  • Main Toll-Free: 1-800-888-4476

  • Global Toll-Free: International Access code, then 800 48977489