Tech Built for a Better
Claims Experience

Today more than ever, it is a priority to provide solutions that will support front-line claims staff in the management of workers' compensation pharmacy and ancillary medical services. Consider this: technology that is easy to learn and easy to use, drives efficiencies through streamlined and automated workflows, and empowers front-line claims staff with decision support. Built on a fully integrated platform that helps our customers connect, manage, monitor, measure and adjust across the spectrum of medical products and services involved in an injured worker's care.
Connect to multiple medical services, products and interventions within a single platform
Monitor claim activity in real-time
Manage referrals and authorizations across pharmacy and ancillary medical benefits
Measure performance at individual vendor and program levels

Workflow Automation & Clinical Decision Support

Claims staff face tremendous workloads with ever-increasing challenges, and they need solutions that reduce their burden and provide effective clinical and cost-saving guidance. This makes claims automation solutions perhaps the most important growing technology in workers’ comp.

Healthe continually evaluates current medical practices, prescribing trends, and cost drivers to identify opportunities where low-touch/no-touch automated solutions can be leveraged to support, simplify and reduce complex claims decisions for claims staff, resulting in:
Increased operational and desk-level efficiencies
Reduced injured worker exposure to potentially inappropriate or ineffective therapy
Faster identification and escalation of complex problems that require greater focus and resources
The elimination of opportunities for fraud, waste, and abuse
Increased cost savings by targeting opportunities often lost in manual processes
“Healthesystems provides excellent messaging to guide adjuster decision-making.”

- Director, Third-Party Administrator

Vertice Claims Portal

Workflow for claims staff is presented via Vertice, Healthesystems’ web-based claims portal. Vertice is a centralized resource for claims professionals — a single source of real-time information about pharmacy and ancillary medical benefits claims activities. It allows claims professionals to perform real-time referrals, authorizations, referral tracking, report generation and more across the services and vendors connected to our platform. 

Research-Driven Design

Components of our Vertice claims portal have recently been optimized based on direct insights from user research studies we have conducted with our customers, with the goal of creating an even more simplified and efficient experience. It is a tool designed for claims professionals, with claims professionals.
Customizable user preferences help claims staff prioritize information
Embedded clinical guidance when and where it’s needed
Intuitive dashboard view with simple step-by-step workflows
"The Healthesystems user interface is comprehensive and easy to navigate."

- Workers' comp medical program leader