Claims Intake and Processing

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Overview

Plexos’s systems afford the flexibility for claimants to provide supporting information and documents regardless of their technical abilities. Claimants may elect to mail, fax, or electronically submit their claims with the knowledge and confidence that their documents will be quickly and accurately linked to their claim and moved forward in the process. For this program, we propose implementing a solution in which claimants can opt to file claims 100 percent electronically.

A prerequisite to filing a claim, claimant registration ensures that prospective claimants are members of the class. From the claimant registration, a case—or claim—identification number is generated that becomes the identifying attribute of that claim going forward. Plexos’s intake system allows claimants the flexibility of registering their claim and following up with the supporting documentation or as an integral part of submitting a claim in a single session, with real-time registration validation.

Document Categorization

Plexos employs a clear, concise, and consistent nomenclature to ensure that documents are named to correspond with the requirements of the settlement, thereby enabling claims reviewers to spend the minimum amount of time possible searching for documentation to support claim data capture. Data capture is critical to accurate and timely process claim determinations. The results of claims review can only be as accurate as the data that drives them. Where practical, Plexos uses electronic data capture (EDC) to improve accuracy, enhance productivity, and provide reviewers with faster access to data. Where EDC is impractical, for example, in the case of mailed or faxed submittals, Plexos develops a rigorous training program to ensure that claims reviewers are educated in interpreting the data they are transcribing, are adept at determining anomalies, and are empowered to question inconsistencies. For all data capture, Plexos employs an automated system that uses statistical analysis to identify data that is potentially incorrect. Any results that are identified as incorrect are escalated for further analysis and verification.

Causation Review

Causation review is the first gate in the claims adjudication process. This phase is highly automated and reliant on information gleaned from the data capture step. Prior to receipt of the first potential claim, Plexos performs robust testing of the system calculator(s) to ensure that they provide consistently accurate results. Throughout the program, Plexos employs and maintains a comprehensive quality assurance and quality control (QA/QC) program at this and every subsequent step in the review process to ensure that results are consistent with the settlement agreements and that the claimant satisfies all defined requirements.

Claims Review

Claims review accuracy is dependent upon the IT systems that drive claims review and the people who provide review outcomes. Plexos performs robust multiparty variance tests of all algorithms and calculators to ensure compliance to the settlement framework and to deliver consistently accurate results. Additionally, multi-party variance testing enables Plexos to identify potentially vague settlement framework language that can cause differences in the framework interpretation. Claims review requires an educated and trained organization. Plexos believes in hiring the right people for the job.

Award Determination

Award determination accuracy and timeliness are critical to the success of any settlement administration. Plexos’s team of analysts and accountants conducts robust quality assurance and quality control testing of determinations to ensure that the determinations are consistent with the settlement framework, accurate to the data provided, and aligned with the results of the review.