One queue for every claim decision.
Claimatix gives claims operations a single governed workflow for utilization review, pharmacy benefit review, bill review, peer review and case management. Your administrators stop chasing faxes, portals and phone calls, and every clinical and payment decision leaves a record you can defend.
Built for complex workers' compensation operations
Clinical expertise
Physician judgment where it matters
Human-in-the-loop AI
Automation within set boundaries
Decision-level audit trail
Every input, reviewer and outcome
The day you're paying for
The work is the chasing.
Most claims operations don't lose time on decisions. They lose it between them.
The intake pile.
An RFA arrives by fax, a second copy by email, a third through a portal. Someone has to notice they are the same request.
Phone tag with the provider office.
A record is missing. The call goes to voicemail. The clock keeps running while the request sits incomplete.
The reviewer scramble.
The reviewer gets the file late, with gaps, and sends it back for the one report nobody requested.
None of this is a clinical failure. It is a coordination failure, and it is where the deadlines are lost.
What changes
One queue, sorted by what expires next.
Every request, from every channel, in one place — with the clock on it from the moment it arrives.
Work queue
Sorted by time remaining
| Claim | IW | Request | Provider | Received | Time remaining | Status | Owner |
|---|---|---|---|---|---|---|---|
| WC-48812 | J.M. | Utilization review | Harbor Spine Associates | Mon 08:14 | 3h | With reviewer | D. Okafor |
| WC-51207 | R.T. | Pharmacy | Valley Ortho Group | Mon 11:02 | 9h | Decision ready | S. Lin |
| WC-47390 | A.K. | Utilization review | Eastside Pain Clinic | Mon 15:40 | 1d 6h | Awaiting records | D. Okafor |
| WC-50033 | L.P. | Bill review | Redwood Imaging | Tue 09:21 | 2d 1h | With reviewer | M. Reyes |
| WC-49158 | C.S. | Utilization review | Coastal Physical Therapy | Tue 13:05 | 4d 2h | Awaiting records | S. Lin |
| WC-52641 | H.N. | Pharmacy | Mission Family Medicine | Wed 07:48 | 4d 19h | Served | M. Reyes |
Timestamped at first touch.
Fax, email, portal or mail, the record starts when it arrives, not when someone opens it.
Sorted by time remaining.
A queue sorted by arrival hides risk. A queue sorted by what expires next shows it.
Nothing sits unassigned.
Every request has an owner, a state and a next action.
The administrator's day
The two conversations your team has all day.
Claims administration is coordination work, with provider offices on one side and expert reviewers on the other: physicians, nurses, pharmacists, and billing and coding specialists. Claimatix puts both sides of it in one record.
WC-47390 · Provider office thread
Eastside Pain Clinic
- FaxInbound· Mon 15:406 pages
RFA received: lumbar epidural steroid injection.
- TextOutbound· Mon 16:05
Please send the most recent PT progress note to complete the request.
- CallInbound· Tue 10:124 min
Office manager confirmed the PT note will be sent today.
- EmailOutbound· Tue 10:20
Confirming receipt of the RFA and the call. We will update you when the note arrives.
- One thread across fax, text, email and call.
- Requests for information name the specific document.
- Every contact is logged on the claim.
For the person accountable for it
What a claims operations leader gets.
Turnaround you can see.
Every open request with its remaining time, by team and by queue.
Fewer vendors in the chain.
Clinical decisions and payment decisions on one governed workflow: utilization review, pharmacy, bill review, peer review and case management.
A record that survives scrutiny.
Inputs, reviewer, communication, timing and outcome captured as one chain, ready for an audit, a judge or a regulator.
Capacity without headcount.
Automation takes the assembly and the chasing. Your people keep the judgment and the relationships.
From request to resolution, without the handoffs.
Most claims operations are split across vendors, inboxes, portals and phone calls. Claimatix runs one governed workflow, without forcing every participant into another system.
Step 1, treatment
Clinical decisions that move faster
Intelligent intake, utilization review, pharmacy benefit review and physician peer review, coordinated from one queue.
- Utilization review
- Pharmacy benefit review
- Peer review
Step 2, payment
Context behind every dollar
Clinical history, authorizations and policy logic travel with the bill to billing and coding specialists, so payment decisions are consistent, explainable and ready to act on.
- Medical bill review
- Payment decision support
- Exception routing
Step 3, outcomes
A clear path to recovery
Case managers and care teams share one view of treatment progress, barriers and next actions, with human judgment intact.
- Case management
- Treatment coordination
- Outcome tracking
Built with the people who make the decisions.
Claimatix pairs workflow intelligence with experienced clinical review operations. Through our partnership with P&S Network, the technology stays connected to physician judgment at the moments that matter.
Explore a partnershipClaimatix
Workflow intelligence
P&S Network
Physician expertise
Questions, answered.
Claimatix is a decision intelligence platform for workers' compensation. It connects utilization review, pharmacy benefit review, medical bill review, physician peer review and case management into one governed, traceable workflow.