Claimwell Claim File Intelligence reads every document on the file, reconciles it against what the file already said, and tells the examiner what is new, what conflicts, and what it implies. Nurses get a structured clinical summary. Every statement cites the page. It annotates. It never decides.
New evidence arrives for the life of a claim: an orthopedic follow-up at week nine, a police report two months in, an updated status form every few weeks. Each time, the file is re-read against itself. What the examiner sees is not the document, it is the difference it makes.
New or changed diagnosis, restrictions, treatment plan, dates, cause, provider. Conflicts with what was on file. A significance score with its reason.
Diagnoses, treatment, restrictions and limitations as structured functional limits, consistency flags, missing elements. Built for the nurse referral.
Click a statement, land on the page with the passage highlighted. The summary is a map of the file, not a replacement for it.
Facts from the claimant, the employer, the provider, and the HRIS feed resolved into one timeline, each with who said it and when.
Written to the file as a note with citations. No status, benefit, or letter is touched. What happens next is the examiner's call.
| Object | Content | When | Never |
|---|---|---|---|
| note · evidence delta | What changed, what conflicts, what it implies, significance score and reason, citations | every time a document lands on an existing claim | status benefit periods payments correspondence decisions |
| note · file summary | Current state of the file against each decision criterion, with the evidence that satisfies or fails each one | on request, and at every handoff when agents are installed | |
| note · clinical summary | Diagnoses, treatment plan, restrictions as functional limits, consistency flags, missing elements, duration against your guideline table | on new clinical evidence, or when a nurse referral is prepared | |
| conditions and restrictions | Structured condition records with ICD-10 codes, onset, treating provider, functional limits | as extracted, with field confidence | |
| timeline facts | Each dated fact with its source, reliability, and conflicts, resolved into one claim timeline | continuously |
The summary is not the determination. The examiner reads it, then decides, exactly as today. For compliance, that is the whole point.
If the Mail Room is installed, nothing new is needed from IT. If it is not, Claim File Intelligence reads documents from your repository through the same adapter and writes notes and conditions back. Surfaces as a panel in your examiner's existing screen or as a page in the Claimwell workbench.
Originals and existing extraction from your repository or from the Mail Room.
Deltas, file summaries, clinical summaries, with citations and model version.
Structured diagnoses and restrictions on the claim.
Your licensed duration table, for the clinical summary's duration comparison.
A panel in your admin system's claim view, or the Claimwell workbench. Either way, citations open the page.
Every summary with its inputs, so an auditor can see what the examiner saw.
Minutes from opening a claim to acting on it. Measured in the workbench, before and after.
Material evidence that arrived and was not acted on within the cadence. Drops to the delta's miss rate.
Your existing file review program, run on files with summaries versus without.
Referrals arrive with the clinical summary attached. The nurse answers a question instead of reading a file.
With the file indexed and understood, the first agent can do the chasing: verify eligibility from HRIS, confirm last day worked with the employer, request the physician statement, follow up by cadence, assign the segment. Still no money, still no determinations. This is where the control plane arrives.
Forty pages, three providers, a conflict in the middle. We'll show you the delta and the citations in twenty minutes.