Case Studies

BUSINESS CHALLENGE 

A premier international law firm with a diversified business practice needed an IT Custom Solution – a system that would provide trust auditing services to one of their clients. 

The client needed the capability to examine and evaluate whether claims were accurately processed and approved for payment by a third party processor based upon predetermined criteria defined by the Trust. 

The new system needed to: 

• Provide the law firm and client with the ability to review, assess, evaluate and, if necessary, edit claim data. 
• Audit several types of claims: Payment Requests from the Trust to the client for payment of claims; Pre-established Claims sent from the Trust to the client for confirmation of payment; and Processed Claims which were processed by the Trust and required an audit by the client. 
• Audit claims to identify systemic failures to comply with payment criteria and identify what claims should be approved / not approved. 
• Store all documents related to claims in an electronic format for easy retrieval and maintenance. 
• Restrict access to claim data based on predefined roles. 
• Generate the reports for the processed batches of claims. 

SMAC Apps’S SOLUTION 

SMAC Apps designed and implemented a system that: 

• Enabled the electronic data import and storage of basic claimant information and related supporting documentation from multiple data sources. 
• Contained a complex set of business rules and backend logic to determine claims eligibility. 
• Presented an intuitive and easy to use interface for claim review and audit management at different levels (basic review and assessment to advanced review for claims evaluation). 
• Provided data editing functionality to allow data to be edited and added when required. 
• Provided the ability to generate standard and ad hoc reports using a list of data fields from tables. 
• Maintained an audit trail of claim data that was changed for auditing purposes. 

BUSINESS BENEFITS 

SMAC Apps delivered a system that enabled the client and their law firm to quickly and accurately: 

• Audit claim data to determine whether the claim met the criteria for payment and where applicable, identify the reasons claims should not have been approved. 
• Ensure that claimants are not paid twice 
• Ensure that awards on pre-established claims were in the correct amounts. 
• Audit claims to identify systemic failures to comply with payment criteria and identify what claims should be approved / not approved.