All-Lines P&C Claims Management Software with Workers' Compensation Compliance Built In | pasClaims.Net
pasClaims.Net is claims management software for property and casualty carriers, managing general agents, and workers’ compensation writers. The system enforces four named operational controls competitors describe as generic automation: Claim Authority limits that block out-of-bounds reserves and payments, a Scheduled Payment Workflow that posts indemnity through Two-Step Authorization process, and an Automated Diary that follows up on every open claim without manual user prompts.
pasClaims.Net runs every line of P&C business on one system, including workers’ compensation and surety. The platform produces FROI and SROI screens for every U.S. jurisdiction, connects to Medicare Section 111 reporting vendors, and replaces paper forms libraries with the pasClaimsPortal.Net self-service claimant portal. The platform operates on infrastructure that meets the SOC 2 Type II trust services criteria, independently audited by Wolf & Company, so IT and compliance reviewers see verified controls rather than self-asserted certifications.
pasClaims.Net - Claims Management Software for P&C Carriers and MGAs
pasClaims.Net delivers a unified claims management system for carriers and MGAs who have outgrown spreadsheets and bolt-on solutions. The product anchors the broader PAS suite alongside pasCarrier.Net for policy administration and pasBilling.Net for billing, and it deploys as a full end-to-end suite or as a standalone module integrated with non-PAS systems.
The platform replaces siloed claim spreadsheets and paper-and-PDF workflows with one online environment where adjusters, supervisors, and compliance officers work from the same record. Adjusters open claims, set reserves, schedule payments, and maintain notes in one application. Supervisors review authority overrides, approve scheduled payments under Two-Step Authorization, and audit the diary trail in the same system. Straight-through processing handles routine notifications and standard payments, while exception paths route through Claim Authority thresholds rather than email handoffs.
pasClaims.Net combined with pasCarrier.Net for policy administration and pasBilling.Net for billing operates from one database on one platform. Policy data flows to claims in real time. Billing connects automatically. No integration overhead between modules, no nightly batch dependencies, no parallel data entry workflows. Best for carriers replacing a legacy core system or launching a new line with full automation.
pasClaims.Net integrates alongside your existing policy administration or billing system via APIs. Database-Driven Configuration adapts claim workflows, authority thresholds, diary intervals, and notification rules without code changes during or after integration. Best for carriers in M&A transitions or multi-vendor environments where claims replacement is the immediate priority.
pasClaims.Net operates as the rules and data engine behind your custom front-end or carrier-branded claimant interface. Quote-and-bind via API, agent, insured and claimant portal integration, and custom UX layers all connect to the same operational controls: Claim Authority, Two-Step Authorization, Notepad and Automated Diary. Best for MGAs or carriers with proprietary UX requirements and internal development capacity.
Real-Time Policy-to-Claims Sync that eliminates manual double-entry
Real-Time Policy-to-Claims Sync moves a finalized policy from pasCarrier.Net into pasClaims.Net through an API call rather than a nightly batch. When an underwriter binds a policy, the claims system reflects the coverage, the limits and deductibles, so a first notice of loss filed an hour later opens against current data. Carriers running pasCarrier.Net alongside pasClaims.Net stop maintaining the parallel data entry workflows that legacy multi-vendor stacks force on adjusters. Carriers integrating pasClaims.Net with a non-PAS policy system get the same API-based sync through the headless deployment.
Database-Driven Configuration that absorbs client change without code
PA Solutions configures Database-Driven Configuration during client onboarding by populating client-specific tables for diary intervals, Claim Authority thresholds, Scheduled Payment Workflow parameters, and notification rules. When a carrier requests fourteen-day supervisor diaries instead of thirty, or a different reserve approval threshold for a new line, PA Solutions updates the configuration tables and the change takes effect on the next claim transaction with no code branch and no release cycle. That principle is what allows PA Solutions to make client-specific modifications competitors refuse on maintenance grounds while still operating a single-system platform, and it applies the same way whether a carrier deploys the full PAS suite or runs pasClaims.Net standalone alongside a non-PAS policy administration system.
Workers' Compensation Coverage: Vendor Connectivity for Compliance and Cost Containment
Workers’ Compensation Coverage is the depth dimension that separates pasClaims.Net from line-of-business specialists and ecosystem-only platforms. The system handles workers’ compensation claims with the same operational controls and the same data model used for property, general liability, auto, and surety, plus the regulatory plumbing workers’ compensation requires: state reporting, federal Medicare reporting, and integrated medical and pharmacy cost review. Compliance officers managing multi-state books see consistent audit trails across every line, aligned to NAIC workers’ compensation regulatory standards and the NAIC Unfair Claims Settlement Practices Act.
Vendor connectivity is built around the three integration categories workers’ compensation carriers cannot operate without:
Medical Bill Review Providers that adjudicate physician, hospital, and ancillary medical bills against state fee schedules and usual-and-customary benchmarks
Pharmacy Review Providers that manage prescription cost containment, formulary controls, and pharmacy benefit management for injured workers
Medicare Section 111 reporting vendors that handle the mandatory reporting of bodily injury settlements involving Medicare-eligible claimants
FROI / SROI Screens that cover every U.S. jurisdiction
FROI and SROI Screens in pasClaims.Net cover every U.S. jurisdiction in a single unified screen design rather than as state-by-state add-on modules. The First Report of Injury and Subsequent Report of Injury screens hold every field any state requires; the user identifies the filing jurisdiction, and the system flags which fields are mandatory and which are optional for that state. That universal-state architecture means a multi-state carrier does not buy state modules incrementally, does not wait for a vendor release when a state updates a field, and does not maintain separate screens per jurisdiction. The screens are built to accommodate IAIABC FROI/SROI EDI Claims standards Release 3.1.
Medicare Section 111 Vendors that cut civil-penalty exposure
Medicare Section 111 Vendor connectivity inside pasClaims.Net handles the mandatory reporting workers’ compensation carriers owe CMS for any settlement involving a Medicare-eligible claimant. The platform routes Section 111 reporting to integrated Responsible Reporting Entity vendors so adjusters do not maintain a separate compliance pipeline. CMS publishes Medicare Section 111 mandatory reporting requirements, and noncompliance carries civil money penalties of up to $1,000 per day per noncompliant record, capped at $365,000.
Medical Bill Review Providers and Pharmacy Review Providers
Medical Bill Review Providers integrated with pasClaims.Net adjudicate medical bills against state fee schedules, PPO networks, and contracted rates before the system schedules payment. Pharmacy Review Providers handle drug utilization review, formulary management, and pharmacy benefit management for injured workers. Both vendor categories operate under URAC-accredited medical bill review vendors standards for utilization management organizations, so pasClaims.Net connects to credentialed organizations rather than commodity vendors.
Schedule a consultation to scope your workers’ compensation compliance and cost-containment requirements.
Workers' Compensation Claims Module: From FNOL to Closure on a Unified Dashboard
The Workers’ Compensation Claims Module walks the workers’ compensation claim from first notice of loss through closure on one unified Claim Dashboard. The FNOL is opened, initial reserves are set, files are routed to medical bill review and pharmacy review vendors, FROI is filed to the relevant state, indemnity is posted through the Scheduled Payment Workflow, subrogation is managed when a third party is liable, and the file is closed with the full audit trail intact.
Claim Dashboard that consolidates the scattered claim picture
The Claim Dashboard consolidates information that legacy claims systems scatter across separate screens. Adjusters and supervisors work from the same view — a supervisor reviewing an authority override sees the full claim context the adjuster sees. Six consolidated data categories that previously required tabbed-screen navigation are now on one surface:
Open Claims:
The claimant’s other open claims are visible in one view, so adjusters spot related files without navigating to a separate search screen.
Catastrophe Codes:
Shared event codes link the file to a broader catastrophe event, enabling supervisors to track aggregate reserve exposure across a single occurrence.
Reserve and Payment Posture:
Current reserve balances and payment totals appear on every open file, so authority thresholds are checked against live data rather than manually refreshed figures.
Diary Follow-Up:
The next follow-up date is auto-set from diary configuration rather than manually entered, so no open claim ages without a scheduled review.
Vendor Activity:
Medical bill review and pharmacy review status is visible without leaving the Claim Dashboard, eliminating the tab-switching that legacy systems require to check vendor workflow progress.
FROI / SROI Status:
The filing status for the claim’s jurisdiction appears on the dashboard, so compliance officers see outstanding regulatory submissions without opening a separate reporting module.
The consolidated view ships as standard for all pasClaims.Net clients rather than as a custom build per carrier.
Request a demo of the Workers’ Compensation Claims Module.
All Lines Claims System: Configurable Claim Authority, Scheduled Payments, and Automated Diaries
Competitors describe claims automation in general terms. pasClaims.Net names the controls: Claim Authority, Two-Step Authorization, Automated Diary. These are not features; they are the mechanism by which internal fraud is prevented and audit trails are created.
The All Lines Claims System is the operational control architecture underneath every line pasClaims.Net handles. The sections below name the processes that prevent internal payment fraud, enforce role-level limits, and eliminate manual diary follow-up.
Claim Authority that enforces role-level limits
Claim Authority is the threshold control that blocks any user from posting reserves or payments above their configured role limit. Limits are configurable per transaction type and per feature, so an adjuster authorized to set indemnity reserves up to one threshold may have a different threshold for medical reserves and a different threshold for settlement payments. When an out-of-bounds transaction is attempted, a block message is displayed and a supervisor diary is automatically created for review. Every override leaves a database-level audit record aligned to NAIC settlement practice expectations, so the audit trail shows who requested the override, who approved it, and when.
| Role | Authority Limit Type | Trigger Action When Exceeded |
|---|---|---|
| Adjuster | Per-transaction reserve and payment limits, configurable per line | Block message displayed, supervisor diary auto-created |
| Supervisor | Higher per-transaction limits and override approval rights | Approval or decline routes back to the originating adjuster |
| Manager | Authority-override rights, threshold configuration | Database audit log entry on every threshold change |
Scheduled Payment Workflow with Two-Step Authorization
The Scheduled Payment Workflow handles recurring indemnity and settlement payments through a controlled three-step sequence. Two-Step Authorization originated from a carrier request to ensure the same person who creates a scheduled payment cannot also approve it:
- The adjuster defines the recurrence frequency, the date range, the payment amount, and the payee bank account on the claim file
- The system routes the schedule for Two-Step Authorization to a separate user with approval rights
- The supervisor approves the schedule before the first payment posts, and the system maintains the audit record of both actions
This is the operational answer to internal payment fraud risk that automated disbursement workflows can otherwise create. Insurance Journal documents that 58 to 82 percent of carriers use AI for claims, but only 12 percent have mature integrated capabilities, leaving a gap that named workflows like Two-Step Authorization fill.
Automated Diary with database-configurable intervals
The Automated Diary creates supervisor and adjuster follow-up entries on every open claim at configurable day-forward intervals. New claim opening, reserve threshold breach, scheduled payment posting, and pending vendor responses each trigger diary entries, and the day intervals live in client-specific database tables rather than in compiled code. Carriers running tighter follow-up cadences for high-severity workers’ compensation claims set shorter intervals; carriers running longer intervals for property files configure the same way without development work.
AI-Powered Notes and Document Summarization
AI-Powered Notes and Document Summarization condenses adjuster claim notes and uploaded documents (PDF, Excel, Word) for faster supervisor review. Summarization is executed on Microsoft Azure AI services. Claim notes and documents are summarized as separate outputs, so a supervisor reviewing a complex file receives a structured digest rather than a raw transcript. AI summarization augments the named operational controls; it does not replace Claim Authority, Two-Step Authorization, or supervisor diary review.
Schedule a Consultation to map your claim authority hierarchy and scheduled payment controls.
pasClaimsPortal.Net: A Real-Time Claimant Portal That Replaces Your Paper Forms Library
pasClaimsPortal.Net is the self-service claimant portal that replaces the paper forms libraries legacy claims platforms still depend on. Claimants log in to view claim status, payment history, document uploads, and ACH banking setup, and they file routine status updates without an adjuster phone call or a returned PDF form. The portal is tested and deployment-ready, built initially for a New York firefighter insurer client and now available as a standalone module for any pasClaims.Net carrier. For carriers running pasInsurerPortal.Net for personal lines where an insured is also a claimant, Insured-Claimant Portal Redirect Logic routes the user to the correct portal.
The Portal vs. Forms Library contrast is direct:
Paper forms library:
Adjuster sends a state-specific PDF, claimant prints, completes by hand, mails or scans, adjuster transcribes back into the system, follow-up by phone when fields are missing
pasClaimsPortal.Net:
Claimant logs in, sees real-time claim status and payment history, files updates and uploads through validated screens, ACH payment data flows to the Scheduled Payment Workflow
Paper forms libraries treat claimants as passive recipients of system outputs. The portal treats them as active participants in their own claim.
Request a Demo of pasClaimsPortal.Net, Schedule a Consultation for an architecture review.
Frequently Asked Questions: pasClaims.Net Claims Management Software
How does the claims system integrate with external medical and pharmacy review vendors?
Workers’ compensation claims management requires connectivity to three vendor categories that operate outside the core claims platform: medical bill review, pharmacy review, and Medicare Section 111 reporting. Medical bill review vendors adjudicate physician and hospital bills against state fee schedules and contracted rates; pharmacy review vendors manage drug utilization and formulary controls for injured workers; Medicare Section 111 vendors handle the mandatory reporting obligation carriers owe CMS for settlements involving Medicare-eligible claimants. These integrations are not optional features in a compliant workers’ compensation operation: they are the mechanism by which carriers contain medical cost and satisfy federal reporting requirements. pasClaims.Net connects to all three vendor categories through established integration points, with medical bill review and pharmacy review vendors operating under URAC-accredited utilization management standards for credentialed quality control.
Can we replace our manual forms library with a real-time self-service claimant portal?
A paper forms library and a self-service claimant portal produce the same outcome: a claimant who has filed a status update or provided requested information. The difference is operational throughput and adjuster workload. Forms libraries require an adjuster to send a state-specific PDF, wait for a returned document, transcribe the information into the claims system, and follow up by phone when fields are incomplete. A real-time portal routes the claimant through validated screens, captures data directly to the claim record, and displays payment history and claim status without an adjuster phone call. The loop closes without manual transcription. pasClaimsPortal.Net is a tested and deployment-ready self-service portal that replaces forms library workflows with a direct claimant-to-system connection: claimants log in to view status, upload documents, set up ACH banking, and file routine updates, and that activity flows to the Scheduled Payment Workflow without adjuster intervention.
Does the platform support automated Medicare Section 111 reporting and compliance?
Medicare Section 111 mandatory reporting requires workers’ compensation carriers classified as Responsible Reporting Entities to report any settlement, judgment, or ongoing payment involving a Medicare-eligible claimant to CMS. This is a federal statutory obligation, not an optional compliance enhancement, and noncompliance carries civil money penalties of up to $1,000 per day per noncompliant record. The reporting obligation applies at settlement, which means claims systems must connect to Medicare Section 111 vendors at the point of disbursement, not as a separate post-settlement workflow. pasClaims.Net routes Section 111 reporting through integrated vendor connectivity built into the claims workflow, so adjusters do not maintain a separate compliance pipeline outside the core system. The integration operates at the Scheduled Payment Workflow level, connecting to established Responsible Reporting Entity vendors rather than relying on manual adjuster submission.
Does the software provide state-specific FROI and SROI screens for Workers’ Comp?
First Report of Injury and Subsequent Report of Injury screens are regulatory outputs that workers’ compensation claims administrators file with state jurisdictions to document injury occurrence and ongoing claim activity. The IAIABC FROI/SROI EDI Claims standards Release 3.1 govern the data fields and transmission formats these reports must meet across U.S. jurisdictions, and individual states add their own mandatory field requirements on top of the base standard. Systems that handle FROI and SROI through state-by-state add-on modules create incremental licensing exposure and release-dependency when states update their requirements. pasClaims.Net delivers FROI and SROI screens covering every U.S. jurisdiction in a single unified screen design: the user identifies the filing jurisdiction, and the system flags which fields are mandatory and which are optional for that state. Multi-state carriers do not purchase state modules incrementally, and field updates accommodate within the existing screen structure rather than requiring a vendor release cycle.
How do we prevent internal payment fraud when using automated disbursement workflows?
Automated payment disbursement eliminates manual check-writing but introduces a segregation-of-duties risk: if the same user who creates a payment schedule can also approve it, the second-reviewer control is removed. Insurance Journal documents that 58 to 82 percent of carriers now use AI for claims processing, but only 12 percent have mature integrated capabilities, meaning most are automating disbursement without the named workflow controls that prevent internal fraud exposure. The mechanism that closes this gap is a defined authorization sequence that separates payment creation from payment approval. pasClaims.Net addresses this through two named controls working in combination: Claim Authority limits block any user from posting reserves or payments above their configured role threshold, generating an automatic supervisor diary on any override attempt, and Two-Step Authorization requires that the user who creates a Scheduled Payment cannot be the same user who approves it before the first disbursement posts. Both controls leave database-level audit records aligned to NAIC settlement practice standards.
How long does a typical implementation take – are we looking at 6 months or 13 weeks?
Insurance core platform implementations vary based on the number of lines being configured, integration complexity with existing policy administration and billing systems, the volume of data migrating from a legacy system, and the carrier’s internal change management capacity. Vendor-driven estimates cluster around 20 weeks for mid-market P&C deployments when all of these factors are scoped at average complexity. A 12-week implementation is achievable when the scope is defined precisely at contract, the carrier assigns a dedicated project team, and the vendor team operates with a fixed configuration-to-UAT schedule rather than a discovery-first approach. PA Solutions has delivered a full claims management implementation in 12 weeks for a regional firefighter insurer where the scope was documented before implementation began and configuration changes followed a database-driven model rather than code deployment cycles. Timeline commitments require scope verification; the appropriate starting point is a scoping consultation that maps your lines, integrations, and data migration requirements against a realistic delivery schedule.
Can I quote and bundle different policy types (like WC and Liability) in one step?
Quoting and bundling multiple policy types in one step requires a platform that links independent policies at the data model level, not just at the presentation layer of a combined quote screen. The underlying requirement is that the policy system recognizes the relationship between a workers’ compensation policy and a general liability or volunteer firefighter benefit law policy, applies any discount logic that the carrier configures for combined coverages, and preserves that relationship when either policy is endorsed or renewed. pasCarrier.Net handles policy origination, policy linking, and the Automated Discount Engine that calculates combined premiums across linked policy types. On the claims side, pasClaims.Net receives the linked policy structure through Real-Time Policy-to-Claims Sync, so a first notice of loss filed under a linked coverage opens against the correct policy data and discount structure without manual cross-referencing between separate claim records.
How do you ensure our policy and claims data stay in sync without manual double-entry?
Policy-to-claims data synchronization failures occur when the two systems operate on different update cycles: a policy is endorsed in the policy administration system, but the claims system does not reflect the updated limits, coverage, or linked discounts until a nightly batch run completes. In the intervening period, a first notice of loss opens against stale policy data, and adjusters either delay file opening or manually verify coverage terms against the policy system. The synchronization mechanism that eliminates this gap is an API-based real-time push rather than a batch schedule. Real-Time Policy-to-Claims Sync in pasClaims.Net moves a finalized or endorsed policy from pasCarrier.Net to the claims system through an API call at the moment the underwriter acts, so a claim filed an hour after policy bind opens against current coverage data. Carriers integrating pasClaims.Net with a non-PAS policy administration system access the same API-based sync through the headless deployment architecture.
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