Dictionary
Spear
Industrial standard name for investigation
Argus
General investigations (Background, Social Media, Statement, …)
- Statements
- Surveillance
- Background
- Social Media
- Medical Canvas
- Auto
- GL
- Homeowner
- Inland Marine
Limos
The specific investigation department that only handles liens
Athena
SIU (Special Investigation Unit):
- Claimant
- Provider
- Premium
Pantheon
Management/search of provider information (NPPES data, EAMS data, various licensing boards, BR/PP, etc.) for the purposes of following individual fraudulent or suspected fraudulent providers.
This includes singular pages for NPI/TIN and entity pages.
Urania
Midas
UR
The process used by employers or claims administrators to review treatment to determine if it is medically necessary. All employers or their workers' compensation claims administrators are required by law to have a UR program.
More information on California Department of Industrial Relations website
Singular Page
A frontend page for a single record, rather than any kind of aggregation or grouping. In the context of an API, this means an API that is meant to be used from this context.
Adjuster / PrimaryContact (ClientContact)
The person who handles the claim. Generally an adjuster working at an insurance company handling an insurance claim.
Carrier (ProgramLocation)
The company providing the policy, bearing the financial risk, and paying claims.
Client (Carrier, TPA, MGA)
Our client
Case Type
Each department can have one or more case types.
Claim Number
Generated by insurance companies to handle cases.
ADJ Number
Generated by DWC (Division of Workers’ Compensation) through EAMS (Electronic Adjudication Management System). One ADJ number per claim number regardless of the number of providers.
NPI Number
Medical provider’s identification number. Each individual provider has generally one Type-1 NPI number. Type-2 NPI number is used for organizations.
Applicant Attorney
Defense Attorney
Subject / Claimant
Claimant is the person or entity who formally requests compensation for an insurance company. The subject can be just an associate to the claimant.
Other
Title
HD (Hard Due)
Client’s due date for the case