Mod Advisor can ingest carrier loss runs to help save time when populating detailed claim data.
The process has four steps:
Import the carrier loss run (PDF, Excel or CSV).
Review the claims. Mod Advisor cleans the data, fills gaps from the mod file and suggests matches to the bureau claims.
Approve the claims you want. A preview shows exactly what will change.
Export the comparison or the record of what was approved.
Nothing reaches your mod file until you Approve.
How to import a loss run
You can import a loss run from the Loss Run tab or the Claims tab. Both use the same upload.
From the Loss Run tab
Open the mod file and go to the Loss Run tab.
Click Import Loss Run.
Drag and drop the carrier loss run, or click to select it. PDF, Excel (.xls, .xlsx) and CSV files are accepted.
The file is sent for scanning. When the scan finishes, the loss run appears in the Loss Runs list.
Click the loss run to open its review screen.
From the Claims tab
On the Claims tab, open the import and choose Carrier Loss Run. Drop the file in the same way. The scanned loss run appears on the Loss Run tab.
Import from LossScan
If your company scans loss runs in LossScan, click Import from LossScan on the Loss Run tab. Search by file name, insured or carrier, then click Import on the scan you want.
The import window shows your page count, for example "120 / 250 pages used (130 remaining)". If your company has no page limit, it shows Unlimited pages.
Combine loss runs
To review several loss runs together (for example, three carriers over three years):
Tick the loss runs in the Loss Runs list.
Click Combine Selected.
Enter a group name and click Create Group.
The group appears under Combined Groups and opens the same review screen.
How the data matching works
Mod Advisor compares each loss run claim with the claims on your bureau worksheet and puts it in one of three groups. The bar above the table shows the count for each, for example "67 claims: 0 matched to the worksheet, 40 suggested (34 high, 5 medium, 1 low), 27 not on the worksheet".
Matched to the worksheet: the loss run claim matches a bureau claim. Approve updates that claim.
Suggested: probably the same claim as one on the bureau worksheet, but there are minor variables that need to be reviewed such as a partial claim number or missing state on the loss run. Approve accepts the suggestion and updates that claim.
Not on the worksheet: no bureau claim fits. Approve adds it as a new claim.
Hover over a row's status to see the reasons behind it.
Finding the policy period
Loss runs often leave out the state, the policy number or the policy period. Mod Advisor uses the date of loss to find the policy period on the mod that covers it. If only one state covers that date, the state is filled in too. If more than one state does, you choose the state before that claim can be approved.
How suggestions are scored
Carriers and TPAs often use their own claim numbers, so Mod Advisor looks at several details together. It only compares claims inside the same policy period. It checks:
Claim number: the same number once prefixes, hyphens and leading zeros are ignored (for example, CAR-0000710071 and 710071).
Dollars: how close the loss run's incurred amount is to the bureau's.
Claim type: indemnity or medical only.
Status: open or closed.
Each suggestion gets a confidence level:
High: the dollars agree and at least one more detail agrees.
Medium: the dollars agree closely, but little else confirms it. Worth a look.
Low: a weak lead. Check it by hand. Low suggestions are never approved from the Approve menu.
Each bureau claim is suggested for only one loss run claim. When a row has no suggestion, the status says why: $0 incurred, outside every policy period, a state not on the mod, probably inside a grouped row, or not on the worksheet.
Accept and Unlink
Click Accept on a row to link it to the suggested bureau claim. Mod Advisor then fills in only what the loss run left blank, such as state, policy number, policy dates and injury code.
Click Unlink to undo an Accept. The row goes back to unmatched and the filled-in values are removed.
You don't have to Accept every row first. The Approve preview asks what to do with suggestions you haven't accepted yet.
Grouped rows (NO. 5, NO. 25)
NCCI often groups small medical-only claims into one line, such as "NO. 5" for five claims. The loss run lists those claims one by one. Mod Advisor looks for the set of small medical-only claims in that policy period that adds up to the grouped row's total.
Click the arrow on the group row (Show the claims) to see the loss run claims indented under it.
If the totals agree within rounding, the group can be replaced as is.
If they differ by up to $150, the row says so, for example "worksheet $9,964, a difference of $12.85". Accepting replaces the worksheet amount with the loss run amounts.
If they differ by more than $150, the row says the totals are more than $150 apart and the grouped row stays.
Click Accept group to link all of the claims to the grouped row.
A grouped row is replaced only when all of its claims are approved together. On Approve, the grouped row is removed and its individual claims are added, so your claim count and claim details stay correct.
Loss Run Claim Number
When a loss run claim is linked to a bureau claim, the carrier's own claim number is saved in the Loss Run Claim Number field on that claim. This is an internal linking field. It connects the loss run claim to the bureau claim number, so the next loss run from the same carrier matches automatically.
Loss Run Claim Number doesn't appear on any report. Reports always use the Claim Number. The field is hidden on the Claims tab by default and is the last column in the column and import lists. You can turn it on or move it up. It is included in the claims Excel export, and you can fill it through the claims Excel import.
Enhanced vs As extracted
The switch above the table changes which values you see. Enhanced is the default and shows the data Mod Advisor has cleaned and completed. As extracted shows exactly what the loss run scan returned, untouched.
The switch only changes the view. Approve always uses the Enhanced values, plus any edits you make.
What Enhanced does
Cleans the scan. Values in the wrong place are moved or cleared, and the original is kept:
A policy period that landed in the State column becomes the policy period.
Text that isn't a state, class code or name (a PO box, an address, page text) is cleared.
The state is taken from a real state code, the location address, or a class code suffix such as 9154FL.
Exact duplicate rows are dropped.
Dates are checked, for example a report date before the date of loss.
Fills blanks from the mod file. The policy period, policy number and (when only one state covers the date) state come from the policy period that covers the date of loss.
Fills blanks from the matched bureau claim. Once a row is linked to a bureau claim, details the loss run left out are taken from that claim.
Infers a missing injury code. If the carrier didn't state one, it is inferred from the dollars: any indemnity is 15, medical only is 6, neither is 0. Claims matched to the worksheet keep the bureau's injury code.
How to read the colors
In the Enhanced view, a value Mod Advisor filled in or changed has a colored bar on the left edge of its cell. Hover over the cell to see where the value came from and what the scan originally said ("As extracted: ...").
Orange: a data issue. The scanned value didn't fit the field and was cleared. The tooltip shows what was extracted.
Yellow: an injury code guessed from the dollars. Check it before you approve.
Dashed bar: a value you edited.
Other colored bars show a value filled from the mod file, taken from the matched bureau claim, or cleaned at import.
The summary bar also counts rows with data issues, so you can filter and fix them first.
Editing values
Click Edit to change values before you approve:
Choose a Column and a Value, then click Save to N row(s) to write that value into the highlighted cells (for example, set the state on every selected row).
Click Paste a column to paste values copied from Excel, one per row, from the top down.
Your edits are kept and shown with a dashed bar.
How to approve
Approve writes the loss run claims to your mod file. Every Approve opens a preview first, so you can see each change before anything is saved.
1. Choose what to approve
When you approve claims it's a one way sync. Claims from the loss run move to the claims screen in Mod Advisor. Please note you can select or deselect any column from the loss run by checking or unchecking the column header box. If unchecked, the data in that column will not flow to the loss run. When you are ready click Approve on the review screen and pick an option:
Approve selected rows: only the rows you ticked in the Import column. Shift+click another row to select every row in between.
Approve all matched: claims already matched to the worksheet.
Approve matched + high: adds high confidence suggestions.
Approve matched + high + medium: adds medium confidence suggestions too.
Low confidence suggestions and unmatched claims are never included by these options. Select them by hand if you want them.
2. Review the preview
The Review changes before Approve window shows a summary at the top, for example "12 matched claims updated, 8 with changes, Incurred: 5 up, 3 down, 4 new claims added, 1 NCCI grouped row(s) replaced by 5 claims".
Switch between Changes, New claims and All to see the rows. For each claim the table shows the loss run claim, the bureau claim, what happens to it, and each value as "bureau now → after Approve".
The preview may ask you to decide a few things:
Suggestions not accepted yet: choose Accept the suggested matches and update those bureau claims (recommended), or add them as new claims anyway. Adding them can count a claim twice.
No state: a new claim with no state, where more than one state covers its date of loss, stays on the Review tab until you choose a state. The rest are approved.
Incomplete group: claims that belong to a grouped row stay on the Review tab unless all of the group's claims are approved together.
Columns not selected: differences in columns you didn't tick are shown in grey and keep the claim's current value.
3. Approve
Click Approve claim(s). Mod Advisor then:
updates each matched claim with the loss run's values;
keeps the bureau's injury code on matched claims (a claim coded 9 stays 9);
adds claims that aren't on the worksheet as new claims;
removes each replaced NCCI grouped row and adds its individual claims;
saves the carrier's claim number in Loss Run Claim Number;
stores recoveries and deductibles as negative numbers;
moves the approved rows to the Processed tab.
Click Back to review to close the preview without changing anything.
Approved changes
Every Approve is recorded. Open Export > Approved changes on the review screen, or Approved changes on the loss run in the Loss Runs list, to see who approved, when, and what changed.
The exports
There are four places to download loss run data.
Worksheet vs loss run (PDF or Excel)
On the review screen, click Export and choose PDF or Excel under Worksheet vs loss run. You can run it any time, before or after Approve.
The report lists every bureau worksheet claim next to its loss run claim, grouped by state and policy period:
Bureau worksheet side: State, State Name, Policy Period, Policy #, Claim #, Injury Code, Status and Bureau Incurred.
Loss run side: Loss Run Claim #, Loss Run Incurred, Variance ($), Variance (%) and Differences.
A worksheet total, and the loss run claims that aren't on the worksheet.
A header with the account, rating effective date, worksheet production date, loss run file, valuation date and who prepared it.
The Differences column lists only what doesn't match, so a blank row matches. Incurred differences under $1 are rounding and aren't listed. Use this report to show a client how their claims have developed since the worksheet.
Approved changes (PDF or Excel)
Click Export > Approved changes on the review screen, or Approved changes on a loss run in the Loss Runs list. Each Approve is listed with its date, who approved it and a summary. Click PDF or Excel on any entry.
The report, "Loss run changes approved", has one line per changed value: Action, Bureau Claim #, Loss Run Claim #, State, Date of Loss, Field, Before, After and Note. The Action is one of:
Updated: a matched claim's values changed.
Added (new claim): a loss run claim that wasn't on the worksheet.
In NCCI group (no change): a small claim already counted in the bureau's grouped row.
NCCI grouped row removed: the grouped row was replaced by its individual claims.
Use it as your audit trail of what changed on the mod file and why.
The loss run itself
In the Loss Runs list, open a loss run's menu:
Download File: the original file you imported.
Excel Download: the scanned claims as a spreadsheet.
A combined group has its own Excel Download for all of its loss runs.
Tips and common questions
Why didn't a matched claim's injury code change? Matched claims keep the bureau's injury code. A claim coded 9 on the worksheet stays 9. Inferred codes (15, 6 or 0) are used only for new claims that aren't on the worksheet.
Why wasn't my NO. 5 grouped row replaced? Either the loss run claims total more than $150 away from the grouped row, or not all of the group's claims were selected. Open the group row to see the claims and the difference, then select the group's row so all of its claims are approved together.
A bureau claim shows "No loss run claim" in the comparison. Why? The loss run has no claim that matches it. The claim may be on another policy's loss run, closed out by the carrier, or on pages missing from the file.
Why are my recoveries and deductibles negative? Mod Advisor stores them as negative numbers so the math reads naturally: $500 paid and -$50 recovered nets to $450. They are for display and the Excel export only. They aren't used in the mod calculation or on reports.
Can I approve low confidence suggestions? Yes, but only by selecting the rows yourself and using Approve selected rows. Check them first: hover over the status to see why the match was suggested.
The scanned data looks wrong. What should I do? Switch to As extracted to see what the scan returned, then fix the values with Edit before you approve. If the scan misread the file, re-import a clean copy from the carrier.