blueClaims manual

Anchors a proposed claims-review packet to the exact policy clauses and record evidence that earned it, and types every “not found” so a denial can never claim absence of evidence the review couldn't have found anyway.

What this product is and is not

Is: Claims shadow-review, health and P&C lanes.

Is not: blueClaims never approves, denies, pays, reserves, or alters a claim. The human adjuster is the only adjudication authority.

Who uses it

Claims adjusters and compliance leads at a payer or carrier.

Getting started — the local demo

From the product's own repository:

make dev            # one-time setup
make demo
make verify-demo

This runs entirely offline against synthetic fixtures and exits non-zero on any mismatch. It does not connect to any production data source.

Screen-by-screen walkthrough

Library — the default screen, listing claims Workbench — the claim mapped against policy clauses and evidence Evidence — typed gaps: SEARCHED-ABSENT / NEVER-SEARCHED / UNDETECTABLE-WITH-THESE-RECORDS Receipt — the signed packet and its offline verification

blueClaims Claim review library screen: the default view listing claims, with options to start a new claim from files, import prior work, or open a bundled synthetic sample. — Synthetic demo data
Library — the default screen, listing claims.

blueClaims Plan and clinical document anchors screen: three claim objects with verdicts Supported, Discrepant, and Cannot certify, with an evidence inspector showing the exact plan clause and clinical document that anchor a Supported verdict. — Synthetic demo data
Workbench — the claim mapped against the plan clauses and clinical documents that support or contradict it.

What a receipt proves

A signed receipt proves what blueClaims ran and recorded; it does not prove an underlying real-world claim is true. Anyone can check the signature offline with the standalone verifier shipped alongside the product, without installing blueClaims itself.

Known gaps, stated plainly

Library pagination at large record counts is a known, named gap.
No signed pilot yet.

FAQ

Does blueClaims make the decision for me?

No. blueClaims never approves, denies, pays, reserves, or alters a claim. The human adjuster is the only adjudication authority.

Does blueClaims replace the system I already use?

No — it is an overlay. Your existing record system, LIMS, or claims platform stays exactly where it is.