Requirement-mapping software

Every requirement that applies,
mapped against the evidence in the file.

Outcomer identifies every rule that applies to a case — statute, regulation, guidance and the organization’s own procedures — checks the file against each one, and produces a Case Orientation Report (COR) before the reviewer begins.

We build it for teams that review claims, complaints, financial applications and other regulated cases.

Today that work is done by hand, on every file, before anyone decides anything.

How it works

Three steps, before the reviewer opens the file.

  1. Selects the requirements that apply to this case, under the rules in force on its date.
  2. Checks the file against each requirement.
  3. Shows the evidence that answers each one, or states that the evidence is absent or conflicts.
One requirement, as it appears in a claims QA reportIllustrative
The benefit notice carried the prescribed content and was issued within the period, on the version of the requirement in force at the date of injury.
Statutory notice provision · version in force at date of injury · not the current version
Evidenced
Notice on file, dated inside the period, carrying the required content as the provision stood at the time. Tested against the standard in force when the work was done, not against today’s.
Every requirement in a report is shown this way: the requirement, its source, the version in force at the time, and what the file evidences against it — or that nothing does.

The reviewer opens the report, not a raw file.

Why it matters

Expertise spent on judgment, not on working out which rules apply.

Nothing applicable is left out of what the reviewer considers.

Every reviewer starts from the same point, whether they are your most experienced or a new hire.

Experienced people spend their time on expertise, not on assembling the requirement set.

There is a dated record of what was put in front of the reviewer, if a decision is ever questioned.

Where it applies

Configured only where a department asks for it.

We configure Outcomer for a type of review only when a department tells us it values it and wants it. Each configuration is built with that team, to their rules, and signed off by them before anything runs.

Claims and complaints teams Insurance examiners and adjusters reviewing claims against statute and their own handling standards. Medical device teams assessing complaints for reportability against FDA requirements and internal procedures.
Financial review teams Financial aid offices verifying applications and resolving conflicting information under Title IV. Financial crime teams reviewing customer and case files against AML regulation and internal policy.
Quality assurance teams Checking completed reviews against the regulatory and internal standards they were meant to meet.
Governance

Run it the way your organization requires.

Outcomer runs as a hosted service in a US region, with your data held separately from every other organization’s, or inside your own cloud environment under your existing security and identity controls. Either way, your data is never shared with or used for anyone else.

You sign off the requirement set before anything runs: every requirement, its source, and when it applies.

Every rule is date-gated. A case decided under last year’s rules is reproduced against last year’s rules, so updating the rules never changes an answer already given.

Security Hosted by us under a written data agreement, or run in your own environment where your data never reaches us. How each option works → Governance Every requirement traced to the authority that issued it, held under version control, and reproducible against the rules as they stood. How the corpus is controlled →