INSURER USER MANUAL Chapter 6
Contents
1. 7 User Manual LOGOUT CLAIMS Claimant Details Fill In he Teld fo Sodedh a claimant for Chim 753 MOTE All fekis wih an asterisk are required Claimant ID Od Date ofBirtn Sw tastName d EE Cee Orea FirstName SSSCS i Middle Name i y Address i fC O cy SSCS Province State ON Ontario Ay Postal ZIP Code Adjuster ag cE 2011 Heal Claims for Auto insurance Processing Privacy Polly Change Password Updating Claim Details This section describes how to update and view Claim details that have been manually entered or Claim data that was provided through an Insurer data feed To update and view Claim details 1 Navigate to the Claim in the search results list and click on the link in the Claim column The Claim Details screen opens The fields in this section are pre populated with the Claim information KOH Global Re HCA a PLANS INVOICES search MANAGE 5 5 c pr es o LocouT CLAIMANTS Claims gt Claim Search gt Claim Details for claim 55 Claim Details Fill in the fields te addvedit a daim into HCALI MOTE All fields with an asterisk sre required Insurer KOH Global Re Branch Claim Policy Policy Holder Last Name Policy Holder First Name Date of Accident 2005 07 02 SAVE CANCEL DEACTIVATE 9 Insurer Manual Chapter 6 HCA Health Claims for Auto Insurance 2 Edit the a Claim Numb2. gt Claimant D 0 8 PAdjuster Branch iInDispute Status Zizou 1971 06 23 Cisse Djibril Rockwood Deactivated Add Claimant ADD CLAIMANT 2013 Health Claims for Auto Insurance Processing Privacy Policy Change Password The button is enabled only when all the Claimants associated with a Claim have been deactivated The LLJ button is enabled when a Claim is deactivated 12 Insurer Manual Chapter 6 HICIA Health Claims for Auto Insurance Claimant Management The Claimant management functionality is accessed from the Claimants sub tab which is accessible from the Insurer home page if you have the Claim Claimant Administrator or Plan Invoice Manager role Claimant Management enables search update add deactivate reactivate Claimant s functionality The ability of Users to perform these tasks depends on the roles they have been assigned in HCAI For more information on task authority and User roles see Chapter 10 Insurer User Management When you successfully add a new Claimant HCAI performs a check against all unmatched documents and attempts to match them with the new Claimant The following matching criteria are used Policy number or Claim number Date of Accident Gender and Date of Birth Documents that match are displayed in the Associated Documents section at the bottom of the Claimant Details screen Click on the Claimant in the Claimant Name column of the Claimant search results list to proceed
3. Branch O Higgins Zidane Zinedine Francesca zizouls 1946 0212 Acton View Add Claimant ADD CLAIMANT 2013 Health Claims for Auto Insurance Processing Privacy Policy Change Password 11 Insurer Manual Chapter 6 Hea Health Claims for Auto Insurance Deactivating Reactivating a Claim You can deactivate reactivate a Claim from the Claim Details screen To deactivate or reactivate a Claim Search for the desired Claim Click on the Claim in the Claim column of the search results list to proceed to the Claim Details screen Click either the or button at the top of the screen KOH Global Re HCA plans invoices SEARCH MANAGE 7 User Manual CLAIMANTS Claims gt Claim Search gt Claim Details for claim 55 Claim Details Fill in the fields to add edit a claim into HCAI NOTE All fields with an asterisk sre required Insurer KOH Global Re Branch Rodwood came id Poley Poy Hole Last Name Poicy Hote Frst Name Date of Accident 2503 97 02 lt dr State Status Active Latest Version 1 Activity Log Activity Log 1 of 5 View 2 items E 12345 Next gt Date amp Time Description Actor 2013 01 29 15 06 Claim information retrieved Benitez Rafa 2013 01 29 15 02 Claim information retrieved Benitez Rafa 2011 07 06 15 02 Claim information retrieved Benitez Rafa Vew Associated Claimants Associated Claimants 1 of 1 View _
4. and change the status to Active 20 Insurer Manual Chapter 6 HCA Health Claims for Auto Insurance To deactivate reactivate a Claimant from the Claim Details screen Click on the Claimant s name in the Claimant Name column of the search results list to proceed to the Claimant Details screen Click the BEL button at the top of the screen to deactivate an active Claimant The button is enabled only when all of the documents associated with a Claimant have had an Adjuster s response recorded against them Click the button at the top of the screen to activate a deactivated Claimant KOH Global Re HcCe D Plans mvoices F SEARCH GE User Manual Oooo a FLocour CLAIMS Claimant Details Fill in the fields to add edit a claimant for Claim 189_sbv_099 MOTE All fields with an asterisk are required OoOO Date of Birth F la Gender Mae Female First Name Zinedine poe ee Middle Name Address Finch City Toronto Province State ON Ontario PostaliP Code MEV 4t5 Adjuster O Higgins Francesca SAVE CANCEL DEACTIVATE Activity Log 1 of 3 View 3 items 2013 06 05 09 01 Claimant information retrieved Benitez Rafa 2013 08 05 08 16 Claimant information retrieved 2 Benitez Rafa 2013 01 20 09 12 Claimant information retrieved z2 Benitez Rafa View 2 items l Associated Documents Documents associated with Zidane Zinedine 1 of
5. button If the plan or invoice has not been automatically matched by HCAI you are taken directly to the Match Claimant screen 22 Insurer Manual Chapter 6 DGO Health Claims for Auto Insurance Match Claimant T CANCEL Current Branch Information Transfer Document Switch the branch of the document Select a new insurer andlor branch to transter the doucment Insurer HCAS Test Insurer IneuUrer HCl Test Insurer Branch 123 Branch 123 Claimant Match The system has determined 1 potential claimants Please match the applicant to a list of known claimants or search for one inthe system SEARCH FOR CLAIMANT Submitted Applicant Possible Match Lees Nein Mackinnon There is no associated claim CREATE CLAIM First Mame Andrew l Middle Mame Applicant cannot be matched with any claimant Forward tor Gender Male oora Address 330 Mcecowan Road m J7 City Scarborough Last Name Mackinnon Province OM First Mame Andrew Postal Code WJ 3M2 Middle Marne Claim Mumber 789 Gender Male Policy Holder Date of Bith 1963711730 First Mame Address 330 MceCoywrtan Aad Policy Holder City Scarborough Last Mame Province ON Policy Mumber 759 Postal Code MiiJ 3M2 Date Of Accident 2006 09 05 Claim Mumber 789 Policy Holder First Mame Policy Holder Last Mame Policy Number 7859 Date Of Accident 2006 09 07 Andrey Mackinnon If you are satisf
6. of any Claimant who has not yet been associated with an Adjuster The lt Assign Adjuster gt text link that appears here leads to the Claimant Details screen where you can assign a new Adjuster to the Claim KOH Global Re HCA Dp INVOICES AIMS SEARCH MANAGE User Manual ein A Forms EJ 2 Advance LOGOUT CLAIMS Claims Claimant Search General Hotification hic The following tems need your attention Diaz Carmen has not been associated with an adjuster Please assign an adjuster Assign Adjuster Miller Janice has not been associated with an adjuster Please assign an adjuster Assign Adjuster Hood Salmon has not been associated with an adjuster Please assign an adjuster Assign Adjuster 3 Insurer Manual Chapter 6 HICIAH Health Claims for Auto Insurance Searching for a Claim Claim Search screen Click the Claims tab at the top of the Insurer home page The Claim Search screen appears by default You can enter search criteria in the fields provided To search for a Claim enter data in any of the following fields Claim If known the Claim number returns the exact Claim for which you searched Policy If known the policy number returns the exact Claim for which you searched Date of Accident Enter the date of accident in YYYY MM DD format or use the icon to engage the calendar feature Policy Holder Last Name and First Name The Policy Holder First Name field ca
7. the Adjuster chosen click Diin Deactivating Reactivating a Claimant To deactivate reactivate a Claimant from the Claim Details screen If a Claimant s status is active the adjacent button is Search for the Claim that is linked with the desired Claimant as described in Searching for a Claim in Chapter 6 Click on this Claim in the Claim column of the search results list to proceed to the Claim Details screen Activity Log Activity Log 1 of 5 Ta 12345 Next gt Date amp Time Description Actor In Dispute 201301 29 15 06 Claim information retrieved Benitez Rata 2010129 15 02 Claim information retrieved Benitez Rata 2011 07 06 15 02 Claim information retrieved Benitez Rata View 2 items Associated Claimants Associated Claimants 1 of 1 4Claimant Name Claimant FD 0 68 Adjuster FAranch Fin Dispute Stat Zidane ee ol Ble Ci jibri ockwo act ACTIVATE E Zizou 1971 06 23 Cisse Djibril Rockwood Deactiv ACTIVATE View 5 items Add Claimant ADD CLAIMANT 2013 Health Claims for Auto Insurance Processing Privacy Policy Change Password DEACTIVATE Click this button to deactivate the Claimant and change the status to Deactivated You can deactivate a Claimant only if all of the documents associated with that Claimant have been adjudicated If a Claimant s status is deactivated the adjacent button is ACTIVATE Click this button to activate the Claimant
8. to the Claimant Details screen The fields are pre populated with the current Claimant data KOH Global Re I HCA MANAGE 7 User Manual PLANS INVOICES LA 5 IRCH TA C pvences LOGOUT All Forms S v Exae Claims gt Claimant Search gt Search Results Claimants Claimants Search 1 of 4 Claimant Results for Claimant Status Active Claimant Insurer Name KOH Global Re aClaimant Name eT FD 0 8 Phone Cech Peter 11 1246 0216 Refine Search View 5 items P Adjuster Branch F Status Heassion O Higgins Francesca Acton Active Cruz Penelop 1992 or 4 048 Mascherano Javier Moffat Active Diaz Carmen 1SP2 0890 905 222 2272 Acton Active Ferguson Alex 19841 12431 Keane Robin Rockwood Active Barrie Active View REASSIGN ADJUSTER To reassign claimants from this page you must refine your search Either you have not selected a branch or there are no Claimants that match the current search criteria Hood Salmon 197 F060 Reassign to Adjuster 2013 Health Claims for Auto Insurance Processing Privacy Policy Chan Documents associated with a Claimant For your convenience you can sort the documents associated with your Claimant which are listed in the bottom of the Claimant Details screen by clicking on the column header of the fields displayed i Documents associated with Diaz Carmen 1 of 3 Showing associated documents which are active To
9. 2 Showing associated documents which are active To show archived documents click Show Archived Documents View 3 tems Document Facility aD te Subr itted gt Status In Di 12097900002 Health 4 Life Approved 12011700008 Health 4 Life 2013101 117 Approved 12050500001 Health 4 Life 20120509 Approved 2073 Health Claims for Auto Insurance Processing Privacy Policy 21 Insurer Manual Chapter 6 HICIADI Health Claims for Auto Insurance Matching Claimant Details Linking Claimants with Documents lf there is a perfect match between the applicant details specified by the Facility and the Claim and Claimant details recorded in HCAI by the Insurer HCAI links the information and documents automatically so there is no need for Users to match documents to Claimants A perfect match occurs when the following data elements match between the information provided by the Facility and the information provided by the Insurer Either the policy number or the Claim number matches Facility leaves the other one blank Date of Loss Accident Date of Birth Gender However if the Facility does not leave the other one blank either the policy or Claim number and enters some information that is not matched HCAI will cross match the Claim and policy number The cross match allows for the following additional matches If either the Policy number of Claim number match the other one need no
10. 85 4 iri Date Submitted 2011 02408 Date of Accident 20080615 25 Source Web OCF Effective aan nan Date 20100001 Part 1 Applicant Information Mote This Document amp owned by Claimant Details UPDATE CLAIMANT DETAILS Claimant Information on Form Insurer Claimant Information Date of Birth 1540 12 31 Date of Birth 1340 12 31 Genders yom D Femaie Gender Mak Femde Last Name Ferguson Last Name Ferguson First Name Alex First Name Alex Middle Mame Middle Name Address 1 1888 Gowan Fark Address 1 1288 Gowan Park Address 2 Address 2 City Toronto City Toronto Province State ON Ontario Province State ON Ontario Become WG 261 Se MAG 2Gi Phone Phone Update the Claimant information in HCAI and click to accept your changes HCAO 7 User Manual Ss H Exact Locour Claimant Details FII in he Tels b addek a claimant tor Calm 1933 MOTE All Tekis wih an asterisk are required Claimant ID Date of Binh V2 LastName Pega O OO O O o Ora First Name ee ee ae wase nsee OOO Po A Province State O ontario Postal ZIP Code iia 25 Insurer Manual Chapter 6
11. ADD CLAIM Search for Claims Enter vour search criteria and click Search Raman Policy Holder Last Mame oOo O O d Exact Match Policy Holder First Mame Insurer Branch d Active Claim Status LI Deactivated 2013 Health Claims for Auto Insurance Processing Privacy Policy Change Password 2 Insurer Manual Chapter 6 HICIA Health Claims for Auto Insurance Working with Claim and Claimant Notifications The General Notification Area is located in the upper part of either the Claim Search or Claimant Search screen and is available only to Users who have been granted the Claim and Claimant Administrator or Plan invoice Manager roles If you are responsible for Claim and Claimant administration the General Notification Area displays Claims that do not have any associated Claimants The lt Add Claimants gt text link that appears here leads to the Add Claimant screen From the Add Claimant screen you can add a Claimant KOH Global Re a INVOICES IMS search Y MANAGE b 7 User Manual aaa i AIT Fors ES EE advanced LOGOUT CLAIMANTS Claims Claim Search General Notification The follaying tems need your attention 1 Claim 156354 12K does not hawe any claimant please Add Claimant Add a Hew Claim To add a claim into HOAI click Add Claim ADD CLAIM If you are responsible for assigning Adjusters the General Notification Area displays the name
12. First Hame fo OS Phone Number Middle Name Adaress Po Bosiaze coss OOO Adjuster SAVE CANCEL 2011 Health Claims for Auto Insurance Processing Privacy Policy To add a new Claimant 1 Enter the Claimant ID This identifier is provided by the Insurer and is unique within the Claim Enter the Claimant s last first and middle name in the respective fields Specify the Claimant s address and city of residence in the respective fields Select the province of residence from the respective drop down list This list defaults to Ontario Specify the Claimant s postal code Dab N Select an Adjuster to manage the Claimant from the Adjuster drop down list This list contains only active Adjusters and is restricted by your access domain Enter the Claimant s date of birth in YYYY MM DD format or use the calendar function Select the gender of the Claimant Enter the Claimant s phone number 10 Click to save the new Claimant details If any information is missing or invalid you are returned to the Add Claimant screen An error message appears in the error list at the top of the screen referring you to the field s in error 11 Click to clear the Claimant details you have entered In the confirmation dialog box click lt Yes gt or lt OK gt A Note All fields with an asterisk are required 16 Insurer Manual Chapter 6 HCA Health Claims for Auto Insurance When yo
13. SAVE Claim Identtier Return this fommi to Invoice bdentifier int Hame Flach Fiet KOH Gibal i i ae Claim Number 2240 RR 1 Number Folicy Number FR211 Moffat Ontario Invoice Number Date of Accident 200S 06 17 LIP 1 0 OCF Type 21E Date Submitted 200G 07 03 Source Web Part 1 Applicant Information Mote This Document is owned by Claimant Details LINK CLAIMANT DATA Claimant Information on Fonn HA TOW Gander s se Last Name First Name Middle Name Address 7 Address 2 City Province State Fostal ZIP Code MIV 9V9 Phone To unlink Claimant data and look for another match m Click the petite ta Me i button on Tab 1 The Insurer Claimant information disappears and the FEJA button appears at the top of the Applicant Information section Click the BEAG button near the top of Part 1 Applicant Information section This takes you to the Claimant Match screen where you can search for a proper match 24 Insurer Manual Chapter 6 HCA Health Claims for Auto Insurance To update Claimant information Click the Cienibusibbstciesbe button that appears at the top of the Applicant Information section The Claimant Details screen opens e a HCAH i 2 3 Ys 1e User Manual F _ _ _ CANCEL PRINT SAVE Claim dentifier Plan bdentitter Applicant Name Ferguson Alex Document Number 11020200027 Claim Number 1599 j OCF Type 18 Policy Number AF_
14. The search results list is numbered and can be sorted Depending on the search criteria used the search may return a single result or multiple results The items can be sorted in ascending or descending order based on field type by clicking on the highlighted header of the column by which you wish to sort To return to the Claimant search form click on the lt Refine Search gt text link above the search results list Adding a New Claimant Only Users who have the Claim and Claimant Administrator and or Plan Invoice Manager roles can add Claimants To create a Claimant manually you must use the Claimant Details screen To open the Claimant Details screen 1 Select the Claims tab on the Insurer home page This defaults into the Claim Search screen 2 Search for the desired Claim and click on the Claim number link in the Claim column of the search results table This takes you to the Claim Details screen 3 Click ADD CLAIMANT in the bottom of the Claim Details screen The Add Claimant screen appears 15 Insurer Manual Chapter 6 H CIAH Health Claims for Auto Insurance KOH Global Re HCAO PLANS INVOICES CIAS j SEARCH MANAGE User Manual Claims gt Claimant Search gt Add Claimant gt Claim 556 Claimant Details Fill in the fields to add edit a daimant for Claim 556 MOTE All fields with an asterisk are required claimant iD OO O Date of Birth stastne OOO E Ou Orea
15. WGO Health Claims for Auto Insurance INSURER USER MANUAL Chapter 6 Claim amp Claimant Management HICIA i T AE EE Chapter 6 Claim amp Claimant Management OVERVIEW HCAI delivers a standard solution for collecting and processing Claims data for the automotive insurance industry HCAI manages the basic Claim data and the associated Claimant information to ensure plans invoices and Adjusters are associated with the correct Claimant Both the Facility and Insurer can manage this information in a way that enables them to accomplish their daily business goals without undue delay HCAI can accept both manual and data feed driven updates to Claim and Claimant information with the information from the Insurer feed considered authoritative The option to manually handle Claim and Claimant information is available and is designed to support Insurers who decide not to provide Claim and Claimant data feeds Only Users who have the Claim and Claimant Administrator role have access to the Claim and Claimant Management component of HCAI CLAIM MANAGEMENT ssicastsntsasnsnonstannianiasacesendandanenantasnrdcactiivndaandasand oudaubsanesaceadeudaddadaendadiaiedis iamedssesdnotdveiaastuies 2 WORKING WITH CLAIM AND CLAIMANT NOTIFICATIONS 0cccecccececeeeceeeeeeeceneeeneeeneeeneeeneeeeeeeeneeeeeeeneeeteeeeeeeees 3 SEARCHING FOR A CLAIM cei ceettentsercttee eects gtetiecatettaaccttnae adnan edene cieeedenateeanncniataeecaceeiaeacigeacec
16. aten 15 ADDING A NEW CLAIMANT ssactcsscivsconcicxnvecsaczvntestsnacdesestxcoostcwe bues de uicpsstdanedautciucoodeduckonnsceeveustdusetaxtcsucectteuetbesees 15 UPDATING CLAIMANT DETAILS ccccccsecccsescceceseueecesecceseneueeueuenseuaesuueneueeceueeseuansauaneueeneuensevanseuaneusseuuesaevenss 17 BATCH TRANSFER OF CLAIMANTS tesiewi cdsicaiceea cna See idan Nenndanissdateltotiocsa chen dniedban Susadussadunbdactuee duces due diauleseduntedeeauaes 18 DEACTIVATING REACTIVATING A CLAIMANT c cceccceeccceeseeceneeeneeeueecneeeneeeaeeeeeeaeeuseeuaeeneenaeeneeseeesteeeteesteesees 20 MATCHING CLAIMANT DETAILS LINKING CLAIMANTS WITH DOCUMENTS ecececececcececececececcacacececececeaeacecs 22 HCA Health Claims for Auto Insurance Claim Management The Claim Management component includes the following topics searching for Claims updating Claim details adding new Claims deactivating reactivating Claims The User s ability to perform these tasks depends on his her roles To open the Claim Management component select the Claims tab at the top of the Insurer home page The first screen that appears is Claim Search KOH Global Re HCA INVOICES Mac MANAGE SS Manual a i B k CLAIMANTS Claims Claim Search General Hotification The following tems need your attention 1 Claim 156364 42K does not hawe any claimant please Add Claimants Add a Hew Claim To add a claim into HCA click Add Claim
17. atendsaasiasedeeutadne ance 4 Get ges e 2 6 c e 2 9 eae a re ee ae eee oe ee ee a eee ee a ee ee ee ee 4 Claim Search Search Results Screen ciacccssassadecncsicacacatnadacsdsncsennideaducesrecatessdendsdxbsnaneanadeadacbsancudensdaadcas 5 Soning ihe Sedih RESUS cheep ocecesnase PajessecGsesashal e nn Tiai iie ioan 5 nevera ages OF RESUS seisein na E S EEE O ES E E ENOCE 6 To Return to the Claim Search FOM cccccccceccccccccccsceeceeeeceeeuseueceeauceeeueaueueeuaueeaaeeeaueeueueeueueeaeusaneanauss 6 ADDINGA NEW CLAIM sencia rrisnin erin ra IE EEEE AIE ine Ea a 6 UPDATING CLAIM DETAILS sacascursenariacabbesnsunths acdeisaensnad iamiivbiauedvushadnduibiasaanaiiaadiisiaagdeubbisadudhiaecanissidadihiasaieont 9 DEACTIVATING REACTIVATING A CLAIM scssscssscssenesecerensuensuensuensuensuensuenusecuaeeuaeeuaeeuaessaessaesaaenanesaaesanenaassas 12 CLAIMANT MANAGEMENT ccccecccccsceeeeccceseeueeceeeeeeeuuceeeeeueusceeueuaeuseeeeeeaeuueeeseuaeuueeeseuueaeeeesuauueeeeeeeueeeeeenens 13 Documents associated with a ClaiMant cc cece cccccceceeeeceeeeseeeeseueeeeeeeeeeuseseueeueueeuaeseaaeueeusenaueeneeeenes 13 SEARCHING FOR A CLAIMANT cccccccceeeeccccseeueecccesceueeueeeeeuueuuceuseuueuseeeseuueuseeeueuueaeeeeeuueaeeeueuauuseeeseuueeeeeeeens 14 Cl imant Search FIC SUNS sirere E RAE O EAA Rie kEi esee Eiei 15 To Return to the Claimant Search FOM xicccsccssisexirscvecenvsatcesiveduicenesiaubnecvpnenteaveesGcndeteeweaieaubnedensouce
18. er Policy Number Policy Holder Last Name Policy Holder First Name and Date of Accident fields Click to save the changes you have made In the confirmation dialog that appears click lt Yes gt or lt OK gt OR Click to cancel the changes you have made In the confirmation dialog that appears click lt Yes gt or lt OK gt The screen is reloaded to display the original Claim information KOH Global Re HCA D F User Manual Og a Faers toh co Asvance Losour CLAIMANTS Claims gt Claim Search gt Claim Details for daim 55 Claim Details Fill in the fields to add edit a claim into HCAI NOTE All fiekts with an asterisk are required Insurer KOH Global Re Branch Rockwood Claim Policy Policy Holder Last Name Policy Holder First Name Date of Accident CANCEL DEACTIVATE State Status Active Latest Version 7 Activity Log Activity Log 1 of 3 Date amp Time Description 20110302 16 30 Claim information retrieved Benitez Rafa 2200910 003 15 24 Claim information retrieved Beneer Jill 2005 10 08 15 19 Claim information retrieved Beneer Jill S00D 08 27 08 56 Claim information retrieved Cisse Djibril 2009008 277 08 53 Claim information retrieved Cisse Djibril View gt items If this is not the first time the Claim is being updated the Activity Log displays a list of previous updates to the Claim To view any of the previous update
19. er The items can be sorted in ascending or descending order based on field type by clicking on the highlighted header of the column on which you wish to sort Several Pages of Results If your search results comprise several pages you can use the numbered links located on the right above the search results list to page through the entire set of results To Return to the Claim Search Form To return to the Claim search form click the lt Refine Search gt text button above the search results list Adding a New Claim Only Users with the Claim and Claimant Administrator role can add new Claims in HCAI Claims can be created manually in the Claims Claims Search screen Note that in the event that an OCF is received for a Claim that has been archived HCAI allows for the creation of a duplicate Claim KOH Global Re 3 HCA PLANS INVOICES gt S SEARCH MANAGE lt Ar bey iN A Forms 2 Va co peee LOGOUT CLAIMANTS Claims Claim Search General Notification The following tems need your attention No records were found Add a New Claim To add a daim into HCA click Add Claim ADD CLAIM Search for Claims Enter your search criteria and click Search Date of Accident Policy Holder Last Name Po Exact Match Policy Holder First Name sid Insurer Branch LJ active Claim Status L Deactivated 2011 Health Claims for Auto Insurance Processing Privacy 6 Insurer Manual Chapt
20. er 6 HICIAH Health Claims for Auto Insurance KOH Global Re HCAO PLANS INVOICES q z k SEARCH MANAGE 7 User Manual a Claims gt Claim Search gt Add Claim Claim Details Fill in the fields to add edit a daim into HCA NOTE All fields with an asterisk are required Branch Poiey HoiderLastnane O0 S ee je 6 2011 Health Claims for Auto Insurance Processing Privacy Policy t 1 Click the button located in the Add a New Claim section of the Claims Claim Search screen The Claimant Details screen appears 2 Select a required Insurer from the Insurer drop down list The set of Insurers available for selection is determined by your domain 3 Specify the Claim number policy number and policy holder s first and last name in the respective fields lt 4 Enter the date of accident in YYYY MM DD format or click on the calendar feature icon to engage the 5 Click SAVE If any information is missing or invalid an error message appears at the top referring you to the field in error Successfully saving the information brings forward the three sections described below State This section shows the status of the Claim and its latest version When you create a new Claim the status is Active and the latest version is 1 Activity Log This section contains a list of activities associated with the current Claim It shows Date amp Time
21. er Manual PLANS CLAIMANTS Claims Claims Search 1 of 1 Refine Search Claim Results for Policy Holder Last Name Diaz KOH Global Re 10 items 2011 Health Claims for Auto Insurance Processing Privacy Policy A search based on criteria other than a specific Claim number may return multiple results KOH Global Re a dk PLANS ji INVOICES SEARCH MANAGE F User Manual CLAIMANTS ims gt Claim Search gt Searct Claims Claims Search 1 of 2 Refine Search Claim Results for No search criteria View 10 items Date e Poli Policy Status 2005 0618 D Diaz Carmen Active KOH Global Re 2005 05 04 42 bail Shannon Active KOH Global Re 2008 09 27 Nash Rob Active KOH Global Re 2005 06 01 Miller Janice Active KOH Global Re 2005 07 01 Cruz Penelope Active KOH Global Re 2005 06 15 Ferguson Alex Active KOH Global Re 2010 05 01 Lampard Frank Active KOH Global Re 2008 06 23 Ronaldo Active KOH Global Re 2005 07 02 Zidane Zinedine Active KOH Global Re 2009 10 14 Dudko Jack Active KOH Global Re View 10 items 42 Next gt amp 2011 Health Claims for Auto Insurance Processing Privacy Policy 4 5 Insurer Manual Chapter 6 HICIAH Health Claims for Auto Insurance Sorting the Search Results When working with a large number of search results you can sort the results using different criteria The default sort order is alphanumeric ascending by Claim numb
22. he respective drop down list The set of Adjusters visible is restricted by the User s domain Insurer Select the Insurer from the drop down list Select the desired Branch from the drop down list Click ES KOH GlobalRe O O O OO HCAO User Manual LOGOUT General Notification The following items need your attention No records were found Search for Claimants Enter your search erker and click Search Date of Accident Oooo O FirstName i s i d soss OOO oS Postal Code Sd Adjuster Claimant Status Places 2011 Healih Claims for Auto insurance Processing Prvacy Palicy Change Password 14 Insurer Manual Chapter 6 HICTAR Health Claims for Auto Insurance If there are no Claimants that match your search criteria or if any of your search criteria is invalid HCAI provides a notification message and you are returned to the Claimant Search form If your search criteria are validated you proceed to the Claimant Search Results screen KOH Global Re H PLANS INVOICES CH s 7 User Manual r 4 LOGOUT Claimants Claimants Search 1 of 1 Refine Search Claimant Results for Claimant Last Name zidane View 10 Rems n F Claim F DOB F Adjuster H Branch P Status Zidane Zinedine 55 1ST ives Cisse Djibril Rockwood Descttiveted View 10 Rems 2011 Healt Claims for Auto merak Processing Pre Claimant Search Results
23. ied with one of the possible matches presented by HCAI click the HAE button next to the respective item This takes you back to the OCF from which you accessed the Match Claimant screen and the OCF is now linked to the Claimant When the Possible Matches section does not contain the Claimant you are looking for you must decide whether to search for the Claimant or to create a new Claim and Claimant to which the document can be linked Should you want to search for the Claimant click the button This takes you to the Claimant Search screen where you can specify your search criteria When the Claimant search produces a possible match that you want to link to the Claim click on the button to complete the link and return to the original OCF If based on the search criteria entered no potential Claimant matches are found you are then returned to the Claimant Search screen where you can try another Claimant search cancel the matching attempt or create a new Claim and Claimant in HCAI to link with the document 23 Insurer Manual Chapter 6 HCA Health Claims for Auto Insurance CREATE CLAIM If you want to create a new Claim to match to the document click the button and proceed to add a new Claim from the Claim Details screen If HCAI has made an automatic match that you want to change you can unlink the document from the Claimant and make a manual match Review OCF21B EZART ra OOO F j ge CANCEL PRINT
24. nnot be used to search unless you also use the Policy Holder Last Name field Insurer Select the Insurer with which the Claim is associated from the Insurer drop down list Branch Select the branch with which the Claim is associated from the branch drop down list Specify the status of the Claim by selecting Active or Deactivated using the checkbox Active Claims are those still being worked on in HCAI deactivated Claims are those that have been concluded in HCAI Click EE KOH Global Re a E CLAIMANTS i Claims Claim Search General Hotification The following tems need your attention Mo records were found Add a Hew Claim To add a claim into HCAI click Add Claim ADD CLAIM Search for Claims Enter your search criteria and click Search Date of Accident we Policy Holder Last Mame d Exact Match Policy Holder First Hame Po Insurer Branch Active T Deactivated _ 2013 Health Claims for Auto Insurance Processing Privacy Policy Change F Claim Status 4 Insurer Manual Chapter 6 HICIA Health Claims for Auto Insurance Claim Search Search Results Screen The search results list is numbered and can be sorted by clicking on the column headings If your search is based on the Claim number the search displays all the Claims that begin with that particular Claim number KOH Global Re Hai a INVOICES F SEARCH MANAGE k Us
25. on Batch Transfer of Claimants Individuals with either the Plan Invoice Manager or Claim Claimant Administrator role have the ability to use the Reassign Adjuster feature in batch Multiple Claimants can be transferred from one Adjuster to another at the same time This feature is commonly used to reassign Claimants when an Adjuster leaves the company or takes on a new role To transfer multiple Claimants from the Claimants gt Claimant Search Results screen 1 Navigate to the Claims gt Claimants sub tab KOH Global Re HcCe d PLANS gt invoices 7 A SEARCH MANAGE User Manual i z i r Sa CLAIMS 18 Insurer Manual Chapter 6 HCA Health Claims for Auto Insurance 2 Apply your search parameters in the relevant fields viz Insurer Branch and or Adjuster in the Search for Claimants section then click SEARCH To reassign the Adjuster Branch must be selected KOH Global Re HCA PLANS INVOICES gt D SEARCH MANAGE gt User Manual CLAIMS Claims gt Claimant Search General Notification The following items need your attention No records were found Search for Claimants Enter your search criteria and click Search Date of accidet M LastName Cleans FirstName o bateot5it OOo A Insurer KOH Global Re Branch Acton j CJ Desctiveted 2012 Health Claims for Auto Insurance Processing Privacy Policy Change Passw
26. ord 3 A list of Claimants associated with the specified Branch or Adjuster depending on what has been specified when executing the Claimant Search will populate the Search Results KOH Global Re HCA PLANS INVOICES gt h SEARCH MANAGE 7 User Manual a a foo ftocour CLAIMS Claims gt Claimant Search gt Search Results Claimants Claimants Search 1 of 1 Refine Search Claimant Results for Claimant Insurer Name KOH Global Re Claimant Branch Name Acton Claimant Adjuster Name Degas Alberto gt Adjuster Carroll Roy 1974 01 29 Degas Alberto Diaz Carmen 1972 03 30 Degas Alberto Kolbe Maximillian 1918 11 30 Degas Alberto Lampard Frank 1977 09 01 Degas Alberto Raeb Pete 1973 06 22 Degas Alberto Ronaldo Cristiano 1985 02 05 Degas Alberto Zidane Zinedine 1986 07 08 Degas Alberto Reassign to Adjuster Degas Alberto REASSIGN ADJUSTER eee Select s New Adjuster Degas Alberto DeGut Melanie Eet Johnny Auto Insurance Processing Privacy Polic gt ange Password 19 Insurer Manual Chapter 6 HICIAH Health Claims for Auto Insurance At the bottom of the Search Results list use the drop down list to select an Adjuster to whom the Claimants should be reassigned In the Reassign column check the box for each Claimant that needs to be assigned to the specified Adjuster Once you have selected the Adjuster and specified which Claimants should be reassigned to
27. s click on the link of the desired version in the Version column A pop up window appears containing the selected version of the Claim details 10 Insurer Manual Chapter 6 HCA Health Claims for Auto Insurance Associated Claimants List In the bottom part of the Claim Details screen there is a list of the Claimants associated with each specific Claim The items in the list can be sorted in ascending or descending order based on field type by clicking on the highlighted header of the column that you wish to sort KOH Global Re H CA g PLANS INVOICES SEARCH MANAGE al T CLAIMANTS _ Claims gt Claim Search gt Claim Details for claim 189_abw_099 Claim Details Fill in the fields to add edit a daim into HCA NOTE All fields with an asterisk are required Insurer KOH Global Re Branch Claim 189_sbw_099 Policy 8795 Policy Holder Last Name Zidane Policy Holder First Name Zinedine Date of Accident oyyonaya ka Status Active Latest Version 1 Activity Log 1 of 2 Date amp Time Description 2013 01 30 09 05 Claim information retriewed Benitez Rafa 2013 01 30 09 02 Claim information retrieved Benitez Rafa 201301 29 15 33 Claim information retriewed Benitez Rata 2013 01 29 15 32 Claim information retriewed Benitez Rafa 2012 0912 10 54 Claimant added Benitez Rata View Associated Claimants Associated Claimants 1 of 1 Claimant D O B Adjuster
28. show archived documents click Show Archived Docul Associated Documents Document Facility 4 Date Submitted Status In Dispute 02063000002 05063000014 11020200024 11030200018 11030300080 Kian Clinic Kian Clinic Kien Clinic Kian Clinic Kian Clinic 20090830 S005 0830 201 1 0208 20110302 2011 0303 Review Required Review Required In Discussion Response Sent Review Required Decdined View S items ie 2013 Health Claims for Auto Insurance Processing Privacy Policy Change Password Insurer Manual Chapter 6 HICIAH Health Claims for Auto Insurance Searching for a Claimant To search for a Claimant In the Claimant Search screen specify the Claimant status Active or Deactivated and any of the following criteria Date of accident Enter the date of the accident in YYYY MM DD format or use the icon to use the calendar feature Claimant last name and first name The Claimant Last Name field must contain at least two characters The Claimant First Name field cannot be used to search unless you also use the Claimant Last Name field Claimant date of birth Enter the date Claimant phone number Enter at least the area code and the prefix i e the first three digits of the number Claimant postal code Enter at least the first three characters of the postal code Adjuster Select the Adjuster associated with the Claimant from t
29. t Details UPDATE CLAIMANT DETAILS Claimant Information on Form Insurer Claimant Information Date of Birth 18411231 Date of Birth 1941 12 31 Gender hale Serie Gender Male Last Name Ferguson Last Name Ferguson First Name Alex First Name Alex Middle Name Middle Name Address 1 1986 Govan Park SA aati lle Address 1 1966 Govan Park Address 2 Address 2 City Toronto City Toronto Province State ON Ontario Province State ON Ontario PostaVZIP Code M4G 261 PostalZiP Code M46 261 Phone Phone 17 Insurer Manual Chapter 6 HCA Health Claims for Auto Insurance KOH Global Re HCA a al eI PLANS INVOICES SEARCH MANAGE b 7 User Manual 7 t Search gt Claimant Details for Ferguson Alex gt Claim 1999 Claimant Details Fill in the fields to addvedit a daimant for Claim 1999 MOTE All fields with an asterisk are required Claimant ID Ferg Date of Birth 1241 12 31 Last Name Ferguson Gender Male Female First Name Alex Phone Number fe Middle Name Address 1988 Govan Park City Toronto Province State ON Ontaria PostalZIP Code M46 261 Adjuster Gudjennson Edith SAVE CANCEL Note The Claimant ID must be unique for each Claimant Click to save the changes you have made If you are not satisfied with your changes click CANCEL The screen refreshes to display the original Claimant informati
30. t be matched and need not be blank Policy number that is set up by the Insurer matches the Claim number that is set up by the Facility Claim number that is set up by the Insurer matches the policy number that is set up by the Facility When the cross match rules are initiated and a match is made for a submission that is not exact the following warning message is provided for the Adjuster in receipt of the form Please review the matching of Claim Claimant and un match if incorrect This warning will display until the form changes from a Submitted state to a Review Required state Organizations containing more than one insurance company as part of their structure or more than one branch may have forms that are misdirected by the Facility to a Branch or Insurer in error If the form is a match with one of the group of companies or another Branch of the company HCAI will search the organization structure for a match and upon discovery will match the form If the form has incorrect information and is Unmatched it will stay in the unmatched bucket of the Branch to which it was submitted until a match can occur The Claimant matching functionality can be accessed only if you have been assigned the role of Plan Invoice Manager To match a Claimant with a plan or invoice Open a plan or invoice with Unmatched status from the Work In Progress work list on the Insurer home page using the Review Form B
31. u successfully add a new Claimant HCAI performs a check against all unmatched documents and attempts to match them with the new Claimant The matching criteria used are the policy number or Claim number date of accident gender and the date of birth If any documents are found that match they display in the Associated Claimants section at the bottom of the Claimant Details screen Updating Claimant Details This section describes the process of updating and viewing Claimant details that have been provided either through an Insurer s data feed or created manually You can update a Claimant associated with a specific Claim in the Claimant Details screen To update Claimant details Open the Plan that belongs to the Claimant whose information you wish to update UPDATE CLAIMANT DETAILS Navigate to Part 1 of Tab 1 in the selected Plan and click on the button Edit the content as required in any of the available fields Review OCF18 HCAR SUMMARY an ACK 3 7 User Manual r k _ a CANCEL PRINT SAVE Claim identifier Retum this form to Plan Identifier Applicant Name Ferguson Alex KOH Global Re Document Number 11020800026 Claim Number 1999 1999 Eramosa Rd OCF Type 18 Policy Number AF_ 36 Rockwood Ontario Date Submitted 2011 02 08 Date of Accident 2009 06 15 R26 2R1 Source Web OCF Effective Date 2010 09 01 Part 1 Applicant Information Note This Document it owned by Claiman
32. when the activity occurred Description the type of activity Version In Dispute and Actor the author of the activity Associated Claimants This section shows a list of Claimants associated with your Claim When you create a new Claim the list contains no records see next page 7 Insurer Manual Chapter 6 HICIA Health Claims for Auto Insurance HCAR 7 User Manual LOGOUT CLAIMANTS The claim has been successfully added Claim Details Fill in he felis fo addled a claim Into HAL NOTE All fekis wih an asterick are required insurer KOH Global Re Branch Cudo Claim Policy Policy Holder Last Name Policy Holder First Name Date of Accident 196115 Sit cga CANCEL DEACTIVATE Activity Log Activity Log 1 of 1 View 10 Rems Date amp Time in Diapute 2011 002 16 03 Associated Claimants Associated Claimants No records were found Add Claimant ADD CLAIMANT 2011 Healh Claims for Auto insurance Processing Privacy Policy To clear the Claim details you have entered without saving click CANCEL In the confirmation dialog box that appears click lt Yes gt or lt OK gt To add Claimants to a newly created Claim click the button that appears in the bottom of the screen The Claimant Details screen opens Enter the Claimant s data 8 Insurer Manual Chapter 6 HICIA Health Claims for Auto Insurance HCAO
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