Chapter 5: Common Functionality
Contents
1. Save This button saves any changes you have made so far When selected it brings up a dialog box to confirm saving Click OK to save and you will be returned to the page where you are currently located Print This button brings up a PDF version of the form Decision buttons The following decision buttons are available at the bottom of the last screen have reviewed this invoice and based upon the information provided l APPROVE PARTIALLY APPROVE DO NOT APPROVE Approve This button validates that each good or service has been approved and marks the OCF as having been approved It moves the OCF to the Adjuster Response work list under the Plans tab Partially Approve This button validates that some of the goods or services have been denied or not fully approved while others may have been approved It also validates the reason codes specified in the case s of partial approval It moves the OCF to the Adjuster Response work list under the Plans Invoices tab Do Not Approve This button validates that all of the goods and services have been denied and respective reason codes have been indicated It moves the OCF into the Adjuster Response work list under the Plans Invoices tab of the Insurer home page Other buttons 5 Insurer Manual Chapter 5 HICA Health Claims for Auic Insurance Other buttons are available within certain OCFs including Need To Discuss This button initiates a discussion between the Adjuster2. a new search can be executed SEARCH ARCHIVES At the bottom of the Search Results screen is l button Click this button to execute the same OCF search in HCAI s archive database KOH Global Re HCA oo B T LOGOUT Search Results 1 of 13 Refine Search Document Results for Date Submitted From 2010 04 28 Date Submitted To 2013027 Archival Status Not Archived View Document Number 11020800024 Claim Number 0203 Submitted by Kian Clinic on 2011 02 08 Proposed Amount 1 730 00 Last Modified Date 2012 02 29 Approved Amount 0 00 Status In Discussion Response Sent Policy Holder Diaz Carmen Policy Number CD_01 Date of Accident 2009 06 18 Diaz Carmen OCF21B Document Number 11030200018 Claim Number 0203 Submitted by Kian Clinic on 2011 03 02 Proposed Last Modified Date 7012 02 29 Approved Amount 0 00 Status Review Required Policy Holder Diaz Carmen Policy Number CD_ 01 Date of Accident 2009 06 18 Diaz Carmen OCF23 Document Number 11030300080 Claim Number 0203 Submitted by Kian Clinic on 2011 03 03 Proposed Amount 1 730 00 Last Modified Date 2012 02 29 Approved Amount 1 700 00 Status Declined Policy Holder Diaz Carmen Policy Number CD_01 Date of Accident 2005 0648 Only active documents are shown Click Search Archives if you would like to search for archived documents that match these search criteria Please note that searching the archives may ta
3. and the associated Health Care Facility It requires the Adjuster to draft a message to the Facility in the Message to Provider field Create or View EOB This button generates and opens the EOB window This information is read only and is available only after the Adjuster has responded You can add or edit your comments here Specifying Reason Codes Reason codes are specified in the final step of any OCF To search for a reason code use the ellipsis buttons found in the Adjuster Response column of the Proposed Goods and Services Section which can also be accessed from the Apply Multiple Reason Codes section To search for a reason code Click the ellipsis button 8 The Reason Code Look Up screen opens Review OCF18 Reason Code Look Up Select the Series that is appropriate for your decision To begin your search click Search To narrow down the search results you can supply a Category and or Reason prior to clicking the Search button Seis g Category Reason To refine your search select a required series from the respective drop down list To view all the codes within the series leave the category and reason unselected Otherwise select the category and reason from the respective lists and click 6 Insurer Manual Chapter 5 DGO Health Claims for Auic Insurance The results page of the Reason Code Look Up screen opens Review OCF21C Reason Code Look Up Search Results REFINE S
4. search criteria and click Search Date Submitted From 2013 04 11 D Document ne iW Exact Match ClamNumber W Exact Match al Exact Match Claimant Last Name SaES F Exact Match Claimant First Name sid iW Exact Match Claimant Phone Number i Exact Match or ns 2 a S Advanced Options Document Type C ocfFi8 i Adjudication Status Submitted L ocF21B _ Need to Discuss LJ ocF21c L Review Required D ocr22 C Approved ocF23 _ Partially Approved Claimant Status active Declined Deactivated L Pending Archival Status jot Archived Archived lt lt Advanced Options nutes BUcumenies are gt aichived one year or more after the insurers aot recent response ORATE B 2015 Health Claims for Auto Insurance Processing Privacy Change Password 3 Insurer Manual Chapter 5 OGO Health Claims for Auic Insurance Search Results Following the execution of a search the search results screen appears HCAI populates the search results according to the order of date the document was submitted i e OCFs submitted earlier appear at the top of the search results list To access an OCF that appears in the search results simply click on the underlined text containing the Claimant last name first name and document type at the beginning of each entry in the search results list A Refine Search text link is provided to direct the user back to the OCF Form Search screen where
5. EARCH code Description j a 3oo Waiting for binding medical opinion Preuat Update description a BA eae BA 3 03 15 Waiting for agreement by all parties Find the required reason code and click the button The button takes you back to the final step of the respective OCF The reason code and its description appear under the ellipsis button 8 you selected at the beginning of your search OR Click to return to the Reason Code Look Up screen and reselect the search criteria Review OCF21C HCA Reason Code Look Up Select the Series that is appropriate for your decision To begin your search click Search To narrow down the search results you can supply a Category and or Reason prior to clicking the Search button Series Adjuster decision v Category Other insurance coverage v Patient has other coverage e g prnornty with other insurer SA4 Claimant is receiving WSIB benefits Collateral insurance information is missing or incorrect Patient has other coverage e g priority with other insurer 7 Insurer Manual Chapter 5 Specifying Dates To specify a date you can enter it manually using the date convention YYYY MM DD or click the calendar icon located to the right of the date fields throughout the form If you enter a number from 1 to 30 it will be populated as the day and the current month and year will be added when you click outside of the entry box To use the calendar icon follo
6. MESSAGEG s sscceccecceccceccecceccceccececuccecaecaccuesuceecucseesecaecuusueecaceeeaes 9 PRINTING A DOCUMENT 0ccecceccececcecceccecccceccuccecaucecsucuecucuececuucuecuucuceecuesuuaecsecseuueaecsusuuaueecseeueaeusuuaeceesetaass 11 SAVING A REVIEWED OCF PLAN ccscececcecececcccccececccecececucueceuecseueaenececacaunenecscaeaenecstacaeaenetstauaunetscsuauaenenass 13 VIEWING HCAI S PRIVACY POLICY ccccccccccecccccccecececececacecscenseeccceccececueccsceescecececucncecncrencetestaneeceeseeteners 13 O60 Health Claims for Auic Insurance Search At any time on the Insurer home page you can 1 search for a specific Claim using a Claim Number or 2 click on the lt Advanced gt text link next to the Search for Claim Number field to bring up the Search gt Document Search tab KOH Global Re 486 Plans f mvoices crams SEARCH manage 000 SS aRUEPTEEGI aey ai it AI Forms we 4 Matc LOGOUT Click on the Search tab to begin a search for an OCF or group of OCFs The Search tab provides access to the Document Search sub tab where you can look for a specific plan OCF 18 or OCF 23 or invoice OCF 21 HCAI provides a 30 day default date range for the OCF search functionality Included is the option to execute an Exact Match search for the specific value s entered in that field If the Exact Match box is checked HCAI will search for an OCF or OCFs using the only the
7. WGO Health Claims for Auto Insurance INSURER USER MANUAL Chapter 5 Common Functionality HTC PTE Chapter 5 Common Functionality OVERVIEW This chapter describes the functionality that is common for all parts of the HCAI application SEAR e E 2 Advanced SeOasrch cccccccecccsccccececsceccecececucaucececseucaucusecscauaesacsuacauaasecseueausanseucauaesacseueausanscstansecseauausanseas 3 NAVIGATING IN AN OCF PLAN OR INVOICE cccccecececcccececcccccececcccccececscacaucececscuenenecscacaeaenecstauuaenscseauaenecstenass 5 DESCRIPTION OF BUTTONGS ccececcecceccececcccuccecccuccucaecaecuecuucecusuuaucaecuucuesecaecseceuausaecuesuuseceesuusuuaeceuseecauseeaes 5 Action DUtTONS cncsdecencxaiscineaedtwrdwaneacpsacnedewnscuiaiscuauddaddennsitadenantadlexsavda seamed E aeaa adadad arenak aera iriri daii 5 Decision buttons cccccccececcececececcececccccuececscueuuuececueuuenecscuaenecscuuunenecsenunenetscauaunensuseseaenecscsuuerseauauneneres 5 Other buttons cece cccececececcecececeucecececaccucucecscceaececscueauaecscauauausecsusuauaesecsesuaesecsesuaucenscseaenecseauaeuenseaeaeners 5 SPECIFYING REASON CODES ccccsccecececcececcececceccccecuccecuucecseuecueaeuecuenecuunecsuaussenecsecuuucueuecsunecsuaesseausueeusauaecass 6 PE GIP ING e IAM Ststetescsecara tote cass necdaetasiessotetcuedenaiaiuasssactduetanetedeeeiceisniatote dasa nesdaetannesdateioaioneonsdanicseaecanenoneantat 8 VIEWING NOTIFICATIONS AND ERROR
8. a a eS a J x ra TOn CANCEL l PRINT SAVE To save a plan Click the button at the top or bottom of each screen in the OCF 18 OCF 21B OCF 21C or OCF 23 Click lt OK gt to get the confirmation message to appear This returns you to the step where you initially saved your information The confirmation appears in green font with a yellow background Viewing HCAI s Privacy Policy The link to the Privacy Policy is located in the bottom right hand corner of each screen Click on this link to review Plymouth Argyle Financial HCAR x J 7 User Manual CLAIMS SEARCH MANAGE ig lt Forms co ADJUSTER RESPONSE LOGOUT PENDING Plan Management Work In Progress AASA Plymouth Argyle Financial Work In Progress 1 of 2 The following tems have not been adjudicated vew lays Left Date Submitted 2011 03 47 42 Next gt ype gt Status Submitted Claim OCU Claimant 11031700013 70043 Staunton 11031700023 11031700032 11031700042 11031700052 11031700062 11031700002 11031500062 11031800092 11031800102 Grobbelaar Rosenthal Hansen Charter Barnes Guk Soloho Nevada Submitted Submitted Submitted Unmatched Submitted Submitted Unmatched Unmatched Unmatched ag T T T T 7 T T 8 8 3 2017 03 47 2011 03 17 2011 03 17 2011 03 17 2011 03 47 2071 03 17 2017 03 16 2011 03 16 2017 03 16 2011 Health Claims for Auto Insurance Pro
9. cessing Privacy Policy Change Password 13 Insurer Manual Chapter 5
10. for Auto Insurance Processing Privacy 9 Insurer Manual Chapter 5 068 Health Claims for Auic Insurance When you successfully save a document a confirmation notification appears in green font against a yellow background Review OCF18 HCA T AN al 1 1 gt E 7 User Manual CANCEL PRINT SAVE Claim Identifier Return this form to Plan Identifier Applicant Mame Zidane Zinedine KOH Global Re NEY Document Humber 13011700008 Claim umber 169 aby 099 2 Speyside Way Policy Number S765 Acton Ontario Date of Accident 2012064 4 L2P Bae OCF Type 18 Date Submitted 20730147 Source Web OCF Effective Date 201241701 Archival Status Not Archived When you successfully submit an approval decision on a plan or invoice a confirmation screen appears containing the Claim Identifier Return this form to and Plan Identifier sections of the plan or Invoice Review OCF18 Claim Identifier Return this form to Plan Identifier Applicant Mame Zidane Zinedine KOH Global Re MEW Document Number 13071700008 Claim Number 189 aby 099 2 Speyside Way Policy Number S765 Acton Ontario Date of Accident 20720644 L2P Bp2 OCF Type 16 Date Submitted 20130147 Source Web OCF Effective Date 2012 1701 Archival Status Mot Archived You have approved document number 13011 rE 2013 Health Claims for Auto Insurance Processing Privacy Policy ee 10 Insurer Manual Chapter 5 0600 H alih Claima fo
11. he Internet can be useful some files can potentially save this file What s the risk Open or save it as you would any PDF i Note PDEs are not saved in HCAI and selecting Save will save a copy of the document in the location you specify on your computer 11 Insurer Manual Chapter 5 CIALL my Health Claims for Auic Insurance To print an OCF for which a decision has been made HCAI was built to mirror the paper version of the FSCO forms As a result there is one column for totalling on all OCFs Once a decision is made by an Adjuster for example Do Not Approve or Partially Approve the system updates the OCF with the amount either approved or not approved When an Adjuster wants to print the form to send to a medical assessment or for his or her own files displaying the monetary amounts proposed the Adjuster should 1 2 3 Open the OCF and navigate to the Summary tab Scroll to the section which displays the Activity Log Click the final version of the form for OCFs submitted after September 1 2010 or click on the version of the form previous to the final adjudication decision for OCFs submitted before September 1 2010 to open the OCF Click PRINT Review OCF18 CREATE OCS i AL Gaim kenther Claim Number 1Gp _atv 290 Policy Number ATE Dele ef Aorment 20120614 Docement Number 1i0117o000s Pires te iair Sistua dgprmared Here m a dat of merg am
12. ke several minutes SEARCH ARCHIVES 2013 Health Claims for Auto Insurance Processing Privacy Policy 1 4 Insurer Manual Chapter 5 0600 Health Claims for Auic Insurance Navigating in an OCF Plan or Invoice Use the navigation numbered tab buttons at the top or bottom of the screen to move from one page of an OCF to another The tab of the page you are currently viewing turns green Use the lt Next gt or lt Back gt navigation text buttons at the top or bottom of each page to move forward and backward through the pages of the form Review OCF23 HCR gt n mmo O summary 2 je faek mxre b Z User Manual PRINT SAVE Description of Buttons While reviewing a plan you may see question mark buttons These buttons provide more details on the subject of a given section Hold the mouse over the button or click it to see pop up menus with either additional comments or definitions Action buttons The following three buttons are common to all screens within an OCF plan or invoice They appear at the top and the bottom of every screen Review OCF23 Ea ap SUMMARY E ag d 4 gt User Manual z PRINT SAVE P Cancel When selected this button brings up a dialog box to confirm cancellation Click lt OK gt to exit the form If you have not saved the information entered in the form thus far this information will be lost when you exit
13. oi wih Pa docemeni Thet are no Tepes Achaya Acii Log for Gecument A 11 TTO F F Description ec Rate autsaed dengan ter a pim Fel Eor Fieni 45 Bente Fate saved HALE p wert n eo ras mgobtar on a document Soar 15 30 SiO 1530 Assocua bod Chores Feel bs Associated Documents 1 of 1 2a posted duure for ing camard a TaT IA ee ea I facility ftatus Hagin d Lite Submited Hiti Png magih a ite Submited Haan t Life Ape ewes hing Sh al Life Hagin d Life Posy Flan dF Tew ts Poi Flac re Feal P ig Pos Fog meen itz fone Wes rei Regained Date Sent HCAR 9 Lier Manual gt PRINT Ji an kentte Cocumend Herter S01ITOOGOE OCF Type I Deis Submitet 20140117 Teuta Ve OCF Eftecove Date Ipi n 512 90 60 18 802 C0 18 902 00 i 805 00 518 902 00 S15 R02 00 18 S02 60 Insurer Manual Chapter 5 068 Health Claims for Auic Insurance Saving a Reviewed OCF Plan You may need to save the plan you are working on if you want to interrupt your work and resume it APPROVE later You do not have to save the plan before submitting your decision The PENDING DO NOT APPROVE or bie nei buttons validate the plan and save it upon submission Review OCF18 H 93 zi e J x 3 lt A o ae oe al ae e Ez aa Er U FET h cHmMMARY 1 a oa 4 aes ae 7 E HET i User Manual a U Ped be tee ie re an ae FE i 2 EF Aj aD
14. r Auia Iiniurancte Error messages appear in red font with an orange background at the top of the screen They refer you to the section where the error occurred The header of this section provides a more detailed error description and a red exclamation mark appears next to the field that contains the error In any plan or invoice a numbered step with a red exclamation mark means that the corresponding line contains an error Estimate Day Projected GS Total Total Adjuster Ref Code Attr Provider Ref Quantity Measure Cost Comt Cost Proposed Tax E i 2 GE 02 Good Dawn Z200 HR 125 89 2 2541 78 oo mer A Assessment Exam i pi 450 00 lo 0o00 rst L est 2 1 CN 12 Wiler Sara 3 00 HR 224 00 3 702 00 Th NEC ret peT ast Printing a Document You can print the forms no matter which work list they are in Work in Progress Adjuster Response or Pending The button is available at the top and bottom of each step as well as on the Summary page of the form HCA User Manual CANCEL GREATE OGFS To print a document Click PRINT A pop up prompt window appears asking you if you want to open or save the PDF file rc een eee La j File Download x Do you want to open or save this file Name O6090700007 0CF18 pdf aa Type Adobe Acrobat 7 0 Document 47 4 KB From beskheai ca harm your computer IF you do not trust the source do not open or While files from t
15. t kinds of notifications and error messages in HCAI A Notification Window may appear immediately after signing into HCAI Users will only encounter a Notification Window when a message Is available for review When a Notification appears after signing in users must carefully review the message contents If prompted users can check off the acknowledgement box located beneath the message once the content is reviewed then click the Gisbbhiees button If the user acknowledges the notification and presses Sates the message will not appear again so it is important the notification contents be reviewed carefully HCAM Health Claims for Auto Insurance This message is a reminder about the extension to HCAI s regularly scheduled maintenance outage The HCAI system will be unavailable from 2 00 a m ET Sunday June 21 2015 and is expected to resume active status at 6 00 p m ET Sunday June 21 2015 The extended hours of this unavailability window are required to perform system maintenance During this time HCAI System Status at www_heailinfo ca will indicate red with the message Scheduled system maintenance underway Visitors to www_hcai ca will be unable to sign in and will instead be presented with a generic web browser generated message indicating the webpage Is unavailable B Iam aware of the upcoming extension to HCAs regularly scheduled system maintenance window gt CONTINUE 2015 Health Claims
16. value s entered in the field s selected Exact Match is by default already selected simply click the checkbox to remove the Exact Match option from your search query The more information you enter into your search query using the search parameters provided the faster HCAI will execute the search KOH Global Re HCA EARCH MANAGE S O C aanas Loaour OCF Form Search Enter your seang p Date Submitted From 20140414 To 20140513 73 Exact Mlatch poranne eae ae oseta TF oean F Claimant First Harme o Exact Match Claimant Phone Number W Exact Match S Adjuster o 4 Deco Provider Registry Number College Registry ID sd Exact Match Advanced Options gt SEARCH 2014 Health Claims for Auto Insurance Processing Privacy O 2 Insurer Manual Chapter 5 ge T j TL Health Claims for Aulo Insurance Advanced Search Clicking the lt Advanced Options gt text link at the bottom right hand corner of the OCF Form Search screen brings up additional search parameters These search parameters are Document Type Claimant Status Adjudication Status and Archival Status that is the option to search for a specific OCF or group of OCFs in HCAI s archive database Whichever additional search parameters you select will further narrow your search query KOH Global Re Hc ap f kl User Manual OCF Form Search Enter your
17. w these steps Click the icon to bring up the calendar overlay It displays the dates as of the current month and year lt a July 2006 Sun bon Tue Wed Thu Fri Sat 2s 26 27 28 29 20 orf P02 os 0a os 05 o7 Poa 40 11 12 19 14 1s Pas 17 18 19 20 2 zap al all Tao af af af os To select a different month use the left and right scroll arrows at the top of the calendar to scroll back and forth through the months To select a different year click on the month year display at the top of the calendar In the drop down menu select a required year To scroll back to an earlier year use the left scroll arrow to scroll forward to a later year use the right scroll arrow These arrows are located in the bottom of the menu You can also use this menu to select months You also have the option to use hotkeys Click in a date field and press the following keys T enters today s date C brings up the calendar overlay UP Arrow changes the date forward one day DOWN Arrow changes the date backward one day Page Up changes the date forward one month Page Down changes the date backward one month Click on the desired option and your selection is inserted into the date field of your screen 8 Insurer Manual Chapter 5 DGO Health Claims for Auic Insurance Viewing Notifications and Error Messages There are differen
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