INSURER USER MANUAL Chapter 9
Contents
1. r LOGOUT USER MANAGEMENT 7 it gt Gainsborough Trinity PRC gt Speyside gt Add Edit Adjuster Add Edit Adjuster Pl in ite Tes add of egi an aier NOTE Al Teids wih an ssterisk are required The adjuster has been successfully saved Adjuster Status Adie Lest Nama Team Mame First Name Phone Ema OIF Heal Claims for AR ineurance Processing Pracy Polley Change Pasowonrd 4 To validate and save the details click If any of the fields are incomplete or contain invalid information your changes are not saved and you are returned to the Add Edit Adjuster screen 5 To exit the form click Miika Deactivating Reactivating an Adjuster Search for the desired Adjuster in the associated Adjusters list Click the emacs button next to the Adjuster to deactivate Upon the successful deactivation of the Adjuster the BEAL button is disabled To activate a deactivated Adjuster Search for the desired Adjuster in the associated Adjusters list Select the desired Adjuster from the list in the Associated Adjusters section of the Add Edit Adjuster of Branch screen Click B next to this Adjuster in the list On the successful activation of the Adjuster the button is replaced by the SAAL button 13 Insurer Manual Chapter 9 Oeea Health Claims for Auto Insurance KOH Global Re HC A ay Eiis ee eee H Al Forms e latr ad Advanced LOGOUT USER MANAGEMENT REPO2. activated individually 9 Insurer Manual Chapter 9 Oeea Health Claims for Auto Insurance Insurer Adjuster Management This section describes how to search add update deactivate and reactivate an Adjuster in HCAI The Adjuster Management functionality is found in the Insurer Management module which is accessible from the Manage tab on the Insurer home page Click on the Manage tab If the Insurer Management sub tab is not the resulting default selection select it At the top of the page the Select Insurer drop down list contains one or more Insurer companies depending on your role in HCAI Selecting an Insurer from the list refreshes the Browse Branches section in the bottom of the screen to contain all Branches associated with the selected Insurer Selecting a Branch from the list displays the Branch information and a list of associated Adjusters Adding an Adjuster The ibis button located in the Associated Adjusters section of the Branch Details screen is available only when the Branch details have previously been provided and validated KOH Global Re H i i INVOICES is SEARCH MANAGE 7 User Manual eee LOGOUT USER MANAGEMENT Y REPORTS h Insurer Management gt KOH Global Re gt Branch Details Fill in the fields to acd or edit an nsurer MOTE All fields with an asterisk are required Branch Status Active Branch Name Dudko Branch ID ded Aadress a E ON
3. ANAGEMENT Fill in re Seis 80 24d or age an isurer NOTE 7 Al Reiss wih am Ssterise y are required DEACTIVATE Insurer Details Ax ROH Glonal Re Phone Fax Contact One Name Contact One Phone _ ____ Contact One E mait Confirm Contact One E mail Contact Two Mame Contact Two Phone Contact Two E mad Confirm Contact Two E mail Configuration Management Virtual Insurer Outbound Payment Feed Inbound Clim Claimant Feed Outbound Insurer Extraction Privacy Gonsent gt Ya Browse Branches r kanoh Name City Status Acton Active DEACTIVATE Milton Active DEACTIVATE Moffat Active DEACTIVATE Roockowond Active DEACTIVATE 2011 Healin Cieims for Auto insurance Processing Priacy Polky Change Password 3 Insurer Manual Chapter 9 Oea Health Claims for Auto Insurance Adding a Branch The GA button located in the Browse Branches section of the Insurer Management screen and is available only when the Insurer details have been previously completed and validated through the HCAI Helpdesk KOH Global Re HCR 7 User Manual ee Ess paan USERMANACEMENT REPORTS Insurer Management gt KOH Global Re gt Branch Details FI in pe fekis 0 300 or edi an insurer NOTE All Sede with an asterisk are required Phone Fax Contact One Mame Contact One Phone Contact One E mail Contact Two Name Contact Two Phone Contact Two
4. E mail 2011 Heal Claims for Auo insurance Processing Privacy Palicy Change Password To add a new branch 1 Click ADD NEW BRANCH The Branch Details screen appears with empty fields waiting to be filled with Branch details The Branch Status value is Active 2 Type in the Branch name as assigned by the Insurer The name is to contain no more than 50 characters Specify the Branch ID The ID is the unique Branch identifier provided by the Insurer Enter the address of the Branch selecting the province from the drop down list Enter the first and last name phone number and email address of Contact 1 in the respective fields 6 Enter similar information for Contact 2 if any in the respective fields 7 Click to save the new Branch 4 Insurer Manual Chapter 9 HI CTA Health Claims for Auto Insurance lf this information is incomplete or invalid you are returned to the Branch Details screen with an error message at the top identifying the field name s that are either incomplete or invalid You must correct the information and save the Branch information again If the Branch information is validated you are returned to the form with a message indicating the successful creation of the Branch entity To clear the form and reload the Branch Details screen click Biitit After you have created and saved a new Branch the Bisi button appears at the top of the Branch Details screen KOH Globa
5. Health Claims for Auto Insurance INSURER USER MANUAL Chapter 9 Insurer Management July 2012 HICIA sii a iis Chapter 9 Insurer Management OVERVIEW Insurer Management involves the setup and maintenance of Insurer organization structures within the HCAI system INSURER MANAGEMENT STRUCTURE 0ccccccccsseeeeecceeeeeeeeceaeeeeeeeseeseceeeseeaeeeeeesseeeeeeeesseaseeeeesseaeeeeesseeeenensas 2 GENERAL BUSINESS WEES oa A EA E E 2 INSURER BRANCH MANAGEMENT ccccccsseeeccccceseeeecesceseececeeaseeeesecaseeeeesecaseeeeesscaseeceesscaseeeeesscseeesssagseeeesses 2 INSURER BRANCH MANAGEMENT ccccccsseeeccccceseeeecesceseeeeceeaseeeesscaseeeeesecaeeeeeescaseeeeesscaseeeeesscseeesssagseeessees 3 AIAT a B E ee ee een ee oer eee nen ee ee ee E ee eee 4 Searching for a Branch in the Insurer Management SCreeNn ccccccecseeeeeeeeceeeeeeeeeeaeeeeeeeeseneeeeeesaaees 6 EATEN ESI ANC Mice ase ts aici dice cine cscs eects E een eatin nt peta cide de nth cece erento A 6 Jpdating a Brane ct rect pe cs pcs tees a deena meowaneamateneunme uontansdndeedeeaenseaneeawemes 7 Deactivating Reactivating a Branch ccccccsesccccseeeeeeeeeseeeeaeseeeeeeeceeseueeeesseeeeeeaeeeeseaseeesaueeessanseeeesaess 7 INSURER ADJUSTER MANAGEMENT ccccceeseccecceeeeceeeeceeescceeeeeeeeceeseeaeeeeessseaseeeeesseaeeeesseaeceeesseaeeeeeseegeeeeeeeas 10 Addmg an Adj StE seneesa E E aes adiboceisesaaeseoespesteee docu 10 Searching
6. Ontario Postal Code Phone Fax Contact One Name Contact One Phone Contact One E mail Contact Two Name Contact Two Phone Contact Two E mail CANCEL SAVE Associated Adjusters e S ADO NEW ADJUSTER Adjuster ID Adjuster Name Status mess Messi Lionel tin 2011 Health Claims for Auto Insurance Processing Privacy Policy Change Fassword 10 Insurer Manual Chapter 9 Oea Health Claims for Auto Insurance Click Gek The Add Edit Adjuster screen appears for you to fill in Adjuster details Because you are creating a new Adjuster the Adjuster status is Active by default KOH Global Re Ha INVOICES SEARCH MANAGE 2 User Manual _ as ors vir LOGOUT Ee IENT USER MANAGEMENT REPORTS 4 Insurer Management gt KOH Global Re gt Dudke gt Add Edit Adjuster Add Edit Adjuster Fill in the fielts to add or edit an adjuster MOTE All fisis with an astensk are required Adjuster Status Active Lest Name Team Name Puno Fist Name Adjust oor carispimkohglobsl es 2011 Health Claims for Auto Insurance Processing Privacy Policy Change Password Enter the last name of the Adjuster or the name of the Adjuster team unit workgroup in the Last Name Team Name field Enter the first name of the Adjuster in the respective field Specify the Adjuster ID The ID is the unique Adjuster identifier provided by the Insurer Ente
7. RTS Insurer Management gt KOH Global Re gt Branch Details Fill in the figids to add or edit an Insurer MOTE All felts with an asterisk are required Add Edit View Details of Acton Branch Status Branch Hame Branch ID Contact One Name Contact One Phone Contact One E mail Contact Two Name Contact Two Phone Contact Two E mail Associated Adjusters ADD NEW ADJUSTER Adjuster ID Adjuster Name Status _ h JBen Benser Jill Dssctivatsd Debut Melanie Active Est Johnny Active Olivier Marco Desctiveted Thoembury Pamela Deactivated 2011 Health Claims for Auto Insurance Processing Privacy Policy Change Password Click on the Adjuster name link to proceed to the Add Edit Adjuster screen Click the button at the top of the Add Edit Adjuster screen to reactivate the Adjuster The button becomes disabled iD Note Activating a deactivated Adjuster does not activate any Claimants associated with the Adjuster Each active claim should be reassigned to another Adjuster or deactivated before deactivating an Adjuster 14 Insurer Manual Chapter 9
8. TIVATE 3011 Healin Claims for AA ineurance Processing Privacy Polky Grange Password To deactivate from the Branch Details screen 1 Go to the Associated Adjusters table at the bottom of this screen and review the status of all Adjusters associated with the Branch Deactivate any remaining Adjusters by selecting the BELAJ button Deactivating Adjusters is only possible if all of the Claimants associated with all the Adjusters are deactivated and there are no outstanding plans or invoices that require approval After you have deactivated all Adjusters click the BHL button at the top of the Branch Details screen Click lt OK gt in the confirmation dialog box that appears The Branch is deactivated 8 Insurer Manual Chapter 9 OG00 Health Claims for Auto Insurance To reactivate a deactivated Branch 1 Select the desired Branch from the list in the Browse Branches section of the Branch Details screen 2 Perform one of the following actions E Click ACTIVATE next to the selected Branch Upon successful activation of the Branch the button is replaced by the POEACTIVATE button ADDE HOW BPA ae Brae Brame DEACTIVATE EST ee Cie Er Ain rns Proce iey Pri ries Lome Pee Click on the name of the Branch to proceed to the Branch Details screen and activate the Branch Note Activating a deactivated Branch does not activate any Adjusters associated with the Branch Each Adjuster must be
9. anch 1 Select a required Branch from the list in the Browse Branches section of the Insurer Management screen 2 Click the button next to the Branch to deactivate This Branch is successfully deactivated if all of the Adjusters associated with the Branch have been deactivated and there are no outstanding plans or invoices that require i roval a successful deactivation of the Branch the FDEACTIVATE button is replaced by the allele button ADD HDA Be ee Bunce Hram CHA Tink TE a If the Branch cannot be deactivated by this process because there are associated Adjusters in an active state click on the name of the Branch and proceed to the Branch Details screen 7 Insurer Manual Chapter 9 HI CT ART Health Claims for Auto Insurance ane User Manual ey _ ao E eJ Anana p Aaanu USER MANAGEMENT REPORTS 7 Pll in he Sids i add or egi an inaurer NOTE gt All Teks wi an aseri are required DEACTIVATE Insurer Details Contact One E mail Confirm Contact One E mail Contact Two Name Contact Two Phone Contact Two E mail Confirm Gontact Two E ma Configuration Management Virtual Insurer 2 oe Outbound Payment Feed Inbound Claim Claimant Feed i Outbound Insurer Extraction Privacy Consent Browse Branches ADD NEW BRANCH City Status Acton Active DEACTIVATE Milton Active DEACTIVATE Moffat Active She Rockwood Active DEAC
10. are deactivated An Insurer cannot be deactivated until all Branches belonging to the Insurer are deactivated A deactivated Insurer Branch or Adjuster cannot be referenced in new plans and invoices created in HCAI New plans and invoices can not be submitted to a deactivated Insurer and Branch An Insurer must have a unique IBC reporting company number All activated Branches belonging to an Insurer must have a unique Branch identifier All activated Adjusters belonging to an Insurer must have a unique Adjuster identifier HI CTR Health Claims for Auto Insurance Insurer Branch Management This section describes how to search add update deactivate and reactivate Branches of an Insurer The Insurer Branch Management functionality is found in the Insurer Management module which is accessible from the Manage tab on the Insurer home page Click on the Manage tab If the Insurer Management sub tab is not the resulting default selection select it Depending on either on your organization type or your role and corresponding access privileges at the top of the page you may see the Select Insurer drop down list which contains one or more Insurer companies Selecting an Insurer from this list refreshes the Browse Branches section in the bottom of the screen to contain all Branches associated with a given Insurer KOHGlobalRe HC AL INVOICES cams MANAGE 7 User Manual P E LOGOUT USER M
11. for an Adjuster cccceeeceeeccecceeeseeseeeceeeeeeeusseeeeeeeesseeesseeeeeeesssseesseeeeeeessaaaaaeeeeesssusaaaaeeeeeeees 12 Updating an AdJUSTET acjasesccoe caiteicusiccsrenacancidemantiensinnstscsiensionaesasibonskistenan E AA EENE AEAEE AR E 13 Deactivating Reactivating an Adjuster ccccccccccssceccseseeeceeeseecceseecseeueeeceuseesseseeessaueeessegseesssaseesens 13 C Hee N Health aims for Auto inturance Insurer Management Structure Insurer Management is used to create an organizational structure or domains within HCAI that are closely linked with and support the roles assigned to individual users discussed in Chapter 10 Insurer User Management Overview Insurer organizations are structured using entities arranged ina hierarchical format Insurer parent gt Insurer child gt Branch es gt Adjuster s A clearly expressed organizational structure in HCAI ensures that Plans and Invoices submitted by Facilities are routed and assigned to the correct Insurer Branch and Adjuster An Insurer is defined within HCAI as an entity that insures the policyholder and owns any claim information generated by the policy A parent Insurer is one that is comprised of several subsidiary organizations child Insurers each of which functions as a distinct insuring entity Each Insurer can be associated with one or multiple Branches A child Insurer that can use only the Branches and Adjusters associated with its parent I
12. hing for an Adjuster In the Ada Eait Branch screen Go to the Associated Adjusters section This section contains a list of Adjusters associated with a given Branch Associated Adjusters ADD NEW ADJUSTER Status Benger Jill Deactivated ACTIVATE Degas Alberto Active DEACTIVATE Deut Melanie Active DEACTIVATE Eet Johnny Active DEACTIVATE Olivier Marco Deactivated ACTIVATE Thoambury Pamela Deactiveted ACTIVATE 2071 Health Claims for Auto Insurance Processing Privacy Policy 4 You can sort the Associated Adjuster list to facilitate the search To search by the Adjuster ID click the Adjuster ID column header This sorts the Adjuster entries in ascending alophanumerical order Click it again to sort the list in descending order To search by the Adjuster name click the Adjuster Name column header This sorts the names in ascending alphabetical order Click it again to sort the list in descending order 12 Insurer Manual Chapter 9 Dea Health Claims for Auto Insurance Updating an Adjuster 1 Search for the desired Adjuster in the associated Adjuster list 2 Click on the name of the Adjuster in the Adjuster Name column which is a link to proceed to the Add Edit Adjuster screen Associated Adjusters ADD NEW ADJUSTER Adjuster ID Jen Status Desctivated ACTIVATE 3 In this screen update the Adjuster details as required HCA 7 User Manual
13. l Re HCA a 7 7 User Manual N al Forms Baile te Advanced ee USER MANAGEMENT REPORTS Insurer Management gt KOH Global Re gt Branch Details Fill in the fisigs to ade or edit ar Insurer MOTE All fielcs with an asterisk are required Add Edit View Details of GeFilte New Branch created Branch Status Branch Name Branch ID Address 42 Cassels Avenue City Province ON Ontario Postal Code Phone 416 387 1111 Contact OneName r OOO O O Contact One Phone Contact One E mail igor kohglobsl vk Contact Two Name Contact Two Phone Contact Two E mail CANCEL SAVE Associated Adjusters ADD NEW ADJUSTER b Adjuster ID Adjuster Name 2011 Health Claims for Auto Insurance Processing Privacy Policy Change Password To add another branch Click to add another Branch This clears the form and you can enter information required to create another Branch entity as described above 5 Insurer Manual Chapter 9 HI CTR Health Claims for Auto Insurance Searching for a Branch in the Insurer Management screen Go to the Browse Branches section This section contains a list of Branches associated with a given Insurer If an Insurer has multiple Branches you can sort the list to facilitate the search To sort by the Branch name click the Branch Name column header This sorts the names in ascending alphabetical order Click it again to sort
14. nsurer and does not have any Branches or Adjusters of its own is classified as a virtual Insurer A Branch is defined as a location entity or domain responsible for handling and adjusting claim information Branches are subsets of Insurers a Branch can belong to only one Insurer An Adjuster is defined as an individual or a team workgroup responsible for direct claim handling within HCAI An Adjuster can either be created in HCAI as a single user or as a team to which any number of users are associated Only a user with the role of Insurer Administrator has access to the Insurer Management module of HCAI HCAI provides the functionality to create view update deactivate and reactivate Insurer Branch and Adjuster entities General Business Rules The following business rules apply to Insurer Branch and Adjuster management at all times An Insurer can be associated with zero or more Branches A single insurer must have at least one Branch An Insurer can be specified as a parent or child Insurer A child Insurer that uses only Branches and Adjusters associated with its parent Insurer and does not have any Branches or Adjusters of its own is categorized as a virtual Insurer A Branch cannot be added to or associated with virtual Insurers An Adjuster cannot be deactivated until all open Claimants are reassigned to another Adjuster A Branch cannot be deactivated until all Adjusters belonging to the Branch
15. r the phone number and email address of the Adjuster in the respective fields if desired Click to save the Adjuster information If this information is incomplete or invalid you are returned to the Add Edit Adjuster screen with an error message at the top identifying the field name s that are not complete or valid You must correct the information and save the Adjuster information again If the Adjuster information is validated you are returned to the Add Edit Adjuster screen with an inline message indicating the successful creation of the entity To reload the Add Edit Adjuster screen click CANCEL 1 After you have created and saved a new Adjuster the abide eM button appears at the top of the Add Edit Adjuster screen To add another Adjuster Click ADD NEW ADJUSTER This clears the form and you can enter the information required to create another Adjuster entity as described above 11 Insurer Manual Chapter 9 HI CTA Health Claims for Auto Insurance KOH Global Re HCA i 7 User Manual es Sear i USER MANAGEMENT 1 REPORTS 9 Add Edit Adjuster DEACTIVATE ADD NEW ADJUSTER Fill in the fields to add or edit an adjuster MOTE All fetis with an astensk are required The adjuster has been successfully sawed Adjuster Status Active Lest Nama Team Name rat Name ae a 2071 Health Claims for Auto Insurance Processing Povacy Policy Change Password Searc
16. the list in descending order To sort by the Branch s city of residence click the City column header This sorts the city list in ascending alphabetical order Click it again to sort the list in descending order HCR User Manual i r mam x ee oma f LOGOUT USER MANAGEMENT REPORTS 1 Fill In fe Seids to add or edk an insurer NOTE All Tels win an asterist are required DEACTIVATE Insurer Details Insurer Status Acie Insurer Name KOH Ghia Re BC ID KOH Addiess 3 KOR Drie Provita ON Ortala Confinn Contact Two E mai Configuration Management Outbound Payment Feed Inbound Claim Claimant Feed 1 Outbound Insurer Extraction Privacy Consent Browse Branches Acton Active DEACTIVATE Milter Active Moffat Active Rockwood Active 2011 Heal Claims for Auto insurance Processing Priecy Policy Change Password Insurer Manual Chapter 9 Health laims for Auto insurance Updating a Branch 1 Select the Branch from the Browse Branch section on the screen 2 In this screen update the Branch details as required 3 To validate and save the details click SAVE If any of the fields are incomplete or contains invalid information the changes are not saved and you are returned to the Branch Details i page HCAI highlights the fields needing attention with the symbol 4 To exit the form click Gages Deactivating Reactivating a Br
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