Scheduled Outages: The HCAI system will be unavailable from 5:00 p.m. (EDT) March 29 to 8:00 a.m. (EDT) April 1
Scheduled Outages: The HCAI system will be unavailable from 5:00 p.m. (EDT) March 29 to 8:00 a.m. (EDT) April 1
Health Care Facility | Insurers | Related Initiatives  

Claims Tools


HCAI has several tools that make it easy to keep track of new submissions and past decisions. Continue reading topics from the left-hand panel for more information on HCAI’s available features, including how to use your worklists to manage incoming documents and how to track a claimant’s HCAI history using the Claimant Summary report and Associated Documents section. This section also provides an overview on HCAI’s powerful document search capabilities.

Claims Tools


Worklist filters

HCAI makes it easy to manage your incoming documents by offering two worklist filters: adjuster record (which is organized by branch) and a new e-mail address option. You can toggle between filter options by selecting the ‘Filter’ drop-down menu on the worklist screen (View screenshot). Whichever filter you choose, your account will retain your viewing preference for next time.

Continue reading below for more information on the two worklist filters and how you can use them to manage incoming documents.

E-mail Address

The benefit of using the new e-mail address filter is that you will only see one worklist per adjuster. If you have been assigned to claimants in several branches, this filter will help you see all of your forms in one view rather than having to review your worklist for each branch individually. When you are monitoring another adjuster’s worklist, you will be able to see all of their forms from a single view.

This filter will only work properly if every adjuster has their own e-mail address entered into their adjuster profile(s) in the Manage > Insurer Management tab (for more information on updating this screen, click here and review the section titled ‘Updating Adjuster Information’). At this time, HCAI recommends that adjusters are set-up with access to only a few additional adjusters worklists to enable support for absences.

If this information isn’t entered correctly, you will see different symbols in your worklist.

  • If an asterisk appears next to an e-mail address, it means that this e-mail address has been used for multiple people in HCAI.
  • If you have the option for ‘<No e-mail set up>’, it means that one or more of the adjuster profiles you have been assigned access to does not have an e-mail address entered into their adjuster profile. For this reason, the ‘<No e-mail set up>’ filter can potentially become a catchall for several different people’s forms. If you see this option, request that an organization administrator review the e-mail addresses entered into each adjuster profile in the Manage > Insurer Management tab.

Adjuster Record

The adjuster record will show you one worklist per adjuster per branch. For example, if you have been assigned to claimants in five branches, you will see five worklists. If you have been assigned to be a backup for one other person, you will see your five worklists, plus your colleague’s five worklists (a total of ten worklists). The adjuster record can be helpful if your company has not entered in adjuster’s e-mail address and you are unable to use the ‘E-mail address’ filter.

Claims Tools


Claimant Summary Report

The Claimant Summary report is available to all adjusters and users with the Report Viewer role.

What is it?

The Claimant Summary report is a decision-support tool that summarizes injuries, goods and services, costs and duration of treatment for an individual claimant. Cost and count totals are drawn from adjudicated OCF-18s, OCF-23s, OCF-21Bs and OCF-21Cs.

This report does not contain archived OCFs.

How do I access the Claimant Summary report?

  1. Take note of the claim number you wish to run the report for
  2. Go to the Manage > Reports Tab (View screenshot)
  3. Under the ‘Generate New Report’ section, select the ‘Claimant Summary’ report, select the relevant insurer and enter the claim number you wish to obtain the report for
  4. Press the “Get Claimants” button (View screenshot)
  5. The screen will refresh and the ‘Select a Claimant’ section will appear
  6. Select the claimant you wish to run the report for using the drop down menu
  7. Press the ‘Generate Report’ button (View screenshot)
  8. The screen refreshes and confirms that the request was received
  9. The report may take some time to process. Once it is ready to review, the Report Name will appear as a hyperlink under the ‘Reports Requested’ section, click it to open the report (View screenshot)
  10. To view the goods and services section of the report as a .CSV file, press the ‘Download Amounts’ button at the top of the report to download the files (View screenshot)
  11.  You can leave the report as-is, or you can add in paid amounts from outside of HCAI

Claims Tools


Claimant Financial Summary

The Claimant Financial Summary provides a summary of the amounts proposed and approved for a particular claimant. To view the report, you will need the Form Manager, Claim-Claimant Editor, or Claim-Claimant Administrator role in HCAI.

The report is found on the Claimants Search Results screen. You can access the Claimants Search Results screen two ways:

  • On your Dashboard, click a section of the Claimant Summary pie chart. This performs a search for claimants based on the pie chart’s criteria. (View screenshot)
  • Visit the Claims tab > Claimants sub-tab and perform a search for claimants. (View screenshot)

On the Claimants Search Results screen, the far right column is titled Financial Summary. Click ‘View Report’ to view the Claimant Financial Summary for this claimant. The report opens in a new window. (View screenshot)

To download the Claimant Financial Summary as a .CSV file, click the ‘Download Report’ button at the top right of the window. This will allow you to save and edit the information as required – for example, you can use Excel to calculate balances, sort documents by different criteria, or add billing that occurred outside of HCAI. (View screenshot)

The Claimant Financial Summary is broken down into separate sections for each OCF type. A maximum of ten documents per section is displayed at a time. If you have more than ten documents in a section, you can press the ‘Next’ button to see more documents.

Each OCF section will display the following columns (View screenshot)

  • Document number: Click on the Document number to open that document in a new window.
  • Plan #: Visible in invoice sections only, the Plan # column displays the associated plan number. If the invoice is not associated with a plan, the column will state ‘Exempt’. If the link between the invoice and plan has been broken, a dash will appear. This can occur if the plan and invoice are matched to different claimants.
  • Facility: Click on the Facility name to open a new window that displays the signing provider’s details, including name, professional details, billing address and service address.
  • Status of the document
  • Proposed Amount
  • Approved Amount: This column will appear in all OCF sections except the OCF-23
  • Pre-Approved Amount: In the OCF-23 section, you will see the Pre-Approved Amount column, which is sub-divided into two columns: Declined and Responded.

At the bottom of each OCF-type section, you will see the following total amounts:

  • Non-archived Sub-total: The sub-total of proposed and approved amounts of all non-archived documents
  • Archived sub-total: The sub-total of proposed and approved amounts on archived documents. Archived documents won’t display in the lists, but the total is included for your reference. If none of the claimant’s documents have been archived, the archived amount will be blank.
  • Total (including taxes): The total proposed and approved amounts, including archived documents and taxes.
  • Tax Amount: Here, taxes are displayed separately. This line will display in the OCF-18, OCF-21B, and OCF-21C sections.

For users who do not have the Form Manager, Claim-Claimant Editor, or Claim-Claimant Administrator role in HCAI, similar information is available in the Associated Documents section of each OCF.

Claims Tools


Associated Documents Section

The ‘Associated Documents’ section is available on the decision-making tab of all forms in the HCAI web application. It does not appear on the printed/PDF version of OCFs. To view the Associated Documents section, open an OCF and navigate to the Associated Documents Results section.  Click the ‘View Associated Documents’ button. (View screenshot)

To download the Associated Documents section as a .CSV file, click the ‘Download Report’ button at the top right of the section. This will allow you to save and edit the information as required – for example, you can use Excel to calculate balances, sort documents by different criteria, or add billing that occurred outside of HCAI. (View screenshot)

The Associated Documents section offers two viewing options: Claimant View (default) and Plan View. Use the ‘View’ drop-down in the top right corner of the section to select a view. (View screenshot)

  • Claimant View: Displays a consolidated view of a claimant’s plans and invoices in HCAI.
  • Plan View: Displays all documents associated with the current plan that are matched to the same claimant.
    • If you are reviewing an invoice, this view will display the parent plan and all its associated invoices.
    • If you are reviewing a plan, this view will display the plan and its associated invoices. Please note: there are no invoices associated to the Form 1 in HCAI.

In both views, the Associated Documents display is broken down into separate sections for each OCF type. A maximum of ten documents per section is displayed at a time. If you have more than ten documents in a section, you can press the ‘Next’ button to see more documents.

Each OCF section will display the following columns (View screenshot):

  • Document number: Click on the Document number to open that document in a new window.
  • Plan #: Visible in invoice sections only, the Plan # column displays the associated plan number. If the invoice is not associated with a plan, the column will state ‘Exempt’. If the link between the invoice and plan has been broken, a dash will appear. This can occur if the plan and invoice are matched to different claimants.
  • Facility: Click on the Facility name to open a new window that displays the signing provider’s details, including name, professional details, billing address and service address.
  • Status of the document
  • Proposed Amount
  • Approved Amount: This column will appear in all OCF sections except the OCF-23
  • Pre-Approved Amount: In the OCF-23 section, you will see the Pre-Approved Amount column, which is sub-divided into two columns: Declined and Responded.

At the bottom of each OCF-type section, you will see the following total amounts:

  • Non-archived Sub-total: The sub-total of proposed and approved amounts of all non-archived documents
  • Archived sub-total: The sub-total of proposed and approved amounts on archived documents. Archived documents won’t display in the lists, but the total is included for your reference. If none of the claimant’s documents have been archived, the archived amount will be blank.
  • Total (including taxes): The total proposed and approved amounts, including archived documents and taxes.
  • Tax Amount: Here, taxes are displayed separately. This line will display in the OCF-18, OCF-21B, and OCF-21C sections.

Claims Tools


Jump to:

HCAI has several tools that make it easy to keep track of new submissions and past decisions. Continue reading topics from the left-hand panel for more information on HCAI’s available features, including how to use your worklists to manage incoming documents and how to track a claimant’s HCAI history using the Claimant Summary report and Associated Documents section. This section also provides an overview on HCAI’s powerful document search capabilities.

Worklist filters

HCAI makes it easy to manage your incoming documents by offering two worklist filters: adjuster record (which is organized by branch) and a new e-mail address option. You can toggle between filter options by selecting the ‘Filter’ drop-down menu on the worklist screen (View screenshot). Whichever filter you choose, your account will retain your viewing preference for next time.

Continue reading below for more information on the two worklist filters and how you can use them to manage incoming documents.

E-mail Address

The benefit of using the new e-mail address filter is that you will only see one worklist per adjuster. If you have been assigned to claimants in several branches, this filter will help you see all of your forms in one view rather than having to review your worklist for each branch individually. When you are monitoring another adjuster’s worklist, you will be able to see all of their forms from a single view.

This filter will only work properly if every adjuster has their own e-mail address entered into their adjuster profile(s) in the Manage > Insurer Management tab (for more information on updating this screen, click here and review the section titled ‘Updating Adjuster Information’). At this time, HCAI recommends that adjusters are set-up with access to only a few additional adjusters worklists to enable support for absences.

If this information isn’t entered correctly, you will see different symbols in your worklist.

  • If an asterisk appears next to an e-mail address, it means that this e-mail address has been used for multiple people in HCAI.
  • If you have the option for ‘<No e-mail set up>’, it means that one or more of the adjuster profiles you have been assigned access to does not have an e-mail address entered into their adjuster profile. For this reason, the ‘<No e-mail set up>’ filter can potentially become a catchall for several different people’s forms. If you see this option, request that an organization administrator review the e-mail addresses entered into each adjuster profile in the Manage > Insurer Management tab.

Adjuster Record

The adjuster record will show you one worklist per adjuster per branch. For example, if you have been assigned to claimants in five branches, you will see five worklists. If you have been assigned to be a backup for one other person, you will see your five worklists, plus your colleague’s five worklists (a total of ten worklists). The adjuster record can be helpful if your company has not entered in adjuster’s e-mail address and you are unable to use the ‘E-mail address’ filter.

Claimant Summary Report

The Claimant Summary report is available to all adjusters and users with the Report Viewer role.

What is it?

The Claimant Summary report is a decision-support tool that summarizes injuries, goods and services, costs and duration of treatment for an individual claimant. Cost and count totals are drawn from adjudicated OCF-18s, OCF-23s, OCF-21Bs and OCF-21Cs.

This report does not contain archived OCFs.

How do I access the Claimant Summary report?

  1. Take note of the claim number you wish to run the report for
  2. Go to the Manage > Reports Tab (View screenshot)
  3. Under the ‘Generate New Report’ section, select the ‘Claimant Summary’ report, select the relevant insurer and enter the claim number you wish to obtain the report for
  4. Press the “Get Claimants” button (View screenshot)
  5. The screen will refresh and the ‘Select a Claimant’ section will appear
  6. Select the claimant you wish to run the report for using the drop down menu
  7. Press the ‘Generate Report’ button (View screenshot)
  8. The screen refreshes and confirms that the request was received
  9. The report may take some time to process. Once it is ready to review, the Report Name will appear as a hyperlink under the ‘Reports Requested’ section, click it to open the report (View screenshot)
  10. To view the goods and services section of the report as a .CSV file, press the ‘Download Amounts’ button at the top of the report to download the files (View screenshot)
  11.  You can leave the report as-is, or you can add in paid amounts from outside of HCAI

Claimant Financial Summary

The Claimant Financial Summary provides a summary of the amounts proposed and approved for a particular claimant. To view the report, you will need the Form Manager, Claim-Claimant Editor, or Claim-Claimant Administrator role in HCAI.

The report is found on the Claimants Search Results screen. You can access the Claimants Search Results screen two ways:

  • On your Dashboard, click a section of the Claimant Summary pie chart. This performs a search for claimants based on the pie chart’s criteria. (View screenshot)
  • Visit the Claims tab > Claimants sub-tab and perform a search for claimants. (View screenshot)

On the Claimants Search Results screen, the far right column is titled Financial Summary. Click ‘View Report’ to view the Claimant Financial Summary for this claimant. The report opens in a new window. (View screenshot)

To download the Claimant Financial Summary as a .CSV file, click the ‘Download Report’ button at the top right of the window. This will allow you to save and edit the information as required – for example, you can use Excel to calculate balances, sort documents by different criteria, or add billing that occurred outside of HCAI. (View screenshot)

The Claimant Financial Summary is broken down into separate sections for each OCF type. A maximum of ten documents per section is displayed at a time. If you have more than ten documents in a section, you can press the ‘Next’ button to see more documents.

Each OCF section will display the following columns (View screenshot)

  • Document number: Click on the Document number to open that document in a new window.
  • Plan #: Visible in invoice sections only, the Plan # column displays the associated plan number. If the invoice is not associated with a plan, the column will state ‘Exempt’. If the link between the invoice and plan has been broken, a dash will appear. This can occur if the plan and invoice are matched to different claimants.
  • Facility: Click on the Facility name to open a new window that displays the signing provider’s details, including name, professional details, billing address and service address.
  • Status of the document
  • Proposed Amount
  • Approved Amount: This column will appear in all OCF sections except the OCF-23
  • Pre-Approved Amount: In the OCF-23 section, you will see the Pre-Approved Amount column, which is sub-divided into two columns: Declined and Responded.

At the bottom of each OCF-type section, you will see the following total amounts:

  • Non-archived Sub-total: The sub-total of proposed and approved amounts of all non-archived documents
  • Archived sub-total: The sub-total of proposed and approved amounts on archived documents. Archived documents won’t display in the lists, but the total is included for your reference. If none of the claimant’s documents have been archived, the archived amount will be blank.
  • Total (including taxes): The total proposed and approved amounts, including archived documents and taxes.
  • Tax Amount: Here, taxes are displayed separately. This line will display in the OCF-18, OCF-21B, and OCF-21C sections.

For users who do not have the Form Manager, Claim-Claimant Editor, or Claim-Claimant Administrator role in HCAI, similar information is available in the Associated Documents section of each OCF.

Associated Documents Section

The ‘Associated Documents’ section is available on the decision-making tab of all forms in the HCAI web application. It does not appear on the printed/PDF version of OCFs. To view the Associated Documents section, open an OCF and navigate to the Associated Documents Results section.  Click the ‘View Associated Documents’ button. (View screenshot)

To download the Associated Documents section as a .CSV file, click the ‘Download Report’ button at the top right of the section. This will allow you to save and edit the information as required – for example, you can use Excel to calculate balances, sort documents by different criteria, or add billing that occurred outside of HCAI. (View screenshot)

The Associated Documents section offers two viewing options: Claimant View (default) and Plan View. Use the ‘View’ drop-down in the top right corner of the section to select a view. (View screenshot)

  • Claimant View: Displays a consolidated view of a claimant’s plans and invoices in HCAI.
  • Plan View: Displays all documents associated with the current plan that are matched to the same claimant.
    • If you are reviewing an invoice, this view will display the parent plan and all its associated invoices.
    • If you are reviewing a plan, this view will display the plan and its associated invoices. Please note: there are no invoices associated to the Form 1 in HCAI.

In both views, the Associated Documents display is broken down into separate sections for each OCF type. A maximum of ten documents per section is displayed at a time. If you have more than ten documents in a section, you can press the ‘Next’ button to see more documents.

Each OCF section will display the following columns (View screenshot):

  • Document number: Click on the Document number to open that document in a new window.
  • Plan #: Visible in invoice sections only, the Plan # column displays the associated plan number. If the invoice is not associated with a plan, the column will state ‘Exempt’. If the link between the invoice and plan has been broken, a dash will appear. This can occur if the plan and invoice are matched to different claimants.
  • Facility: Click on the Facility name to open a new window that displays the signing provider’s details, including name, professional details, billing address and service address.
  • Status of the document
  • Proposed Amount
  • Approved Amount: This column will appear in all OCF sections except the OCF-23
  • Pre-Approved Amount: In the OCF-23 section, you will see the Pre-Approved Amount column, which is sub-divided into two columns: Declined and Responded.

At the bottom of each OCF-type section, you will see the following total amounts:

  • Non-archived Sub-total: The sub-total of proposed and approved amounts of all non-archived documents
  • Archived sub-total: The sub-total of proposed and approved amounts on archived documents. Archived documents won’t display in the lists, but the total is included for your reference. If none of the claimant’s documents have been archived, the archived amount will be blank.
  • Total (including taxes): The total proposed and approved amounts, including archived documents and taxes.
  • Tax Amount: Here, taxes are displayed separately. This line will display in the OCF-18, OCF-21B, and OCF-21C sections.

Document Search

HCAI allows you to quickly launch a search from your worklist screen. Simply enter a claim number into the ‘Search for Claim Number’ search bar and press ‘Go’, or press the ‘Advanced’ button to go directly to the OCF Form Search screen (View screenshot). You can also go directly to the ‘Search’ tab at any time (View screenshot) to go to the Document Search screen.

When you get to the OCF Form Search screen, you can enter your specific search criteria and press ‘Search’. The more information you enter into your search query, the faster HCAI will execute the search.

Clicking the ‘Advanced Options’ link at the bottom right-hand corner of the OCF Form Search screen (View screenshot) will provide you with additional search parameters. These additional parameters include:

  • Document Type (e.g. OCF-18, OCF-21B, OCF-21C, etc.)
  • Document Status (e.g. Submitted, Approved, Declined, etc.)
  • Claimant Status (e.g. Active, Deactivated, Unmatched)
  • Days Left to Respond (From/To, Overdue, Days Left Not Tracked Payable to Claimant, Days Left Not Tracked Response Withdrawn)
  • Matched to Claimant (Matched and Assigned, Matched but Unassigned, Unmatched)
  • Archival Status (Archived, Not Archived)
  • Provider Information (Provider name, Profession, Registry Number)
  • Facility name

Once you enter your search criteria and press the ‘Search’ button, you will be brought to the search results screen. HCAI populates the search results according to the date the document was submitted. The most recent results appear first. There are also options to download the results in CSV format or refine the search. Up to 100 search results can be viewed at a time. (View screenshot)

If you are expecting to see a search result and it’s not there, re-check your search criteria and perform the search again. If it still does not appear, escalate the issue to an administrator who can search for the form across the entire organization. For more information, please visit the Can’t Find an OCF? page.

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