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Health Care Facility | Insurers | Related Initiatives  

Claim Groups


HCAI has developed an easy way for insurers to organize claims and to manage users’ access to claims. Claims are now organized into claim groups, and User Administrators can either grant or restrict a user’s access to each claim group. Claim groups directly replace the branch concept in HCAI.

What is a Claim Group?

Claim groups permit insurers to gather all claims that have the same access restrictions into a single group, rather than putting them in different branches that were historically associated with the company’s physical locations. Once this grouping is done, it becomes easier to manage users’ access to claims by either granting or restricting each user’s access to the claim group, if required.

Companies without access restrictions may only have one claim group for all claims. Other companies may choose to have more than one claim group. For example, if you have confidential claims that only a handful of users are allowed to access for privacy reasons, then a separate claim group like “Confidential Claims” can be set up for this purpose. Only the users who need to access these claims will be granted permission to this claim group.

Companies should have as few claim groups as they need. You may be tempted to create separate claim groups for each team or adjuster, but this should be avoided. Use claim groups only when you identify a group of claims for which some of your adjusters must not have access.

Branch/Claim Group Level of Access

After migration, when creating or updating a user account, User Administrators will grant each user either Insurer, Child Insurer, or Branch/Claim Group level of access. At the Branch/Claim Group level of access, the administrator can decide which claim group(s) the user should have permission to access. The Adjuster level of access will no longer be used.

If a user should be able to access all claim files, the user can simply be granted Insurer or Child Insurer level of access. Those users will be able to search and see all claim files in their company.

However, if access to claims should be restricted, the user can be granted Branch/Claim Group level of access and the administrator can specify which claim group(s) the user can access. Review the Update a User’s Level of Access page to learn how.

Explore the side menu for step-by-step instructions for tasks related to claim groups.

Claim Groups


Bulk Transfer Claims Between Claim Groups

Please note: This page is intended for insurers who have already migrated.

Claims can be transferred in bulk via the HCAI web interface or via integration.

  • Claims can only be moved into claim groups that have the setting “Allow claim-claimants to be set up in this branch/claim group?” set to Yes. To change this setting, see Turn On/Off New Claim-Claimant Setup in a Claim Group above.
  • The tool is only visible to non-integrating insurers or to integrating insurers who request the web functionality be enabled. Integrating insurers who wish to move their claims via the web need to coordinate this change with their HCAI integration team to prevent any disruption to their Claim-Claimant Feed. They can then use the HCAI Integration Settings Update Form to request the web functionality be enabled.

When a claim is moved to a new claim group, the claimant file owner remains the same. If the claimant file owner does not have access to the new claim group, they will not be able to see these claimant’s documents. Review the user’s account to ensure they have access to the claim group.

To move claims via the web, you must have the Form Manager or Claim/Claimant Administrator role in HCAI.

  1. Go to the Claims tab and Claims sub-tab.
  2. Enter search criteria to search for the claim(s) you would like to move. Note: If you choose to select from the “insurer” drop-down list, select only one company or the “move claims” functionality will be disabled. Claims can only be transferred to claim groups within the same insurance company.
  3. Click the “Search” button.
  4. On the Claims Search Results screen, you will see all claims that meet your search criteria. Use the checkbox to select the claim(s) you would like to move. You can move up to 50 at once.
  5. At the bottom of the search results, you will see a drop-down list labeled “Move Claims”. Select the claim group to which you would like to move the claims. (View screenshot).
  6. Click the “Move” button.
  7. A pop-up will ask “You are about to move all of the selected claim files to the selected claim group. Do you want to proceed?” Click OK.
  8. You will see a confirmation message stating the number of claims that were successfully moved.

Claim Groups


Transfer an Individual Claim Between Claim Groups

Claims can be transferred via the HCAI web interface or via integration.

  • Claims can only be moved into claim groups that have the setting “Allow claim-claimants to be set up in this branch/claim group?” set to Yes. To change this setting, see Turn On/Off New Claim-Claimant Setup in a Claim Group above.
  • The tool is only visible to non-integrating insurers or to integrating insurers who request the web functionality be enabled. Integrating insurers who wish to move their claims via the web need to coordinate this change with their HCAI integration team to prevent any disruption to their Claim-Claimant Feed. They can then use the HCAI Integration Settings Update Form to request the web functionality be enabled.

To move claims via the web, you must have the Form Manager or Claim/Claimant Administrator role in HCAI.

  1. Go to the Claims tab and Claims sub-tab.
  2. Enter search criteria to search for the claim(s) you would like to move.
  3. Click the “Search” button.
  4. On the Search Results screen, click the Claim # to open the claim.
  5. On the Claim Details screen, locate the Branch/Claim Group drop down. Select the new claim group. (View screenshot).
  6. Click the “Save” button.
  7. If all of the claimants associated to the claim are assigned to the same claimant file owner, the claim will be transferred to the new claim group.
  8. If the claimants associated to the claim are unassigned or are assigned to multiple different file owners, a pop-up will appear allowing you to reassign the file owner associated to each claimant. You can also leave the fields unchanged if you do not want to reassign the claimant file owners. Click “Save”. (View screenshot).
  9. A confirmation message will display indicating the claim has been successfully updated.

Claim Groups


Turn On/Off Claim Group Visibility to Facilities

When a health care facility submits a document, they are prompted to pick the branch/claim group to which they wish to submit.  To prevent confusion, health care facilities will continue to see claim groups referred to as “branches”.

A setting in HCAI allows you to decide if a claim group name will be visible to the health care facility when submitting their OCF.  However, even if the claim group name is hidden, submitted forms are automatically directed to the claim group in which the associated claim-claimant record resides. As a result, documents can be routed to a claim group such as “Confidential Claims” without the facility being aware of the claim group’s existence.

To hide a claim group from facilities, a user with the Organization Administrator role in HCAI can do the following:

  1. Go to Manage tab and the Insurer Management sub-tab.
  2. If your organization has child insurers, locate the “Select Insurer” dropdown at the top of the page and select the insurer whose claim group you’d like to edit.
  3. Scroll down to the bottom of the screen and locate the ‘Browse Branches/Claim Groups’ section.
  4. Click the name of the claim group you would like to edit.
  5. In the ‘Branch/Claim Group Management’ section, it asks “Allow facilities to submit documents to this branch/claim group?” Select ‘No’ to hide the claim group from facilities or ‘Yes” to make the claim group visible. (View screenshot).
  6. Click “Save”.

Claim Groups


Turn On/Off New Claim-Claimant Setup in a Claim Group

If you have a branch/claim group you would like to wind down, you can prevent new claim-claimant records from being set up in it. This setting will also prevent claims from being transferred into this branch/claim group.

To turn on/off the new claim-claimant setup in a claim group, a user with the Organization Administrator role in HCAI can do the following:

  1. Go to Manage tab and the Insurer Management sub-tab.
  2. If your organization has child insurers, locate the “Select Insurer” dropdown at the top of the page and select the insurer whose claim group you’d like to edit.
  3. Scroll down to the bottom of the screen and locate the ‘Browse Branches/Claim Groups’ section.
  4. Click the name of the claim group you would like to edit.
  5. In the ‘Branch/Claim Group Management’ section, it asks “Allow claim-claimants to be set up in this branch/claim group?” Select ‘No’ to prevent claim-claimants being set up or select ‘Yes” to allow it. (View screenshot).
  6. Click “Save”.

Claimant File Ownership


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HCAI has developed an easy way for insurers to organize claims and to manage users’ access to claims. Claims are now organized into claim groups, and User Administrators can either grant or restrict a user’s access to each claim group. Claim groups directly replace the branch concept in HCAI.

What is a Claim Group?

Claim groups permit insurers to gather all claims that have the same access restrictions into a single group, rather than putting them in different branches that were historically associated with the company’s physical locations. Once this grouping is done, it becomes easier to manage users’ access to claims by either granting or restricting each user’s access to the claim group, if required.

Companies without access restrictions may only have one claim group for all claims. Other companies may choose to have more than one claim group. For example, if you have confidential claims that only a handful of users are allowed to access for privacy reasons, then a separate claim group like “Confidential Claims” can be set up for this purpose. Only the users who need to access these claims will be granted permission to this claim group.

Companies should have as few claim groups as they need. You may be tempted to create separate claim groups for each team or adjuster, but this should be avoided. Use claim groups only when you identify a group of claims for which some of your adjusters must not have access.

Branch/Claim Group Level of Access

After migration, when creating or updating a user account, User Administrators will grant each user either Insurer, Child Insurer, or Branch/Claim Group level of access. At the Branch/Claim Group level of access, the administrator can decide which claim group(s) the user should have permission to access. The Adjuster level of access will no longer be used.

If a user should be able to access all claim files, the user can simply be granted Insurer or Child Insurer level of access. Those users will be able to search and see all claim files in their company.

However, if access to claims should be restricted, the user can be granted Branch/Claim Group level of access and the administrator can specify which claim group(s) the user can access. Review the Update a User’s Level of Access page to learn how.

Bulk Transfer Claims Between Claim Groups

Please note: This page is intended for insurers who have already migrated.

Claims can be transferred in bulk via the HCAI web interface or via integration.

  • Claims can only be moved into claim groups that have the setting “Allow claim-claimants to be set up in this branch/claim group?” set to Yes. To change this setting, see Turn On/Off New Claim-Claimant Setup in a Claim Group above.
  • The tool is only visible to non-integrating insurers or to integrating insurers who request the web functionality be enabled. Integrating insurers who wish to move their claims via the web need to coordinate this change with their HCAI integration team to prevent any disruption to their Claim-Claimant Feed. They can then use the HCAI Integration Settings Update Form to request the web functionality be enabled.

When a claim is moved to a new claim group, the claimant file owner remains the same. If the claimant file owner does not have access to the new claim group, they will not be able to see these claimant’s documents. Review the user’s account to ensure they have access to the claim group.

To move claims via the web, you must have the Form Manager or Claim/Claimant Administrator role in HCAI.

  1. Go to the Claims tab and Claims sub-tab.
  2. Enter search criteria to search for the claim(s) you would like to move. Note: If you choose to select from the “insurer” drop-down list, select only one company or the “move claims” functionality will be disabled. Claims can only be transferred to claim groups within the same insurance company.
  3. Click the “Search” button.
  4. On the Claims Search Results screen, you will see all claims that meet your search criteria. Use the checkbox to select the claim(s) you would like to move. You can move up to 50 at once.
  5. At the bottom of the search results, you will see a drop-down list labeled “Move Claims”. Select the claim group to which you would like to move the claims. (View screenshot).
  6. Click the “Move” button.
  7. A pop-up will ask “You are about to move all of the selected claim files to the selected claim group. Do you want to proceed?” Click OK.
  8. You will see a confirmation message stating the number of claims that were successfully moved.

Transfer an Individual Claim Between Claim Groups

Claims can be transferred via the HCAI web interface or via integration.

  • Claims can only be moved into claim groups that have the setting “Allow claim-claimants to be set up in this branch/claim group?” set to Yes. To change this setting, see Turn On/Off New Claim-Claimant Setup in a Claim Group above.
  • The tool is only visible to non-integrating insurers or to integrating insurers who request the web functionality be enabled. Integrating insurers who wish to move their claims via the web need to coordinate this change with their HCAI integration team to prevent any disruption to their Claim-Claimant Feed. They can then use the HCAI Integration Settings Update Form to request the web functionality be enabled.

To move claims via the web, you must have the Form Manager or Claim/Claimant Administrator role in HCAI.

  1. Go to the Claims tab and Claims sub-tab.
  2. Enter search criteria to search for the claim(s) you would like to move.
  3. Click the “Search” button.
  4. On the Search Results screen, click the Claim # to open the claim.
  5. On the Claim Details screen, locate the Branch/Claim Group drop down. Select the new claim group. (View screenshot).
  6. Click the “Save” button.
  7. If all of the claimants associated to the claim are assigned to the same claimant file owner, the claim will be transferred to the new claim group.
  8. If the claimants associated to the claim are unassigned or are assigned to multiple different file owners, a pop-up will appear allowing you to reassign the file owner associated to each claimant. You can also leave the fields unchanged if you do not want to reassign the claimant file owners. Click “Save”. (View screenshot).
  9. A confirmation message will display indicating the claim has been successfully updated.

Turn On/Off Claim Group Visibility to Facilities

When a health care facility submits a document, they are prompted to pick the branch/claim group to which they wish to submit.  To prevent confusion, health care facilities will continue to see claim groups referred to as “branches”.

A setting in HCAI allows you to decide if a claim group name will be visible to the health care facility when submitting their OCF.  However, even if the claim group name is hidden, submitted forms are automatically directed to the claim group in which the associated claim-claimant record resides. As a result, documents can be routed to a claim group such as “Confidential Claims” without the facility being aware of the claim group’s existence.

To hide a claim group from facilities, a user with the Organization Administrator role in HCAI can do the following:

  1. Go to Manage tab and the Insurer Management sub-tab.
  2. If your organization has child insurers, locate the “Select Insurer” dropdown at the top of the page and select the insurer whose claim group you’d like to edit.
  3. Scroll down to the bottom of the screen and locate the ‘Browse Branches/Claim Groups’ section.
  4. Click the name of the claim group you would like to edit.
  5. In the ‘Branch/Claim Group Management’ section, it asks “Allow facilities to submit documents to this branch/claim group?” Select ‘No’ to hide the claim group from facilities or ‘Yes” to make the claim group visible. (View screenshot).
  6. Click “Save”.

Turn On/Off New Claim-Claimant Setup in a Claim Group

If you have a branch/claim group you would like to wind down, you can prevent new claim-claimant records from being set up in it. This setting will also prevent claims from being transferred into this branch/claim group.

To turn on/off the new claim-claimant setup in a claim group, a user with the Organization Administrator role in HCAI can do the following:

  1. Go to Manage tab and the Insurer Management sub-tab.
  2. If your organization has child insurers, locate the “Select Insurer” dropdown at the top of the page and select the insurer whose claim group you’d like to edit.
  3. Scroll down to the bottom of the screen and locate the ‘Browse Branches/Claim Groups’ section.
  4. Click the name of the claim group you would like to edit.
  5. In the ‘Branch/Claim Group Management’ section, it asks “Allow claim-claimants to be set up in this branch/claim group?” Select ‘No’ to prevent claim-claimants being set up or select ‘Yes” to allow it. (View screenshot).
  6. Click “Save”.
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