Health Care Facility | Insurers | Related Initiatives  

Updating Your Response/Decision

As an adjuster, you may encounter a situation where you need to update your decision or response on an OCF.

Withdraw an OCF

Some examples of possible situations where you would need to withdraw your response and render a new one:

  • A facility has contacted the insurer and asked to resubmit an updated version of the form
  • The claim-claimant profile was initially set up in the wrong branch and needs to be re-created in a different one
  • The decision was rendered in error

In all of these situations, you will need to withdraw the decision on the form and render a new one. Continue reading for more information on how to perform this function in HCAI.

Withdrawing your decision in HCAI:

  • Open the plan or invoice you wish to update—you can find previously adjudicated plans or invoices in the ‘Adjuster Response’ tab.
  • The plan will open to the ‘Summary’ tab.
  • In the ‘Plan Details’ or ‘Invoice Details’ section, press the ‘Withdraw Response’ button. (View screenshot)
  • The screen will refresh and the plan or invoice will be placed in ‘Review Required’ status.
  • You can now proceed to adjudicate the form. If you need to update the claimant to be in a different branch, you will need to contact a claim-claimant administrator who can unlink the claimant and match it to a claimant in the correct branch.

Please note that adjudication decisions cannot be withdrawn more than 365 days after the decision was rendered.