Health Care Facility | Insurers | Related Initiatives  

Adjuster Support

About this section:

We’ve organized this section as a learning module to guide you on the form adjuster’s role in HCAI. We’ll cover the basics like reviewing a form in HCAI and how to mark a decision but we’ll also get in-depth about topics like partial approvals, the target date and how you can make your processes more efficient in HCAI.

Who should review this module:

You’ll find this module helpful if you are involved with:

  • Adjudicating OCFs in HCAI
  • Receiving and paying invoices

This module can also help clarify system functionality if you are:

  • A manger or supervisor interested in learning more about form adjusters and their role in HCAI
  • Involved with setting up or managing feeds and extracts through our integration channels

What you’ll learn:

  • An overview of the forms available in HCAI
  • Entering a response on a form
  • An overview of the ‘Target Date’ column
  • The purpose and importance of reason codes
  • Updating your response and/or decision in HCAI

How to proceed with this module:

We have organized this module into five logical steps: a form overview, entering a response/decision, the target date, reason codes and updating your response/decision. For the best learning experience, we recommend that you follow these steps in this order.

  • Adjuster Dashboard

  • Claims Tools

  • Form Overview

  • Entering a Response/ Decision

  • Target Date

  • Adjuster Reason Codes

  • Updating Your Response/ Decision

  • Insurer User Manual