Health Care Facility | Insurers | Related Initiatives  

HCAI Update – Release 3.22 for Adjusters / October 23, 2019

Phase I of HCAI Modernization is nearing completion and will culminate with the launch of HCAI System Release 3.22. Some system enhancements will be visible on February 3, 2020 - however, many major changes in this release will only become available after your company migrates to the new view of HCAI on a migration date that we will schedule for each insurer throughout 2020. Your organization will receive more information about those enhancements as your migration date nears.

This bulletin outlines the changes that will be visible to you on February 3. Many of these changes are preparatory for migration and will lead to the following exciting enhancements that will streamline your workflow and address many of your requests:

Changes coming February 3, 2020
  1. Form Adjusters can now review their own Claim-Claimant Records
  2. You can now view claim and claimant details for your assigned claims without having to ask an administrator for help. Simply click on the Claims tab to search and browse your claim-claimant records in read-only mode.

    You can also access this information directly from your Dashboard by clicking a piece of the Claimant Summary pie chart. This will bring you to the Claimants Search Results screen, where you can also open a Claimant Financial Summary to view a summary of amounts proposed and approved for that particular claimant.

  3. The Dashboard has been updated
  4. We’ve improved the HCAI Dashboard to reflect your feedback by adjusting categories on the Claimant Summary pie charts, so you can see precisely how long the claimant has been open or the date of the last activity. Activity implies that a form was submitted for the claimant and is pending adjudication.

  5. Each Document has a Target Date
  6. We’re making it easy to see the date your response is due for any document. The Document Search results screen now displays a Target Date for each document. This target date is calculated according to the SABS: 30 calendar days for invoices, 10 business days for the OCF-18 and Form 1, and 5 business days for the OCF-23.

    After your organization migrates, you’ll also see this Target Date populated directly on your worklist in place of the Days Left column, so you’ll know exactly when your response is due.
    The Document search screen also has a new field that will help you prioritize your worklist. You can now search for documents by indicating a range of Days Left to Respond, and specify either business days or calendar days. For example, you can search for a list of all documents that have 1 to 5 business days left to respond.

  7. Tag your Documents to indicate they’re in review
  8. The “Take Ownership” button on OCFs has been renamed “Tag Document”. The feature will function the same way as before: if you are reviewing a document, you can click the Tag Document button to let others who can see this document know.

  9. Prepare for Claimant File Ownership
  10. After your organization migrates, the adjuster record concept will be replaced by claimant file ownership. Each claimant will now be associated directly to a user account (the “file owner”) which will eliminate the need for adjuster profiles.

    Only some functionality will be available as of February 3. Claimant file ownership will not be fully functional until migration. However, you will begin to see some mention of file owners throughout the application as we prepare to fully implement the functionality.

    • Next to the new Tag Document button on an OCF’s Summary tab, you will see a new field labeled “Claimant File Owner”. For now, this field will remain blank. After your organization migrates, this field will populate with the name of the user who is assigned to the claimant file.
    • You will also see the Claimant File Owner field on the Claimant Search screen. Again, this will become more useful after your organization migrates. You’ll then be able to search for claimants by selecting the name of the user who is assigned to the claimant file.
Planned HCAI System Unavailability

In preparation for Release 3.22, the following system unavailability window is planned:

Friday, January 31– Monday, February 3

  • The HCAI system will be unavailable from 5:00 p.m. (EDT) on Friday, January 31, 2020 and is expected to resume active status at 8:00 a.m. (EDT) on Monday, February 3, 2020.