Health Care Facility | Insurers | Related Initiatives  

HCAI Update – Release 3.22 for Management and Administration / 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. The Form Adjuster role is being enhanced to allow them to view claim and claimant details for their assigned claims in read-only mode. This will advance their use of the Adjuster Dashboard without having to grant them the Claimant Editor role.

    The Claim-Claimant Editor role is no longer necessary to view claimant records, but the role is still useful for those who need to edit claimant records. This allows insurers more flexibility when choosing which privileges each user should be assigned.

  3. The Dashboard has been updated
  4. A new Manager Dashboard Viewer role has been added.  Insurer, Child-Insurer, and Branch-level users who are granted this role will be able to view the HCAI Dashboard for an overview of their organization or branch’s claimant and document information. You can unassign this role to hide the dashboard from a user’s view.

    The HCAI Dashboard provides an interactive display of assigned, open claimants and outstanding documents that allows you to drill-down for additional information. We’ve also improved the 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.

  5. Each OCF now has a Target Date
  6. We’re making it easy to see the date a 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 a 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. Restrict Permission to View User Information in HCAI
  8. We’re providing you with more control over who has permission to view user information within your organization. You may wish to restrict access for users who are external to your organization, such as independent adjusters or short-term contractors. A new setting on each user profile asks “Allow the user to search and filter by all other users in the company?” enabling you to limit the information they can see.

  9. Tag Documents to indicate they’re in review
  10. 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.

Changes that are related to Migration

The following changes will become available on February 3, but will become more useful or fully functional after your organization migrates. Your organization will learn more about these changes when they attend their migration workshop.

  1. Create and Manage Teams in HCAI
  2. You are now able to create Teams in HCAI to better reflect your claims department, improve reporting, and make it easier for managers to view key information about their teams’ worklists. While you are able to set up teams as of February 3, the full scope of team functionality will become available after migration.

    As a result, a new role called Team Administrator has been added to HCAI. Both Team Administrators and User Administrators can create and delete teams, add or remove team members, and grant users permission within the team - such as the ability to view the team’s dashboard. After migration, team members will be able to support one another and managers will be able to oversee their teams with easy access to the team’s worklist, team dashboard, and the ability to generate reports for a team.

  3. Prepare for Claimant File Ownership
  4. After your organization migrates, the adjuster profile concept will be replaced by the new file owner concept. Each claimant will be associated directly to a user account (the “claimant file owner”), which will eliminate the need for multiple adjuster profiles.

    Only some functionality will be available as of February 3. Claimant file ownership will not be fully functional before migration, so you will continue to use adjuster profiles until your migration date. However, you will begin to see some mention of claimant file owners throughout the application as we prepare to fully implement the functionality.

    • When adding or editing a user account, in the Roles and Responsibilities section, you will see an additional question: “Allow this user to have ownership of claimant files?” For users with the Form Adjuster role, the default answer will be “Yes”, which will allow them to be claimant file owners. However, you can select “No” if the user should not have permission to be a claimant file owner.
    • The Claimant Details screen will have a new field called Claimant File Owner, which will display a list of eligible file owners. However, you should not yet begin assigning Claimant File Owners to each claimant. When you begin the migration process, you will see that HCAI has developed a Migration Wizard that will help automatically assign the correct File Owners to claimants. This will be explained in detail at the workshop your organization will attend prior to migration.
    • On each 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 be populated 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 and User Search screen. Again, this will become functional after your organization migrates. You’ll then be able to search for Claimants by selecting one or more claimant file owners.
  5. The Migration Wizard is visible
  6. Organization Administrators will now have access to the Migration Wizard on the Insurer Management page. This wizard is a tool to be specifically used for migration. Those attending our workshop will learn how and when to use this tool.

  7. Branches will be replaced by Claim Groups
  8. Claim groups are a way of organizing claims that directly replaces branches in HCAI. They provide users with greater access to claims while still allowing your organization to keep some claims confidential if needed. Across HCAI, you will begin to see references to claim groups wherever branches are mentioned - for example, the branch level of access is now called branch/claim group-level access.

    • After migration, your current branches will turn into claim groups. To prepare for migration, your organization will determine if they need to create new claim groups. Any new claim groups will be used only after your migration date.
    • More information about claim groups and claim group-level access will be distributed closer to your migration date.
  9. Bulk Change of User Permissions
  10. We’ve made it easy for you to update several users’ level of access at once. This will come in handy after your organization migrates and the Adjuster level of access is no longer necessary. You can also deactivate multiple user accounts at once using the same tool, which is found on the User Search Results screen.

  11. Bulk Claimant Transfer
  12. After migration, claimants will be associated to Claimant File Owners rather than adjuster profiles. We have created a tool that will make it easy for you to transfer several claimants to a new Claimant File Owner in bulk, via the web. On the Claimant Search Results screen, you will see the option to reassign claimants to a new adjuster or file owner.

    Integrating insurers will not see this tool on the web, to avoid interference with their Claim-Claimant feed. During their migration workshop, we’ll explain how they can request access to it.

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
  • All integrating insurers must have all of their integration transactions successfully processed by 4:59 p.m. (EDT) Friday, January 31, 2020