Health Care Facility | Insurers | Related Initiatives  

HCAI Update - Release 3.19 / February 22, 2018

Spring System Release 3.19

This spring, we’re focused on delivering business improvements that will offer you more flexibility in how you manage your claims, users and branches. To make things easier, we’re also adding quick links throughout the application to help provide quick access to guidelines.

Keep reading to see what’s changing on April 9, 2018 and what you can do to prepare.

Improvements to Claimant Management

  1. New ‘Change Claimant’ button
  2. If you’ve ever needed to update the claimant associated with an adjudicated document, this button is for you! The new ‘Change Claimant’ button will appear on OCFs for HCAI users with the ‘Form Manager’ role. Users can press it to transfer the document to another claim/claimant record without withdrawing the adjudication decision.

    This functionality will be especially handy when a claim-claimant is to be disabled and the associated OCFs need to be moved (see next item) before permanently disabling claim/claimants created in error.

  3. Permanently disable claim/claimants created in error
  4. For users that match documents or manage claim/claimant records, having a duplicate or incorrect claim/claimant record can be a pain. That’s why we’re adding a ‘disable’ button to permanently disable claim/claimant records that are duplicate or created in error.

    Once a claim/claimant record has been disabled, it can no longer be matched to incoming forms, so it should be reserved for instances when the claim/claimant record was a true error. To assist you, the Disable button will only appear if there are no documents associated to the claim/claimant record.

    To prepare for this change, assign a Claim/Claimant Administrator and/or Form Manager to begin identifying possible duplicate or error claims. Those claims can be permanently disabled starting April 9.

  5. Changes to the Claimant Search screen
  6. For users that search for claimants in HCAI, we’re simplifying your steps with a new field on the Claimant Search screen. You can now choose to search by an adjuster’s e-mail in addition to by branch. If an adjuster’s e-mail address has been entered correctly in all of his/her adjuster profiles, you will only have to perform the search once to see all of his/her associated claimants.

    To prepare for this change, confirm with an Insurer Administrator that all adjuster profiles have an e-mail address accurately entered.

  7. New, optional Claim-Claimant Editor role for adjusters
  8. Nobody knows the lifecycle of a claim better than the adjuster reviewing it. That’s why we’re adding an optional new role that will give adjusters more control over their claims handling in HCAI. Adjusters with this role will be able to deactivate claims in HCAI that have closed. They will also be able to update claimant details such as name or date of birth. This additional role must be manually added to the user account.

    To prepare for this change, evaluate your current claim-claimant deactivation/update process to see how this new role would fit into your existing claim management processes. You can then assign a User Administrator to manually add this role to your adjuster’s permissions in the User Management tab starting April 9.  If you are interested in adding this new role and you integrate your claims software with HCAI, we recommend notifying your technical team to ensure that an adjuster’s update to a claim-claimant record is not automatically overridden.

Organizational Improvements

  1. New Branch Management settings
  2. We recognize that the concept of a ‘Branch’ has evolved over the years. That is why we’re adding new settings to help you manage your branch structure in HCAI. For the first time, you’ll be able to turn off new claim/claimant set up in a branch. You’ll also be able to turn off facility document submission to a branch. Documents can still be manually and automatically matched to existing claimants in branches that do not allow new document submission, so existing adjuster profiles should be retained. We will continue to evolve the branch concept as business processes mature, so stay tuned!

    To prepare for this change, identify branches that you’d like to turn off document submission or claim set up for. If you integrate your claims software with HCAI, we recommend assigning a business lead to work with your technical staff to prepare for a branch setting change. You can then assign an Insurer Administrator to make the necessary changes starting April 9.

  3. New Chief Privacy Officer contact
  4. Privacy and security continues to be paramount on the HCAI system, which is why we are adding a new Privacy Officer contact on the Manage > Insurer Management screen on HCAI. This person should be someone who is available to review privacy-related communications and inquiries on behalf of your organization. This new contact will not replace your current Contact 1 and Contact 2.

    To prepare for this change, identify someone who serves as your Chief Privacy Officer (CPO) for privacy-related matters in HCAI. You can then assign an Insurer Administrator to fill in the CPO’s contact information starting April 9.

  5. An easier way to grant worklist access
  6. We’ve heard that granting worklist access can be time consuming, which is why we’ve added a new search option to streamline the process. Insurers can now search for users and choose to see adjuster profiles consolidated by e-mail address. 

    To prepare for this change, confirm with an Insurer Administrator that all adjuster profiles have an e-mail address entered. User Administrators are encouraged to watch our upcoming Release 3.19 ‘What’s New?’ video, scheduled to be distributed in March to see the new feature in action.

Adjuster Improvements

  1. Warning message to facilities and insurers to raise awareness of applicable guidelines
  2. We heard that it can be challenging for facilities and insurers to recall maximum fees and submission timelines. That’s why we’ve added new warning flags and messages to the OCF-23, OCF-21C and OCF-21B in HCAI. These informational tools won’t prevent submission or adjudication of forms that exceed guideline amounts or timelines. Instead, they will provide guidance and information to facility and insurer users.

    To prepare for this change, adjusters are encouraged to watch our upcoming Release 3.19 ‘What’s New?’ video, scheduled to be distributed in March to see the new warning messages and flags and where they will appear.

  3. New links to resources on the HCAI application
  4. We know that adjusters like having information to support their decision making right at their fingertips. That’s why we’re adding links to relevant resources on HCAI. This change won’t impact the normal adjudication process; it will just make it easier for you to access.

    Adjusters are encouraged to try out the new links when they become available on April 9.

  5. Improvements to the OCF search screen
  6. We’re enhancing the document search screens with a new and improved layout and a new ‘adjuster email’ search field. This new search option will allow users to search by adjuster email across the whole organization in addition to by individual branch. For now, search results will continue to be limited to worklists an individual user has access to. In the future, this functionality will be enhanced to allow users to launch even wider searches.

    To prepare for this change, confirm with an Insurer Administrator that all adjuster profiles have an e-mail address entered. All HCAI users are encouraged to watch our upcoming Release 3.19 ‘What’s New?’ video, scheduled to be distributed in March.

Technical Updates

For the best user experience, access HCAI using a supported, up-to-date browser. Starting in Release 3.19, HCAI will add support for Safari 10. HCAI recommends using Internet Explorer 11 for Microsoft users and Safari 10 for Mac users.

Microsoft no longer provides security updates or technical support for Internet Explorer 8, 9 or 10, and the XP and Vista operating systems. Review HCAIinfo’s Computer Requirements and Tips page to determine if a browser update for your organization is necessary.

Planned HCAI System Unavailability

In preparation for Release 3.19, the following system unavailability window is planned:

Friday, April 6 – Monday, April 9

  • The HCAI system will be unavailable from 5:00 p.m. (EDT) on Friday, April 6, 2018 and is expected to resume active status at 8:00 a.m. (EDT) on Monday, April 9
  • All integrating insurers must have all of their integration transactions successfully processed by 4:59 p.m. (EDT) Friday, April 6, 2018

What’s Next?

  • Review each change individually to find out what preparation work is needed to benefit from Release 3.19
  • Share this update with individual(s) at your organization who interact with the HCAI system so they know what to expect this spring