Health Care Facility | Insurers | Related Initiatives
Health Care Facility | Insurers | Related Initiatives  

Branch/Claim Group Management

HCAI has developed an easy way for insurers to organize claims and to manage users’ access to claims. Claims are now organized into branches/claim groups, and User Administrators can either grant or restrict a user’s access to each branch/claim group.

In HCAI, all claims are associated to a branch/claim group, which is why it is necessary for every insurer to have at least one branch/claim group.

What is a Branch/Claim Group?

Branches/claim groups permit insurers to gather all claims that have the same access restrictions into a single group, rather than putting them in different branches that were historically associated with the company’s physical locations. Once this grouping is done, it becomes easier to manage users’ access to claims by either granting or restricting each user’s access to the branch/claim group, if required.

Companies without access restrictions may only have one branch/claim group for all claims. Other companies may choose to have more than one branch/claim group. For example, if you have confidential claims that only a handful of users are allowed to access for privacy reasons, then a separate branch/claim group can be set up for this purpose. Only the users who need to access these claims will be granted permission to this branch/claim group.

Companies should have as few branches/claim groups as they need. Use branches/claim groups only when you identify a group of claims for which some of your users must not have access.

Branch/Claim Group Level of Access

When creating or updating a user account, User Administrators will grant each user either Insurer, Child Insurer, or Branch/Claim Group level of access. At the Branch/Claim Group level of access, the administrator can decide which branches/claim group(s) the user should have permission to access.

If a user should be able to access all claim files, the user can simply be granted Insurer or Child Insurer level of access. Those users will be able to search and see all claim files in their company.

However, if access to claims should be restricted, the user can be granted Branch/Claim Group level of access and the administrator can specify which branches/claim group(s) the user can access. Review the Updating User Information page to learn how.

This section outlines options insurers have for managing branches/claim groups in HCAI. Continue reading from the side menu for more information.

Branch/Claim Group Management

Turn on/off Document Submission to a Branch/Claim Group

Insurers can control whether a facility can select a particular branch/claim group from the submission drop-down menu at the time of document submission. Ultimately, however, the form will be directed to the branch/claim group the associated claimant has been set up in. For this reason, if you have a branch/claim group with active claims, you should continue to manage user access to that branch until all claims are run down and are deactivated.

To turn off facility submission to a branch/claim group, you must have the Organization Administrator role.

  1. Go to Manage tab and the Insurer Management sub-tab.
  2. If your organization has child insurers, locate the “Select Insurer” dropdown at the top of the page and select the insurer whose claim group you’d like to edit.
  3. Scroll down to the bottom of the screen and locate the ‘Browse Branches/Claim Groups’ section.
  4. Click the name of the branch/claim group you would like to edit.
  5. In the ‘Branch/Claim Group Management’ section, it asks “Allow facilities to submit documents to this branch/claim group?” Select ‘No’ to hide the claim group from facilities or ‘Yes” to make the claim group visible. (View screenshot)
  6. Click “Save”.

Branch/Claim Group Management

Turn on/off New Claimant Set Up in a Branch/Claim Group

If you have a branch/claim group you would like to wind down, you may wish to prevent new claim-claimant records from being set up in it. Insurers can control whether new claim-claimant records can be set up in a branch/claim group in the Branch/Claim Group Management section. This setting will also prevent claims from being transferred into this branch/claim group.

If you integrate your claims software with HCAI, you should first speak with your technical team to ensure that claim/claimant records are not being automatically routed to that branch. Otherwise, you may encounter issues with your integration feed.

To turn off new claim/claimants set up in a branch, you must have the Organization Administrator role.

  1. Go to Manage tab and the Insurer Management sub-tab.
  2. If your organization has child insurers, locate the “Select Insurer” dropdown at the top of the page and select the insurer whose branch/claim group you’d like to edit.
  3. Scroll down to the bottom of the screen and locate the ‘Browse Branches/Claim Groups’ section.
  4. Click the name of the branch/claim group you would like to edit.
  5. In the ‘Branch/Claim Group Management’ section, it asks “Allow claim-claimants to be set up in this branch/claim group?” Select ‘No’ to prevent claim-claimants being set up or select ‘Yes” to allow it. (View screenshot)
  6. Click “Save”.

Branch/Claim Group Management

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HCAI has developed an easy way for insurers to organize claims and to manage users’ access to claims. Claims are now organized into branches/claim groups, and User Administrators can either grant or restrict a user’s access to each branch/claim group.

In HCAI, all claims are associated to a branch/claim group, which is why it is necessary for every insurer to have at least one branch/claim group.

What is a Branch/Claim Group?

Branches/claim groups permit insurers to gather all claims that have the same access restrictions into a single group, rather than putting them in different branches that were historically associated with the company’s physical locations. Once this grouping is done, it becomes easier to manage users’ access to claims by either granting or restricting each user’s access to the branch/claim group, if required.

Companies without access restrictions may only have one branch/claim group for all claims. Other companies may choose to have more than one branch/claim group. For example, if you have confidential claims that only a handful of users are allowed to access for privacy reasons, then a separate branch/claim group can be set up for this purpose. Only the users who need to access these claims will be granted permission to this branch/claim group.

Companies should have as few branches/claim groups as they need. Use branches/claim groups only when you identify a group of claims for which some of your users must not have access.

Branch/Claim Group Level of Access

When creating or updating a user account, User Administrators will grant each user either Insurer, Child Insurer, or Branch/Claim Group level of access. At the Branch/Claim Group level of access, the administrator can decide which branches/claim group(s) the user should have permission to access.

If a user should be able to access all claim files, the user can simply be granted Insurer or Child Insurer level of access. Those users will be able to search and see all claim files in their company.

However, if access to claims should be restricted, the user can be granted Branch/Claim Group level of access and the administrator can specify which branches/claim group(s) the user can access. Review the Updating User Information page to learn how.

This section outlines options insurers have for managing branches/claim groups in HCAI.

Turn on/off Document Submission to a Branch/Claim Group

Insurers can control whether a facility can select a particular branch/claim group from the submission drop-down menu at the time of document submission. Ultimately, however, the form will be directed to the branch/claim group the associated claimant has been set up in. For this reason, if you have a branch/claim group with active claims, you should continue to manage user access to that branch until all claims are run down and are deactivated.

To turn off facility submission to a branch/claim group, you must have the Organization Administrator role.

  1. Go to Manage tab and the Insurer Management sub-tab.
  2. If your organization has child insurers, locate the “Select Insurer” dropdown at the top of the page and select the insurer whose claim group you’d like to edit.
  3. Scroll down to the bottom of the screen and locate the ‘Browse Branches/Claim Groups’ section.
  4. Click the name of the branch/claim group you would like to edit.
  5. In the ‘Branch/Claim Group Management’ section, it asks “Allow facilities to submit documents to this branch/claim group?” Select ‘No’ to hide the claim group from facilities or ‘Yes” to make the claim group visible. (View screenshot)
  6. Click “Save”.

Turn on/off New Claimant Set Up in a Branch/Claim Group

If you have a branch/claim group you would like to wind down, you may wish to prevent new claim-claimant records from being set up in it. Insurers can control whether new claim-claimant records can be set up in a branch/claim group in the Branch/Claim Group Management section. This setting will also prevent claims from being transferred into this branch/claim group.

If you integrate your claims software with HCAI, you should first speak with your technical team to ensure that claim/claimant records are not being automatically routed to that branch. Otherwise, you may encounter issues with your integration feed.

To turn off new claim/claimants set up in a branch, you must have the Organization Administrator role.

  1. Go to Manage tab and the Insurer Management sub-tab.
  2. If your organization has child insurers, locate the “Select Insurer” dropdown at the top of the page and select the insurer whose branch/claim group you’d like to edit.
  3. Scroll down to the bottom of the screen and locate the ‘Browse Branches/Claim Groups’ section.
  4. Click the name of the branch/claim group you would like to edit.
  5. In the ‘Branch/Claim Group Management’ section, it asks “Allow claim-claimants to be set up in this branch/claim group?” Select ‘No’ to prevent claim-claimants being set up or select ‘Yes” to allow it. (View screenshot)
  6. Click “Save”.
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