Claims General Settings

In This Topic...

The General Settings section contains options and default settings controlling various parts of the system.

In the main menu, select Claims, Configuration, then General Settings.  The General Settings page opens.

The information is divided into multiple pages.  The pages are accessed through the General Settings Menu widget to the left of the screen.

Click a link to view the page details.

Claim Numbering

Includes settings for claim numbering.
Claim Payments Includes settings for claim payments.
Reserves / Estimates Includes settings for reserve and estimate amounts.

Party Roles

Includes settings for managing claim parties.

Scheduled Emails

Includes settings for automatic claim payment summary e-mails.

Additional Settings

Includes miscellaneous claims settings.

General Settings - Claim Numbering

The General Settings - Sequence Numbering page provides options to set how claims are numbered. Fields marked with a red asterisk * are required.

The Claim Number Generation panel provides settings for the creation, formatting, and sequential numbering of claim numbers.

Prefix

Enter any text that should precede the sequence number.  Any separator characters should be included here.

Next Sequence Number

Enter the number to be assigned to the next claim created in the system.  The number is incremented with each claim, and this field is automatically updated to show the next number to be assigned.

Zero Padding

Adds leading zeroes to the sequence number to bring it to a set length.  If unchecked, the entire claim number will gradually increase in length as more claims are created.

Length

This field is available when Zero Padding is checked.  Enter the required length of the sequence number, not including the prefix and suffix.  Leading zeroes are added to the sequence number to bring it to this length.  The minimum length is 2, and the maximum length is 20.
 

Note: The sequence number does not reset to zero when the selected length reaches its maximum value.  The length is extended to continue counting in sequence.

Suffix

Enter any text that should follow the sequence number.  Any separator characters should be included here.
Generate Claim Number On Specify the Claim Status / Claim Status Sub-Status combinations for which the system will generate a Claim Number. The Notice of Intent status is selected by default, but can be removed using the Include/Exclude control.

Example: With the prefix set as "Pr-" (a sales code), the sequence number set as 2507 (picking up from previous business), and the suffix set as "/SA" (a regional code), the next three claims will have the following numbers.

Pr-2507/SA

Pr-2508/SA

Pr-2509/SA

With the prefix set as "Pr", the sequence number set as 1 with leading zeroes up to seven digits, and no suffix, the next three claims will have the following numbers.

Pr0000001

Pr0000002

Pr0000003

Click Save to save the settings.

General Settings - Claim Payments

The General Settings - Claim Payments page provides options for claim payments.

Default Payment Currency to Displays the payment information in the selected currency as configured at the Policy level or the Payee level.
  • Policy Currency
 Displays the payment information in the selected currency as configured in the General Information settings of the Policy Settings.
  • Payee Currency
 Displays the payment information in the selected currency as configured in the payee information panel.
Claim Payment Coverage List When configured, the Claim Payment Coverage List is populated based on the data source specified.

The Claim Payment Export / Import File panel allows users to export the Claim PaymentsList to an external system (Excel) and make the necessary changes before importing the file back into the system.

Editable Columns Select which columns can be edited in the exported file. When a setting is checked, the Export / Import button becomes available on the Claim Payments page.
  • Check Number
Enables editing on the Check Number column.
  • Status
Enables editing on the Status column.

Enable Scheduled Claim Payments This checkbox enables the feature and displays the settings below.
Claim Status Select the claim Status, or Status and Sub-Status combination, for which scheduled claim payments should be generated. If a status is selected without an associated sub-status, scheduled claim payments will be evaluated for all sub-statuses configured within that status.
Trigger Optionally select a trigger to control whether scheduled claim payments are generated.

Note: When Scheduled Claim Payments is enabled, options to manage automatic payments for individual Claim Parties are made available in the Claim Parties window when attaching a party to a claim. For additional information, see the Claim Parties Widget section.

Only claims that have been attached to a policy are available for Scheduled Claim Payments. For additional information on selecting a policy, see the Claim Actions Widget section.

General Settings - Reserves / Estimates

The General Settings - Reserves / Estimates page provides options for managing Reserve and Estimate amounts. These settings provide additional control over whether the system automatically adjusts and closes Reserve and Estimate amounts based on the claim payment status.

Payment Status

Select the claim Statuses for which Reserve and Estimate amounts should be automatically adjusted.
 

Note: Reserve and Estimate amounts are only adjusted when the Automatic Adjustment checkbox in the Payment window is checked and at least one payment status is selected. For additional information, see the Adding a Payment to a Claim section.

Note: Reserve and Estimate amounts are only adjusted once, even if the defined criteria is met again as the result of a future action.

If, however, a Reserve or Estimate amount subsequently meets the criteria established for a configured Close Reserve Rule, the corresponding amount(s) will be fully depleted and closed according to that configuration. For additional information, see the Close Reserve Rules section below.

If a claim payment status triggers an automatic adjustment, and the claim then changes back to a non-triggering status, the Reserve or Estimate amount is not restored. The amounts can be manually adjusted in the Reserves / Estimates panel.

The Close Reserve Rules panel displays all the close reserve rules configured within the claims module.

  1. Click Add to create a new close reserve rule, or click a link in the Name column to view an existing rule.

    To delete close reserve rules, check the boxes for all rules to be deleted and click the Delete button.

  2. If adding or viewing a close reserve rule, the Close Reserve Rule window opens. This window includes settings for the close reserve rule and related actions.

    Complete the necessary information. Fields marked with a red * are required.

    Reserve Type Select the Reserve / Estimate type. The following options are available.
     
    • Expense
    • Indemnity
    • Recovery
    • Salvage
     

    Note: Only one Close Reserve Rule can be configured for each Payment Type.
    Fully Deplete Reserve on Final Payment Check this box to fully deplete and close the related Reserve or Estimate amount when the Final Payment checkbox in the Payment window is checked.
    Close Corresponding Reserve Only

    This field is displayed when the Fully Deplete Reserve on Final Payment checkbox is checked. When checked, the system searches for Reserve and Estimate amounts by Payment Type, Payment Category, and Coverage. If an exact match is not found, the system searches for a matching Reserve or Estimate of the same Payment Type only.
     

    Note: Claim Payment Categories are configured through a custom Option List. For additional information, see the Managing Option Lists for the Claims Workflow section.
    Fully Deplete Reserve When Claim is Closed Check this box to fully deplete and close the related Reserve or Estimate amount when the claim is changed to Closed status.
    Closed Sub-Statuses

    This field is displayed when the Fully Deplete Reserve When Claim is Closed checkbox is checked. Optionally select the Closed Sub-Statuses for which Reserve and Estimate amounts should be depleted and closed. If no selection is made, all claims in Closed status will trigger the automatic closure of associated Reserve and Estimate amounts regardless of the Sub-Status.
     

    Note: Sub-Statuses are configured in the Claims Sub-Statuses section in the General Settings menu.

  3. Click Add & New or Save & New to save the payment rule and clear the form to enter another rule, click Add & Close or Save & Close to save the rule and close the window, or click Close to close the window without saving the rule.

Note: A configuration must be saved in the Payment Statuses Eligible for Automatic Reserve Adjustment panel before a Close Reserve Rule can be saved.

In the event that a claim payment is reversed at a later date, the system will automatically restore any Reserve or Estimate amounts that were impacted by a configured Close Reserve Rule.

General Settings - Party Roles

The General Settings - Party Roles page provides options for managing claim parties.

When attaching a claim party to a claim, a role can be specified to identify how the party is involved in the claim process. The Party Roles panel lists all available roles.

Tip: By default, only Active roles are displayed. Clear the filter in the Status column to view all roles.

Click Add to create a new role, see Creating a New Party Role.  Click a link in the Name column to view an existing role, see Viewing and Modifying a Party Role.  To deactivate roles, see Deactivating a Party Role.

Creating a New Party Role

  1. In the main menu, select Claims, Configuration, then General Settings.  The General Settings page opens.  Navigate to the Party Roles page.  See Navigating Claims General Settings for instructions.

    2. When attaching a claim party to a claim, a role can be specified to identify how the party is involved in the claim process. The Party Roles panel lists all available roles.

    Tip: By default, only Active roles are displayed. Clear the filter in the Status column to view all roles.

  2. Click Add.  The Party Role window opens.
  3. Complete the necessary information.  Fields marked with a red asterisk * are required.

    4. Name

    Enter the name of the role.  This is the name that will be displayed when selecting the role.

    Code

    Enter a code to identify the role internally.

    Description

    Enter a description of the role.
  4. Click Add & New to save the role and clear the form to enter another role, click Add & Close to save and close the window, or click Close to close the window without saving the role.

    5. The Status panel is added to the page once the role has been saved.

    Active

    Marks the role as active and available for use.  If unchecked, the role will remain selected for existing parties, but can no longer be selected when adding or editing parties.

    Created By

    Identifies the date and time the role was created, and the user who created it.

    Last Modified By

    Identifies the last date and time the role was changed, and the user who made the changes.

Viewing and Modifying a Party Role

  1. In the main menu, select Claims, Configuration, then General Settings.  The General Settings page opens.  Navigate to the Party Roles page.  See Navigating Claims General Settings for instructions.

    2. When attaching a claim party to a claim, a role can be specified to identify how the party is involved in the claim process. The Party Roles panel lists all available roles.

    Tip: By default, only Active roles are displayed.  Clear the filter in the Status column to view all roles.

  2. Click a link in the Name column to view the role details.  If there are a large number of available roles, see the Using Grids section for help on finding the appropriate role.
  3. See the section on Creating a New Party Role for a detailed description of the fields.
  4. Click Save & New to save the role and clear the form to enter another role, click Save & Close to save and close the window, or click Close to close the window without saving the role.

Deactivating a Party Role

  1. In the main menu, select Claims, Configuration, then General Settings.  The General Settings page opens.  Navigate to the Party Roles page.  See Navigating Claims General Settings for instructions.

    2. When attaching a claim party to a claim, a role can be specified to identify how the party is involved in the claim process.  The Party Roles panel lists all available roles.

    Tip: By default, only Active roles are displayed.  Clear the filter in the Status column to view all roles.

  2. Locate the roles to be deactivated.  If there are a large number of available roles, see the Using Grids section for help on finding the appropriate roles.
  3. Check the boxes for all roles to be deactivated.
  4. Click Deactivate, then confirm the deactivation when prompted to do so.  All selected roles are deactivated.  If the Party Roles list is still defaulted to only show active roles, they disappear from the list.

Tip: Individual roles can also be deactivated or reactivated directly through the Custom Party Role window.  See the section on Viewing and Modifying a Party Role for details.

General Settings - Scheduled E-mails

The General Settings - Scheduled E-mails page provides settings for sending scheduled emails related to claim payments.  An e-mail is sent to each payee who received at least one payment since the last e-mail was sent, and summarizes all payments within that period.

Complete the necessary information.  Fields marked with a red asterisk * are required.

Enable Scheduled E-mails

Check this box to enable the scheduled e-mails feature.  This displays the remaining settings on the page.

Frequency

Defines how often the email should be sent.  This is set to Daily.

Time Of Day

Select the time of day when the e-mail should be sent.
Include Backdated Payments (in days) Enter the number of days of backdated payments to be included in the e-mail. The system will include unsent claim payments that have been marked as 'Paid' within the number of days defined from the daily scheduled time.

E-mail Configuration

Select an e-mail configuration.  E-mail templates are created and managed in the E-mail Templates section. In order to be available for selection as a scheduled e-mail, a Claims E-mail Configuration must also be configured and must be set to Scheduled E-mail.

In general, not all payment types require notification e-mails.  The Claim Payment Summary Criteria panel is used to define which combinations of Type and Category should produce e-mails.  Select all combinations that apply.

Click Save to save the settings.

General Settings - Additional Settings

The Navigation Preferences panel controls access to policy information from within a claim.

Policy Navigation Preference

When viewing a claim that has been associated to a policy, the Policy Information widget displays the policy number as a link.  This option controls the functionality of that link.
  • Policy Summary Window

The link will open a detail window within the current page, containing a summary of the policy information.  The summary window includes a link to open a new tab or window with the full policy workflow.
  • Policy Page

The link will open a new tab or window with the full policy workflow.

Click Save to save the settings.