ISO ClaimSearch Reporting Article

L1 Support

Modified on: Tue, 13 Aug, 2024 at 11:28 AM

ClickClaims offers automatic reporting with the implementation of the ISO ClaimSearch optional feature. When enabled, claims will be automatically reported to ISO via XML once the newly created claims meet the validation of ISO’s data requirements. ISO will then send Risk Responses and Alerts that will display within the “ISO ClaimSearch Status” section of the claim’s “Summary” tab in CMS. This article provides detailed information about this feature.

Required Fields:

The table below lists the name of each field that must be populated within the claim in ClickClaims CMS before it can be validated and reported to ISO.

ClickClaims CMS Field Name	Note
Client # *
Policy #
Date of Loss *
Client/Carrier	The claim will not be advanced to the ISO queue for validation if this field is null (blank) or contains a client/carrier record that isn’t configured with the ISO EDI.
Peril
Last Name (insured) *
First Name (insured) or Is Insured an Organization	The insured’s “Last Name” field must be populated or, if not applicable, the “Is Insured an Organization?” checkbox must be selected.
Insured Loss Location (Address 1; City; State)	At minimum, the “Address 1”, “City” and “State” fields must be populated.
Insured Mailing Address (Address 1; City; State)	At minimum, the “Address 1”, “City” and “State” fields must be populated.
Loss Description

* This is a required field, by default, in the ClickClaims CMS application.

Claim Validation and ISO ClaimSearch Status:

Approximately every 15 minutes, a scheduled task runs in CMS to identify, validate, and queue eligible claims for ISO processing. To be eligible, the claim must have been created after the implementation of this feature and the client/carrier record associated to the claim must be configured for the ISO EDI.
1. If the claim is not eligible when the scheduled task runs, the “Current Status” field of the “ISO ClaimSearch Status” section, which is located at the bottom of the claim’s “Summary” tab, displays a status of “Not Validated”.

Mouse over the information tooltip icon for additional information about this status.

2. If the claim is eligible when the scheduled task runs, CMS validates the claim to ensure that the data ISO requires for processing is populated.

If one or more of the required fields are not populated, the “Current Status” field of the “ISO ClaimSearch Status” section displays a status of “Not Valid”.

i. Mouse over the information tooltip icon to display a list of the missing required field(s).

1. IMPORTANT: The system validates approximately every 15 minutes. If a change is made to any of the required fields listed within the tooltip, the tooltip text will not reflect the change(s) until the next time the scheduled task runs and the page is manually refreshed.

3. If all required fields are populated and the claim is valid when the scheduled task runs, the “Current Status” field will display a status of “Valid – waiting to be queued”. The claim is then held for approximately 30 minutes allowing time to review the data entered to ensure accuracy and to make revisions if necessary. (Once the claim is added to the ISO queue, further changes made in CMS will not be exported and must be manually entered in ISO.)

a. Mouse over the information tooltip icon to display this notification.

4. After this 30-minute window, the claim data is validated one last time and then an XML containing the applicable claim data is created and transmitted to ISO. The “Current Status” field of the “ISO ClaimSearch Status” section will display a status of “Reported – Pending Response”.

IMPORTANT: Once the claim is reported to ISO, no further changes are sent to ISO from CMS. If a claim modification made in CMS also needs to be reflected in ISO, those changes need to be entered manually in ISO by an authorized user.
The insured and co-insured are sent as ISO role type of ‘Claimant/Insured”.
Only the insured and co-insured’s name and address are sent to ISO. The Social Security Number (SSN), Driver’s License Number (DLN), Personal Identification Number (PIN), etc. are not sent or collected.

5. If the transmission to ISO is successful, a synchronous message is received from ISO with the ISO Risk Response. The “Current Status” field will display one of the risk response statuses below, as applicable. Mouse over the information tooltip icon to view ISO’s definition of the risk indicator responses.

a. Reported – ISO Response: LOW Risk

b. Reported – ISO Response: MEDIUM Risk

c. Reported – ISO Response: HIGH Risk

6. If the transmission to ISO is not successful, the “Current Status” field will display a status of “Reported – Failed”. This status means that ISO rejected the claim during transmission, and it could not be properly reported. While this should be rare, if it occurs, CMS will not attempt to report the claim again automatically. If desired, a ClickClaims CMS Help Desk Support ticket can be submitted to E-Claim for research into the cause of the rejection, or an authorized user can manually enter the claim directly from ISO’s website.

7. IMPORTANT: Return Reports must be accessed directly from ISO. If the ISO Return Report needs to be accessible from the claim in CMS, it must be downloaded from ISO and manually uploaded from the claim’s “Documents” tab in CMS by an authorized user.

Single Sign-On (SSO)

Single Sign-On (SSO) is an optional feature for the ISO ClaimSearch functionality which enables authorized users to gain access directly to the ISO ClaimSearch website from the ClickClaims CMS application via the claim’s “Summary” tab in order to view and print the claim’s Return Report. If your company has incorporated this functionality into your workflow, the section below provides detailed information about this feature.

Navigate to the “Summary” tab of the applicable claim in ClickClaims CMS.
Click on the button.

a. IMPORTANT: In order for the button to display within the claim’s “Summary” tab, a site administrator must have selected the “ISO ClaimSearch SSO Access” checkbox located under the “Special Permissions” section of the user’s profile record. Otherwise, the button will be hidden for that user.

3. If the claim’s Risk Response has yet to be received from ISO, the user will be advanced to the ISO website’s homepage upon clicking the button.

4. If the Risk Response has been received, the corresponding Risk Response indicator icon will display on the button ( = LOW Risk; = MEDIUM Risk; = HIGH Risk) and, upon clicking the button, the user will be directed into the claim in the ISO ClaimSearch website.

IMPORTANT: The logged in user must have a valid ISO user account. If the logged in user does not, they will receive an error message from the ISO ClaimSearch website after clicking the button in ClickClaims.

i. For those who should have SSO capability, identify the value located within the “Username” field of the user’s account in ClickClaims and enter it within ISO’s “SSO ID” field when setting up new users, or when updating current users, on ISO’s website.

ClickClaims users who are configured with their username in ISO’s “SSO ID” field can click on the button from the claim’s “Summary” tab to be brought directly into the ISO ClaimSearch website without the need to manually login. They will land on the corresponding claim to view the Return Report, risk responses, etc.

5. Once in the claim from the ISO ClaimSearch website, users may utilize that site’s functionality to view and print the report as needed.

Users can navigate to “My Learning Center” within the ISO ClaimSearch website or contact their manager/administrator (depending on your company’s protocols) for assistance.

6. When a user clicks on the button, an activity note is automatically generated on the claim’s “Notes” tab under the “System” note and “Activity” note sub-type stating, “Access to external site was initiated by {logged in user’s full name} from Claim Summary to ISO ClaimSearch {home page / report file # 123}.”

Acknowledge New Risk Response

“Acknowledge New Risk Response” is another optional feature for the ISO ClaimSearch functionality which, when enabled, permits users to add the “Activity – ISO ClaimSearch” widget to their Dashboard to manage acknowledgment of a claim’s Risk Response. If your company has incorporated this functionality into your workflow, the section below provides detailed information about this feature.

“Activity – ISO ClaimSearch” Widget:

Add the “Activity – ISO ClaimSearch” widget to the “Dashboard” via the icon.

By default, this widget contains all claims within a default number of days (configured by a site administrator) that have not yet had the ISO Risk Response acknowledged.
1. IMPORTANT: Site administrators can configure the desired number of days via the “ISO ClaimSearch Widgets Filter Default (days)” setting located within the “Settings” tab of the “Application Options” page (accessed by selecting “Application Settings” from the “Tools” menu bar button). The default value for this setting is “1” day.

2. Utilize the “List ALL” filter field that’s found within the widget to further filter out the claims displayed within it. Options include:

List ALL (default): Displays all unacknowledged claims within the default number of days.
High: Displays all claims within the default number of days that have a “High” Risk Response.
Medium: Displays all claims within the default number of days that have a “Medium” Risk Response.
Low: Displays all claims within the default number of days that have a “Low” Risk Response.
Updates: Displays all claims within the default number of days, no matter the Risk Response value, that have an updated status.
Validation Issues: Displays all claims within the default number of days that cannot be validated.

3. Select “ISO ClaimSearch Report” from the widget’s “Select Grid View” field’s drop-list to advance into the “ISO ClaimSearch Report” data grid page.

Selecting this with the “List ALL” filter set will advance users into the “Default View” of the “ISO ClaimSearch Report” page.
Selecting this this the “High”, “Medium”, or “Low” filter set will advance users into the “Risk Responses” view of the “ISO ClaimSearch Report” page.
Selecting this with the “Updates” filter set will advance users into the “Updates View” of the “ISO ClaimSearch Report” page.
Selecting this with the “Validation Issues” filter set will advance users into the “Validation Issues View” of the “ISO ClaimSearch Report” page.

“ISO ClaimSearch Report” Page:

Once in the “ISO ClaimSearch Report” page from the “Activity – ISO ClaimSearch” widget, users who have modification rights to the “Acknowledge New Risk response” field of the claim’s “Summary” tab can use the button to acknowledge the Risk Response of selected claims.

The button will not display within the “ISO ClaimSearch Report” page if the logged in user isn’t authorized to acknowledge Risk Responses (does not have modification rights to the claim’s “Summary” tab).
If the icon displays in place of the icon, the claim is ineligible for selection.
1. Mouse over the icon to display a tooltip stating why the Risk Response cannot be acknowledged.
IMPORTANT: Site administrators can specify which Risk Response level(s) require acknowledgement by setting the minimum threshold level via the “ISO ClaimSearch Acknowledgement Threshold” setting located on the “Settings” tab of the “Application Options” page accessed by selecting “Application Settings” from the “Tools” menu bar button. Setting options are:
1. Off: Acknowledgement is not required no matter the Risk Response value.
2. Low (default): Acknowledgement required is the Risk Response equals “Low” or greater (“Medium”; “High”).
3. Medium: Acknowledgement required if the Risk Response equals “Medium” or greater (“High”).
4. High: Acknowledgement required if the Risk Response equals “High”.

Acknowledging New Risk Response:

The claim’s Risk Response can also be acknowledged from within the claim by navigating to the claim’s “Summary” tab.
Use the checkbox next to the “Acknowledge New Risk Response” field (located at the bottom of the “Summary” tab within the “ISO ClaimSearch Status” section) to acknowledge/unacknowledged the claim’s Risk Response.

a. The logged in user must have modification rights to the claim’s “Summary” tab. Otherwise, the “Acknowledge New Risk Response” field will be read-only.

b. The claim must contain a Risk Response level that requires acknowledgement per ClickClaims’ site configuration. Otherwise, the “Acknowledge New Risk Response” field will be read-only.

Mouse over the icon located within the field to display a tooltip stating what the Acknowledge Threshold is and whether or not the claim’s Risk Response needs acknowledgement.

Alert Score

“Alert Score” is another optional feature for the ISO ClaimSearch functionality which, when enabled, adds the “Alert/Match Information” field to the “ISO ClaimSearch Status” section of the claim’s “Summary” tab when the claim contains a Risk Response of “Low”, “Medium”, or “High” capturing the claim’s ISO alert score. If your company has incorporated this functionality into your workflow, the section below provides detailed information about this feature.

IMPORTANT: “Single Sign On” is required to implement this functionality.

IMPORTANT: This process is subject to availability based on ISO’s Alert Score reporting practice.

Navigate to the “ISO ClaimSearch Status” section of the claim’s “Summary” tab.
The “Alert/Match Information” field will display a “Pending Response” value while the information is being obtained from ISO.
Once the alert score is received from ISO, the field will be automatically updated to display the number of alerts and the number of matches. Sample alert scores from ISO include:

No Alerts, No Matches
No Alerts, 1 Match
1 Alert, 1 Match
2 Alerts, 3 Matches

4. Users can also mouse over the button at the top of the “Summary” tab to display a tooltip with the matching alert score information.

If the alert score has yet to be imported into CMS, the tooltip will retain the standard tooltip stating, “Opens a new window to the 3^rd party ISO ClaimSearch site.”

5. A .PDF of the alert score will be saved on the claim’s “Documents” tab under the “System Documents” file type and “Import/Export (EDI)” sub-type by default with a naming convention of ISO_{namePart}_{riskLevel}_{alertCount}A_{matchCount}M_{DateTime.Now:yyyyMMdd-HHmmss}_cms{ClaimID}.pdf.

NamePart: Can be the claim’s Client # or can be customized as a different, static value.
RiskLevel: Risk Response level (Low; Medium; High)
AlertCount: Number of alerts per ISO
MatchCount: Number of matches per ISO
DateTime: Date and time stamp of file creation
ClaimID: Claim’s CMS #.
IMPORTANT: The .PDF document’s default file type and/or file sub-type can be changed upon request by an authorized person at your company.

6. An activity note will automatically be generated on the claim’s “Notes” tab under the “System” note type and “EDI” sub-type capturing the creation of the .PDF report.

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