Read ACORD Standards Implementation Guide Template P&C text version

CLAIMS WORKFLOW IMPLEMENTATION GUIDE

V 1.1 JANUARY 2009

(*DOCUMENTATION CHANGE ONLY. NO CONTENT CHANGES MADE.)

References: ACORD P&C/Surety XML v1.13.0 *IMPORTANT NOTE: This document contains or relates to ACORD Standard Property & Casualty/Surety. You are not authorized to use the ACORD Standard contained in this document unless you have accepted the terms and conditions of the Standards License accessible at http://legal.acord.org/standards_license.htm. To gain such authorization, please go to that site and, if you agree with the terms and conditions of the Standards License, enter whatever information is called for, if any, and click on "Accept".

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Table of Contents

1 INTRODUCTION .................................................................................................................................. 1 1.1 PREFACE ....................................................................................................................................... 1 1.2 INTENDED AUDIENCE ...................................................................................................................... 1 1.3 PURPOSE OF THIS GUIDE .............................................................................................................. 1 1.4 XML STANDARD ............................................................................................................................ 1 1.5 HIGHLIGHTS OF AN INDUSTRY STANDARD BUSINESS MESSAGE ........................................................ 2 1.6 ACORD STANDARDS ..................................................................................................................... 3 1.6.1 ACORD Standards Overview .................................................................................................. 3 1.6.2 Resources Available ­ Getting Help ....................................................................................... 3 1.6.3 Purpose of Implementation Guides ......................................................................................... 3 1.6.4 Implementation Reporting ­ Tell us about it!........................................................................... 4 1.6.5 Certification.............................................................................................................................. 4 BUSINESS OBJECTIVES AND EXPECTED BENEFITS ................................................................... 5 2.1 OBJECTIVES AND PROBLEM DESCRIPTION ....................................................................................... 5 2.2 BUSINESS PROCESS(ES) SUPPORTED ............................................................................................. 5 2.3 RETURN ON INVESTMENT (ROI) ..................................................................................................... 7 2.3.1 Business Case: Insurer ........................................................................................................... 7 2.3.2 Business Case: Agent ............................................................................................................. 8 2.4 SCOPE .......................................................................................................................................... 9 2.5 BUSINESS WORKFLOW DIAGRAM(S)................................................................................................ 9 2.5.1 New Claim (FNOL) ................................................................................................................ 10

2.5.1.1 2.5.1.2 New Claim (FNOL) - Preferred Path ...........................................................................................10 New Claim (FNOL) - Full Scope .................................................................................................11 FNOL Acknowledgement - Preferred Path..................................................................................12 FNOL Acknowledgement - Full Scope........................................................................................13 Claim Status Inquiry - Preferred Path .........................................................................................14 Claim Status Inquiry - Full Scope................................................................................................15

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2.5.2 2.5.3 2.5.4 2.5.5

FNOL Acknowledgement ...................................................................................................... 12 Claim Status Inquiry .............................................................................................................. 14 Claim Download .................................................................................................................... 16 Activities / Alerts .................................................................................................................... 17

Activities / Alerts - Preferred Path ...............................................................................................17 Activities / Alerts - Full Scope .....................................................................................................18

2.5.2.1 2.5.2.2 2.5.3.1 2.5.3.2

2.5.5.1 2.5.5.2

3 4

GETTING STARTED.......................................................................................................................... 19 3.1 INITIAL LOAD ................................................................................................................................ 19 MINIMUM DATA REQUIREMENTS .................................................................................................. 20 4.1 MINIMUM DATA SET ..................................................................................................................... 20 4.2 NEW CLAIM (FNOL)..................................................................................................................... 20 4.3 FNOL ACKNOWLEDGEMENT ......................................................................................................... 21 4.4 CLAIM STATUS INQUIRY ................................................................................................................ 21 4.5 CLAIM DOWNLOAD ....................................................................................................................... 22 4.6 ACTIVITIES / ALERTS .................................................................................................................... 23 REVISION HISTORY/CHANGE SUMMARY..................................................................................... 24

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1.1

INTRODUCTION

Preface

This Guide has been prepared by ACORD and its members to provide you with a roadmap for implementing claims workflow solutions. It is not intended to replace the core ACORD Standards specifications, upon which this Guide is built, but rather to focus attention on business case, issues and solution related to claims workflow solutions. This guide identifies the problem, the reason for solving it, the risks and benefits involved, and the resolution method utilized.

1.2

Intended Audience

This Guide is intended for business, operations and technology people. It explains why these business messages were developed, when they should be used, the value of using them, as well as how to do it. We have left most of the technical "how" to the end. Your input is always welcome. Please send all feedback to the ACORD Standards Department (www.acord.org).

1.3

Purpose of THIS Guide

The purpose of this guide is to assist carriers and vendors with understanding the business impact of using ACORD standard technology that supports claims workflows of agents and carriers.

1.4

XML Standard

Why XML? XML, the eXtensible Markup Language, is not a technology, programming language, database or magic tool. It is a markup language used to describe and organize data. XML is a very flexible, effective method for describing information (data) in such a way that the XML document or file provides: Definition ­ a common vocabulary to identify things/information/data Structure ­ a common way of organizing information (a grammar, so that we all structure information the same way) Precision ­ a common method or set of rules for structuring the data that enables automated processing of information being sent between trading partners. XML is not based on any one vendor but transcends and is used by them all. XML is represented as normal, simple text using human readable symbols, which make XML-structured information easy to read and debug, transportable across any machine, operating system or programming language. Another misconception about Standards, and XML, is that it is somehow the best or optimum way of solving a specific business problem.

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Actually, by design it is NOT the optimum solution for any singular problem, since the intent is to provide a means for many trading/business partners to share information regardless of systems or other technology. As a result the ACORD Standards are more a base level common agreement within the industry of how we are all consistently going to describe insurance contract and related properties. This common definition is likely, even intended, to be remapped and repurposed within each trading partner's own organization for their own purposes; however, between organizations, ACORD Standards provide a uniform, consistent way of sharing data.

1.5

Highlights of an Industry Standard Business Message

It's an XML specification (with all the benefits of XML), Based on the ACORD Standards With implementation guidelines that define precisely what the specific fields of information should be (i.e. XML Elements) With well-defined organization or structure Providing Industry defined usage examples Using common code list definitions with agreed upon meanings Developed by industry business and technology experts So now instead of this: We have this:

XML

One-To-One Sharing, All Different

One-To-Many Sharing, All Same

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1.6

1.6.1

ACORD Standards

ACORD Standards Overview

It is important to understand that this guide is based on the ACORD P&C/Surety XML Standard. The official ACORD P&C/Surety XML Standard is the current version of the published specification including any related documents (ex. schema). Any inconsistencies or discrepancies between this Guide and the Standard specification must be resolved using the core Standard. Every effort will be made to keep this guide current and compliant with the core/base Standard. 1.6.2 Resources Available ­ Getting Help

In addition to this Guide, ACORD provides many additional resources to aid implementation including: ACORD Web Site and File Areas where archives of Specification development and Working Group determinations are available Technical support from ACORD Implementation Service Team via telephone or e-mail Training Services from ACORD staff And never underestimate the networking opportunities provided to attendees at ACORD meetings where you can ask peers how they have handled various implementation issues. In addition, each ACORD Standards Program provides many specific resources including: * ACORD P&C/Surety XML Standard (PDF / Adobe file) * ACORD P&C/Surety XML Standard (Windows Help file ­ ACORD members only) * DTD (Document Type Definition) * Schemas (available in various formats for various uses) And much, much more... All can be found on the ACORD web site at www.acord.org. * Please Note - Only the P&C/Surety Standard, DTD and Schemas are in the public domain, available for anyone's use. All other tools and resources, like these Guides, are for the benefit of ACORD members only. 1.6.3 Purpose of Implementation Guides

Implementation Guidelines published under the ACORD Standards Program are not to be regarded as Industry Standards. They contain information regarding practices and suggestions (as of their publication date) of Standards users regarding a particular subject. Implementation Guidelines are published in order to provide practical assistance to Standards users based upon the experience of earlier users. It is intended that no conflict exist between information contained in any ACORD Standards and Implementation Guidelines. In the event of any such conflict, the applicable Standard wording will prevail. ACORD Standard Implementation Guidelines are designed to help developers of systems using ACORD Standards familiarize themselves with the Standards process and how Standards are being used in actual systems. The Guidelines represent the consensus of ACORD`s standards participants on how the ACORD Standards are meant to be used. They originate in response to specific questions or issues that surface in the process of developing or implementing Standards.

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1.6.4

Implementation Reporting ­ Tell us about it!

Standards aren't truly relevant until they are used. To help drive the use of Standards, and to let those organizations who have adopted Standards know who else has too, ACORD publishes a regularly updated schedule of all the organizations using Standards and which Business Messages/Transactions they support. This report can be found on the ACORD web site ­ www.acord.org. As you develop and implement your messages, please report them to ACORD. The website includes an Implementation Survey to indicate the ACORD Standard (Life, P&C, Reinsurance) and messages which you have in development, pilot or production. 1.6.5 Certification

Beyond reporting who has implemented Standards, which is by definition a self-reporting exercise, ACORD offers a Certification Process for all its messages. This provides members with the added acknowledgement of their use of Standards and furthermore notifies other potential clients/trading partners of their ability to support well-formed, compliant ACORD messages. Having all trading partners certify their messages makes implementation much easier, faster and allows a third, neutral party (ACORD) to provide reconciliation of implementation ambiguities (and resolve these in future versions of the Standards). To get certified, or to get more information, visit the ACORD web site, Members Area for more details ­ or feel free to contact ACORD for assistance (www.acord.org).

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2.1

BUSINESS OBJECTIVES AND EXPECTED BENEFITS

Objectives and Problem Description

Non-agency distribution channels provide direct, 24/7 information to policyholders. The strength of the independent agency channel is extra personal service and an agent who can, if necessary, stand in the role of advocate for the customer in claims situations. In the past agencies relied on little or delayed information about their client's claims. Communication was in a reactive mode. In trying to eliminate reactive communications in claims handling, agencies began spending an inordinate amount of time researching claims status and re-keying data into their agency management systems. While this might provide immediate and proactive service to their clients, it resulted in many extra hours of manual work to make sure the agent remained up-to-date in the claims process. As a result, key agents began to work with ACORD to develop multiple electronic transactions that would support a proactive approach to claims handling and reduce the number of hours spent by agency personnel and carrier claims staff. As the number of transactions increased, the carriers, vendors and agents were left confused over which ACORD standards to implement and the impact of their choices on the overall claims workflow. This guide was developed to provide carriers, vendors and agents with an understanding of the positive impact of the ACORD claims transactions. And how those transactions can be implemented to develop an efficient workflow for the agent and carrier to more effectively service their customers.

2.2

Business Process(es) Supported

Several ACORD standard messages have been created to support the claims handling process. 1) New Claim / First Notice of Loss Submission 2) Claim Inquiry 3) Claim Download 4) Activities and Notifications 5) Loss Runs

General Information The claim detail provided may vary based on the carrier to whom the inquiry is submitted.

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New Claim / First Notice of Loss Real Time Submission allows the agency to electronically submit the first notice of loss and accompanying claims attachment to the carrier and instantly receive the claim number and adjuster for the claim. This provides immediate customer service and the benefit to the client knowing the carrier has already received and has begun processing their claim. This process benefits the client as assignment of an adjustor can be completed in minutes, versus hours when manual entry or rekeying is involved and provides a critical service differentiation for agencies and carriers that do not enforce the workflow of reporting direct to a carrier.

Claim Inquiry is intended to support all other claims processes when additional or immediate information on a claim is needed. It supports claims download and alerts by providing additional data that is not kept in an agency management system, but may need to be referenced at some point in time. This provides a current/real-time status on a claim.

Claim Download is a powerful tool that allows agency claims data bases to be electronically maintained by data feeds from carriers ­ much as policy download maintains the agency policy data base today. Using claims download provides an automatic entry for a new claim, all payments, changes (e.g. new adjuster or reserves) and changes in status (closed, subrogation, etc.). From this data base an agency can not only provide support to the customer, but also generate reports by carrier to understand their loss ratios, by customer to prompt for appropriate risk mitigation, or by line of business to understand their business. Depending upon the implementation by the carrier(s) and agency management system vendors, an agency may select to receive only new claims and changes in status, using real time claims inquiries to retrieve details. The opportunities are limited only by one's imagination and interest in managing one's business.

Claim Notification is more simply intended to be a report of a first notice of loss, or provide an immediate update on a claim status that can not wait for a batch process of the claim download. It typically does not populate a data base, but provides a notice that a new claim has occurred. Depending upon the implementation by the agency management system vendor, processing of the Claim Notification is set up based on a profile defined by the agency. The report of a loss may appear, for instance, on the daily activity report to a CSR who handles the specific customer or a claims manager. It is immediately obvious that a new claim has been reported.

While at first glance one might assume that an agency requires only Claim download, it is not actually that obvious. Claim download is intended to maintain a data base. If fully implemented, the data comes in and automatically moves to that data base. If it is processed like policy download, soon no one will pay a great deal of attention to what is received, except to pull periodic reports or review a specific claim. Whereas a Claim Notification is intended to be an "in your face" report that a new claim has occurred ­ no details, no data base updates, just a new claim has happened.

If an agency depended upon claims download for notification of a new claim, whomever processes the download, must review each entry in the download report, identify the first notice of loss, determine to whom the notice must go and generate an email to that person. On the other hand, Claim Notification will automatically put a notice on the right person's desk top.

The two processes go hand in hand. Claim Notification will automatically advise the appropriate person that there is a new claim. Claim Download will maintain the data base. Both are an important part of better managing claims and servicing customers in the agency.

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Loss Runs: Producers value easy access to loss run information on a continual basis. While obviously critical at pre-renewal time, loss run availability can be an important tool at any point in time while dealing with both insurers and clients. This is particularly so when claims are reported directly to insurers on highfrequency or loss-sensitive accounts; catastrophe claims that may follow a different reporting methodology; and as a means of making certain the agency management system is properly updated.

2.3

Return On Investment (ROI)

General ROI/Improvement Perspectives: · · · · · Eliminate redundant data entry Increase speed to service factor (reduction in costs associated with settling claim faster) Improve data accuracy (avoid errors associated with re-keying data). Provide for secure data (as contrasted with fax or email) Reduces carrier staff involvement in responding to agency phone and email requests

Transaction Specific ROI/Improvement Perspectives (these are in addition to those noted above): · First Notice Of Loss Submission o Improves claims response and adjustor assignment time o Provides client with immediate acknowledgement that carrier has received and is beginning to respond to their claim Claim Inquiry o Allows agency to immediately respond to client Claim Download o Allows for immediate agency response to clients on most common inquiries o Allows agencies to report on carrier and client loss activities o Allows agencies to proactively manage claims for a carrier or client ­ reduces amount of time spent on claims (in general) Activities and Notifications o Provides immediate push of new "urgent" claim activity to agency management system o Reduces carrier administration for email support of new activities o Allows agencies to proactively reach out to clients o Automates process of updating agency system with related claim activity/diary/follow-up

· ·

·

2.3.1

Business Case: Insurer

Customer service is one of the most important yet most difficult intangibles to deliver successfully. By fully empowering every agency to respond robustly and with "real time" currency, the company can correctly enable its agents to provide this type of service, thereby not incurring the cost and risk of doing so at the company. Because the company has this information on hand in any case, the extra investment to make it simultaneously available to the client's agent will pay many dividends in time saved on the part of the company's service staff. Also, company staff start out at a disadvantage, compared to the agency, with respect to the risk of alienating a client during the claims process. Staff at the agency always have the ability to present themselves as an intermediary and advocate in dealing with the company during a claim. But to do so successfully, they need current information.

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Providing this information also can save company staff time in dealing with agents (as opposed to clients), because routine communications will be totally executed via electronic messaging (XML). As companies adopt XML for other functions, using it to relay claims data is a good way to leverage this technology and take the fullest advantage of the company's investment. A glance at the "other" ways of communicating this information tells the story of wasted time, phone tag, having to create and respond to email text, follow-ups when the agent requests clarification or additional information, etc. With the preferred path [Section 2.5, below], these types of interaction will not be eliminated entirely, but can be pared down to the unusual or difficult claims situations.

2.3.2

Business Case: Agent

The horrific hurricane season of 2005 provides an instructive example as to how claims download can help agencies. If an agent has had no power and has had clients reporting claims directly to the carrier, how does he or she know what claims have been filed? Once the agency finds out about the claims, who is going to enter the hundreds or thousands of claims into its agency management system? Who is going to update the status on each of the claims, as it is paid or closed? The agency's employees are already working overtime under terrific stress, and they want the needed claims information to be handy in their system. They want to spend their limited time assisting their clients regarding the claim and demonstrating the value added that their agency provides to its clients. The last thing these employees want to spend hours upon hours doing is entering all of this claims information into their system. Claims download would allow for all of the claims to be automatically entered into the agency management system, updated as the status is changed, and closed when the carrier closes it. Claims download would save the typical agency hundreds of hours per year, as well as enable agency employees to provide better service to their clients should a claim occur. An electronic data exchange also provides for an audit trail of claim transactions in the event issues arise later.

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2.4

Scope

This guide was developed to assist carriers and vendors in understanding the benefits and the preferred implementation for claims ACORD standards. This guide seeks to provide the business perspective on the use of ACORD standards to support the claims workflow, as contrasted with an information technology perspective. It is not intended to replace transaction specific implementation guides that provide the detailed information technology requirements for implementing ACORD standards.

This guide excludes the Loss Run business message as it is normally included in the account renewal workflow.

Guide / Business Messages This guide supports the following ACORD transactions and supports the entire claims workflow for an agency through their agency management system: o o o o First Notice of Loss Submission Claim Inquiry Claim Download Claim Activities and Notifications

In addition this guide provide carriers and vendors with a preferred path for improving the claims workflow between a carrier and an agent and will assist in determining priorities for implementation of the supporting ACORD transactions.

2.5

Business Workflow Diagram(s)

The business workflow diagrams noted below are intended to assist carriers and vendors in understanding the preferred agency workflow for the claims lifecycle through an agency management system. The workflow diagrams are based upon multiple decision points and the options available to carriers and agents for implementing ACORD standards into their respective workflows. It is not intended to replace business message specific implementation guides that provide detailed mapping and I/T support information.

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2.5.1

New Claim (FNOL)

The new claim, or FNOL, diagram shows the how and when ACORD standards could be implemented based upon the reporting nature for the claim.

2.5.1.1

New Claim (FNOL) - Preferred Path

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2.5.1.2

New Claim (FNOL) - Full Scope

PREFERRED PATH NOTES: This diagram displays the maximum scope for various methods known for the handling of new claim reporting. Within the diagram, preferred paths have been identified via colored shade.

Claim Process ­ New Claim Reported

Claim Event Occurs Insured or Claimant communication of Claim Event (typically done via telephone call) NOTE: Workers Compensation claims are typically reported directly to the insurer. The workflow below largely assumes non-workers compensation claims.

Ed. Date: March 6, 2008 © ACORD 2007-2008

Preferred Path ­ Claims Reported to Agency = Green Shade Preferred Path ­ Claims Reported to Insurer = Yellow Shade Preferred Path Common to Agents & Insurers = Blue Shade

AGENCY

Does Agency collect claim data for FNOL or direct contact to Insurer or TPA? Insured/Claimant directed to Insurer or TPA

TPA

Third Party Administrator (TPA) collects claim data from insured

Agency collects claim data from Insured

Agency calls insurer (manual process) How does insurer want to receive data via agency?

INSURER CLAIM SYSTEM

Insurer collects data directly from agency (via phone) Insurer collects data directly from Insured/ Claimant

(either via phone or input directly into company web)

Insurer collects data directly from TPA (via phone)

TPA calls insurer (manual process)

How does insurer want to receive data via TPA?

Agency inputs data directly into insurer claim system Agency inputs data to local system

Direct entry to Insurer Claim System

TPA inputs data directly into insurer claim system

TPA inputs data to local system

FNOL created Form: FAX / email / image received by insurer. How does insurer want to receive FNOL? Form: FAX / email / image Insurer Options: 1. Staff re-key data from Form 2. Use of OCR to convert Form to XML Options 1 or 2 used for input into Insurer Claim System Form: FAX / email / image

FNOL created

How does insurer want to receive FNOL?

ACORD XML

XML received by insurer. Data imported directly into Insurer Claim System (no re-keying of data)

ACORD XML

Insurer Claim System contains FNOL data from one of the work-flow sources noted above

Initiate notification / acknowledgement of FNOL (claim summary) (see separate diagram) NOTE: Some insurers may also provide an acknowledgement to the insured, particularly if the claim was reported directly from the insured.

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2.5.2

FNOL Acknowledgement

2.5.2.1

FNOL Acknowledgement - Preferred Path

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2.5.2.2

FNOL Acknowledgement - Full Scope

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2.5.3 2.5.3.1

Claim Status Inquiry Claim Status Inquiry - Preferred Path

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2.5.3.2

Claim Status Inquiry - Full Scope

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2.5.4

Claim Download

Claim Process ­ Claim Download

Claim Download Data transfer originates with the Insurer's Claim System Claim transactions can be created in two scenarios: 1. Solicited 2. Unsolicited

Ed. Date: March 6, 2008 © ACORD 2007-2008

Solicited transactions are created at the request of a trading partner (ex. Agency). Unsolicited transactions are created because of activities that often do not involve an activity on the part of a trading partner (ex. claim payment, reserve change, etc.) Unsolicited claims transactions would be managed similar to policy download and made available in a batch.

Preferred Path = Green Shade

Solicited

Is the claim download occurring by solicitation or unsolicited?

Unsolicited

Inquirer initiates contact with Insurer to request claim download or redownload via any one of the following choices: phone call, email or insurer website. NOTE: Of the options listed here, the preferred options are email or insurer website.

Agent makes contact to pick-up claim download batch (e.g. third party mailbox or direct from insurer)

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2.5.5 2.5.5.1

Activities / Alerts Activities / Alerts - Preferred Path

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2.5.5.2

Activities / Alerts - Full Scope

Ed. Date: March 6, 2008 © ACORD 2007-2008

Claim Process ­ Activity / Alert

Claim Activity Initiated from Insurer to Agency An activity on a claim can be motivated for many reasons. The expectation is that an activity or alert is sent (real time) to the agency as a courtesy for immediate notice and follow-up. Claim status activities include and are not limited to: payment, adjustor, reserves, subrogation, etc.

NOTE: This method is not a notification to the agency. The agency must pro-actively look for the activity/alert on the insurer's website to locate the data. This is NOT a preferred method due to the lack of communication and expectations placed on the agency and suggests the agency will have to key data into their local system (inefficient).

Which methods of real time activities/alerts are provided by insurer?

Insurer Website

Phone

FAX

Email

XML

Agency acts upon notification of claim activity. Requires manual process by agency staff to initiate claim service activities in local system.

Yes

Does insurer provide access to claim data via web or request of XML?

No

Agency receives Activity/Alert via XML and data automatically imports into local system (Data received may include structured and non-structured data ­ will eliminate need to re-key some data). NOTE: Receipt of the XML may include an attachment (ex. photo)

Agency pursues one of the following to automate claim service activities: 1. Request XML 2. Access Insurer website for claim details

Activity/follow-up may be created in agency's local system with appropriate status (ex. urgent) for subsequent service activities.

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3

GETTING STARTED

This guide presents perspectives on various aspects of claims workflows where ACORD has standards that support the information exchange touch points. Pursuit of standards implementations are typically done in a prioritized manner. In addition, trading partners expect that all relevant standards should be implemented to maximize efficiencies. The industry recommendation for "getting started" on the claims implementations noted here involves the following prioritization: 1. 2. 3. 4. Claim Inquiry Claim Download Activities/Alerts Claim Submission (e.g. FNOL)

3.1

Initial Load

The insurer is largely viewed as the authoritative source of insurance policy data, including related claims or accounting information. Trading partners such as agents and brokers often need access to this information for customer service and related activities. Access to this information can be provided via an inquiry service (e.g. internet access to the insurer's system), and/or the insurer may provide the information to the trading partner to import into its local system for local access. The process of sending the information to the trading partner after a given activity (e.g. policy renewal, cancellation, claim activity, etc.) is known as a "download". Many agencies receive download on a daily basis from their insurer trading partners, which results in a synchronization of the agency's system with the data in the insurer's system. When trading partners agree to provide such a data exchange, it introduces the aspect of the insurer providing an "initial load". An initial load is an output of all applicable data to load into the agency system. For example, an agency that does not currently maintain claims data in their local system might first request a claims initial load where all open claims for the agency are provided as of a given date. These claims images are imported into the agency's system, resulting in database synchronization, and the agency would thereafter receive its claims download on a regular schedule (e.g. daily) to keep its system in-synch with the insurer's system. Industry input has recommended that based on the nature of claims and related services, pursuit of an initial load for claims download is not necessary, though this guide should not be considered an authoritative statement and some parties may opt to pursue an initial load based on their business needs and system capabilities.

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4

4.1

MINIMUM DATA REQUIREMENTS

Minimum Data Set

The information below is provided as a guideline for the minimum data that should be considered when transmitting the various claims transactions. They are not intended to imply this is the recommended data set. And this minimum data set does not imply that all trading partners can function with just this set of data. The ACORD standard provides for inclusion of extensive claim data. Each implementing party will need to consider what they can send and/or receive, what is reasonable for the individual type of transaction and what will best meet the needs of their customers.

4.2

New Claim (FNOL)

Producer code Named insured Policy number Carrier Policy term Line of Business Date of loss (if available) Description of loss Contact (if available)

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4.3

FNOL Acknowledgement

Producer code Named insured Policy number Carrier Policy term Line of Business Date of loss (if available) Claim number

4.4

Claim Status Inquiry

Request: Producer code Named insured Policy number Carrier Claim number

Response: Producer code Named insured Policy number Carrier Claim number Any whatever data was asked for or a URL to the carrier site to view the data.

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4.5

FNOL

Claim Download

Producer code Named insured Policy number Carrier Policy term Line of Business Claim number Date of loss Loss description

Payments or Reserves Producer code Named insured Policy number Carrier Policy term Line of Business Claim number Payment Amount or Reserve Amount Payment Date (if a check) Payee Name (if a check)

© 2001-2009 ACORD CORPORATION ­ ALL RIGHTS RESERVED. ACORD CLAIMS WORKFLOW IMPLEMENTATION GUIDE V1.1 ­ JAN. 2009

22

Other changes Producer code Named insured Policy number Carrier Policy term Line of Business Claim number Claim status

4.6

FNOL

Activities / Alerts

Producer code Named insured Policy number Carrier Policy term Line of Business Claim number Date of loss Loss description

© 2001-2009 ACORD CORPORATION ­ ALL RIGHTS RESERVED. ACORD CLAIMS WORKFLOW IMPLEMENTATION GUIDE V1.1 ­ JAN. 2009

23

5

REVISION HISTORY/CHANGE SUMMARY

Date

Jan. 2009

Version

1.1

Description of Change

*ACORD's Standards License (formerly our Terms and Conditions of Use) has been updated. This is a documentation change only. No content changes have been made. Initial publication

1.0

May 9, 2008

© 2001-2009 ACORD CORPORATION ­ ALL RIGHTS RESERVED. ACORD CLAIMS WORKFLOW IMPLEMENTATION GUIDE V1.1 ­ JAN. 2009

24

Information

ACORD Standards Implementation Guide Template P&C

26 pages

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