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This email serves as a heads up about the changes coming to OnBoard! The following updates will be available next week, starting on August 8, 2024.
To allow payers to request insurer review or reassign the claim sender of a prior authorization request (PAR), two new Actions options will be available on the PAR Object details page: Request Insurer Review and Update Claim Sender. Requesting insurer review or updating the claim sender can only be done by the payer workload administrator when a PAR is in Level 1 review status, and each option can only be done once per PAR.
1. Update Claim Sender
- Building upon feedback received, the OnBoard system now allows claim administrators to update the claim administrator assigned to a PAR. For example, if a third-party administrator (TPA) takes over a claim, the previous TPA will have the ability to reassign a related PAR if it is routed to them.
- When the Update Claim Sender action is selected, the workload administrator is redirected to the Justification for Insurer/Sender Update page. After the justification is submitted, the workload administrator will be redirected to the Payer tab and may update the Sender Number (claim administrator) and Claim Admin ID.
- After the workload administrator selects the new Sender Number and Claim Admin ID, the PAR is reprocessed, email notifications are sent, a new document is generated, and the PAR is routed to the correct sender.
2. Request Insurer Review
- Workload administrators will have the option to submit a request for insurer review on PARs they believe have been sent to the incorrect payer. This should only be used if a payer does not have the ability to reassign the PAR to the correct claim administrator under the Update Claim Sender option.
- When the Request Insurer Review action is selected, a pop-up displays prompting the workload administrator to submit proof of the responsible entity via uploaded documents or free text entry to proceed. Upon submission, the PAR status column temporarily updates with Pending – WCB Insurer Review. The proof is stored in the Documents section of the PAR details page.
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- If the Request Insurer Review submission is accepted, the Board will update the insurer information and the PAR will be routed to the new insurer for review. The PAR cannot be reassigned a second time.
- If the Request Insurer Review submission is rejected, the workload administrator who submitted the request will receive an email indicating the request for insurer review has been rejected and the insurer is correct as assigned. The PAR will reset to an “L1 Requested” status for response.
PAR due dates are not extended if an insurer review is rejected by the Board, so please ensure you are not the claim administrator responsible for review before submitting a request.
Training & resources
Training webpages have been developed and launched alongside of this OnBoard update. Please review this update to ensure a smooth and easy adoption of this new feature.
More information
For full OnBoard details, please visit the OnBoard webpage.
Visit the What Payers Need to Know webpage.
Need help? Visit OnBoard Support.
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