This article will help you create and modify the Assessment of Attendant Care Needs (Form 1) for MVA patients via HCAI. An Assessment of Attendant Care Needs (Form 1) is typically issued after an attendant care assessment.
To perform the following procedures, open the Patient Manager and select the patient from the list on the left.
Create and Submit a Form 1 to HCAI
- Open the patients MVA Case and click the Documents tab.
- Click [New Document] on the toolbar, then select Form 1 [Latest OCF version] in the Template type drop-down list.
Note: You may want to clone the OCF from a predefined Form 1 Preset or from a previous Form 1. To do that, click Preset or Previous in the Duplicate From drop-down list, then select one from the list.
- Click Open.
The Form 1 Editor opens.
- Verify the Date of Accident and Document Date.
- Click the numbered links on the left side of the screen to open, review, and complete each section of the Form 1. See Form 1 Sections.
Tip: As you complete pages that specify levels of attendant care, the system calculates total time per line based on the entered time and number of times per week. In the bottom-right of each Level page, you see the calculated subtotal claimed amount for that page.
- When the form is complete, click Submit & Close.
The Document Log captures the state changes of the treatment plan from the moment it was created until the adjuster response via HCAI. Every log record is time-stamped and identified with a status.
To open the Document Log, open an existing Form 1, then click View Log (top right of the screen).
To copy the HCAI document number to the clipboard for use elsewhere:
- Select the number shown in the bottom left of the Document Log window.
- Use Ctrl+C shortcut to copy.
To preview and print the log, click Preview on the bottom-right of the Document Log window. Click [Print] on the toolbar.
The Explanation of Benefits (EOB) is used by adjusters when they choose to provide additional details for declined (not approved) and partially approved claims. Thus, not every Form 1 will have a response with an EOB attached.
Edit a Form 1
Note: This can be done only for Form 1s with the status of Created.
- From the Documents tab, double-click the Form 1.
The form opens for editing.
- Make the necessary changes, then click Save & Close.
Preview and Print a Form 1
- While modifying the Form 1, click Preview.
The Form 1 opens for previewing.
- Click [Print] on the toolbar.
- Choose the printer from the list, then click Print.
Tip: While previewing, you can also export the document to PDF by clicking [Export to PDF] on the toolbar.
Delete a Form 1
- This can be done only for Form 1s with the status of Created.
- You are required to enter a User password and have appropriate permissions in order to delete the form.
- From the Documents tab, select a Form 1, then click [Delete Document] on the toolbar.
- Click Yes when prompted.
Form 1 Sections
|Applicant & Insurance Information||On the first page of Form 1, identify applicant, MVA insurer, and policyholder information.|
|Assessor & Signature of Assessor||On the first page and in Part 5 of Form 1, identify the Assessor(s).|
|Level 1 Attendant Care||In Part 1 of Form 1, specify attendant care for routine personal care.|
|Level 2 Attendant Care||In Part 2 of Form 1, specify attendant care for basic supervisory functions.|
|Level 3 Attendant Care||In Part 3 of Form 1, specify attendant care for complex healthcare and hygiene functions.stay within the boundary of 500 characters per explanation box.|
|Calculation of Attendant Care Costs||In Part 4 of Form 1, specify the hourly rate to fulfill the functions in Part 1, Part 2, and Part 3. The system will calculate the total Monthly Care Benefits.|