New York State Insurance Department Howard Mills Superintendent of Insurance Presented by: Eileen Fox and Sandy Anderson Consumer Services Bureau

Prompt Pay Complaints Expanded on existing technology – CIIMS Built new and secure applications – –On-Line Provider Registration –OCCRS Utilizes clearly defined business rules for automatic closing of cases.

… Web Case Processing CIIMS Web Server

… New Case Processing CIIMS Web Server

The provider files their complaint at

First time users register with us. Once registered, the provider enters a user name and password to access.

Click on Edit Account, Prompt Pay or No Fault.

Provider data populates from log in and can add additional information.

Enter information on the insurance company or HMO.

Enter patient information.

Enter Date of Service information.

… Web Responses CIIMS Web Server

The company responds at

Company representative enters user name and password to access form.

Password and account information can be changed by clicking on Edit Account Information. After entering the user name and password correctly the following screen appears.

To respond to par provider complaints click on the Respond to P/P complaints.

This will bring you to a listing of all open prompt pay complaints on record for the NAIC number connected with the user registration. Please note the ‘dots’ next to the case number which will tell you the status of the complaint.  Green means a response has been received and processed. These files will appear only for a short time after the response has been processed.  Yellow means a response has been received and has not been processed yet OR not all dates of service have been responded to.  Red means no response has been received.

To respond click on the “respond” button next to the complaint.

This will bring you to the response form.

If the response is missing required information, the system will not accept the complaint the first time you hit submit. It will explain what information is missing.

The system will also check to make sure the information submitted makes sense. For instance if the dates of service are after the date the claim was submitted and paid you will receive notification. If you enter a paid date that falls before the date of service, the system will also notify you.

The required information can be left out and the response submitted by clicking on the Submit Response Anyway. You can click Cancel to stop the response process for this date of service all together. These buttons are located at the bottom of the response screen.

If you click submit anyway this screen will appear:

This is the screen you see after you respond to one date of service and hit done. The yellow check mark indicates that you submitted a response to the first date of service.

The system will indicate which dates of service have been responded to by the color of the check mark next to the date of service. * Green - the response has been received and processed. * Yellow - the information has been received but not processed. * No check mark - a response has not been received.

… Automatic Closing CIIMS Web Server

Based upon business rules, cases can automatically close by the System and a disposition letter is sent to the provider.

… Human intervention CIIMS Web Server

Cases that cannot be automatically closed are reviewed by an examiner.

Patient Information:

Service Dates:

Dates of Service List:

Provider Information:

A web based complaint:

For more information contact Sandy Anderson Or Eileen Fox