The Complete TPA Process in FileTrac

 The Complete TPA Process in FileTrac

This document is created to assist TPA’s with the entire process within FileTrac and explain some recent changes that have taken place system wide.  We will walk through the steps to accomplish everything from setting up authority levels for their users, entering Client Companies and Contracts, setting up Claim Shares, creating a Reserve Account which mirrors the bank account, setting Reserves, entering payments and/or recovery amounts, printing checks and voiding checks. 

Steps Involved:

1. Enter Contract Information in the Client Company.
2. Creating/Verifying Reserve Types on the Settings page.
3. Create a Reserve Account.
4. Include the Contract # on each Claim.
5. Setup the Claim Shares for each claim.
6. Set Reserves and Recovery for each claim.
7. Enter Payments and/or Recoveries.
8. Run the Exception Report.
9. Run the Bordereaux Report.

If you are an existing FileTrac customer using the TPA module you will notice some changes that have taken place.  Now that the new Strict TPA rules have been implemented you will no longer have the ability to back date payment entries and checks.  You will notice that the date will auto populate with today’s date rather than allowing you to enter a date in this field.  You will also only be allowed to make a change to a reserve for the previous month’s record within the first 15 days of the new month; and you will only be allowed to make one change.  All reserve changes made within the first 15 days of the following month will be reflected on 11:58pm on the last day of the prior month.  You will also be able to enter payments for the previous month only within the first 15 days of the following month.  These payments will be reflected on 11:59pm on the last day of the prior month. There is no restriction to the number of payments that can be added to the previous month only that it must be done within the first 15 days.  

We have also added the ability to “Close Out” the month.  Once the Bordereaux has been closed the system will no longer allow changes to the prior month’s reserves or payments even if it is still within the 15 day window.   This is done by selecting the Client Company name from the Companies page.  You can either manually closed out the month or once the 15-day window expires for the month it will automatically close.  To close it manually before the 15-day window ends click on the CLOSE Month Year BDX link.

You will then see the pop-up warning reminding you that once you close out the month you will not be able to enter reserves or payments for that month.

Once the month has been closed out you will notice the information on the tab changes to show the month and year of the closed Bordereaux and the name of the person that closed the reporting period as shown below.

It’s important to make sure the contract details are correctly entered under the correct Client Company and that the dates are correct.  FileTrac will alert the user anytime a file is created where either the Policy Start Date or the Date of Loss are not in line with the dates of the contract.  The system will allow the claim to be created but will give you a pop-up box as a notification.  

To enter the Contract, follow the instructions below:

1. Open the list of client companies by clicking on the Companies tab.
2. Click on the name of the Company that the contract needs to be added to.

3. Click on Contracts.

4. Click on New Contract.

When your system is initially setup by FileTrac there will be some default Reserve Types populated in your system. You may need to add to the types of reserves in your system if required by your client.  To enter additional Reserve Types in your system, go to the Settings Page and click on Reserve Types to jump to this section.   

The screenshot below represents some common reserves. It is important to keep in mind that the reserve name and the category for the reserve must be accurate for the reports to populate correctly. Reserve types must be set in this section to be available for use within a claim.

How to Add Reserve Types:

Adding Reserve Types is done on the Settings page under the Reserve Type section. 

1. Check the box adjacent to the blank field, and type in the Reserve Type. 
2. Select the Category by clicking the drop-down and select either Expense or Indemnity.
3. Click Add/Save Changes.

Continue adding and saving each type of Reserve until all have been added.

How to Add Recovery Types:

Adding Recovery Types is done on the Settings page under the Recovery Type section. 

2. Check the box and input the Recovery Type in the field

3. Click Add/Save Changes

Continue adding each type of Recovery until all have been added and are showing in the Recovery Types list.

You can change the order of either the Reserves or the Recovery Types by selecting Move Up/Move Down.  

The FileTrac default for Authority Levels is set at unlimited. An Admin User will need to go into the user’s profile and adjust the limits for each user.  Authority can be limited for Aggregate Indemnities, Aggregate Expenses, Reserves and Payments. If there is no value typed in a field, then the user has no limits set. A blank field = no limit; however, a payment cannot be entered that is greater than the Reserve Amount that is set.  

How to set the Authority Limits for a User:

1. Click on Personnel Manager from the main screen in FileTrac.
2. Locate the User and click on their Name.
3. Click on User Authority Setup near the top of the page.
4. In the appropriate column type in the Users Amount of Authority.
5. Once you have finished entering the fields click Update User Authority.

It’s important to remember that the contracts will not automatically populate on the claim.  This information can be added at the time the claim is created or can be added or changed in the Edit Claim page under the Primary Insured’s Information section.  

To navigate to the Edit Claim page:

1. Click on Manage Claims
2. Locate the correct File # in the list or use the search to locate the correct file and click on the File #.  Clicking on the blue file # opens the Edit Claim page where you can then add the contract/treaty.

Claim Shares can only be added once the claim has been created.  The system will not allow you to create claim shares that do not equal 100%.  If you are receiving an error, please verify that the shares equal 100.  

To enter the claim share: 

First click on Claim Shares from the Edit Claims page. 

The Client Company will default as the first on the contract/treat at 100%.  As you begin adding other companies in the claim share you will notice that the % of share will accordingly. 

How to enter additional companies that share in this claim:

1. Check the “Add New Claim Share” box
2. Select the Company Name
3. Select the Contact
4. Enter the Client Claim #
5. Select the Contract/Treaty
6. Enter the Policy #
7. Enter the share % this company is responsible for
8. Click Save Claim Share

Continue repeating the above steps until all have been entered.

Deductibles are only stored in the claim edit page under the coverage information section. This feeds to the financials screen for the deductible. This is the only place the deductible can be created. To enter the deductible in a claim, follow the instructions below:

1. From the main screen in FileTrac click on Manage Claims 
2. Scroll down to the Coverage Information Section
3. Enter the amount of the deductible 
4. Scroll to the bottom of the page and Save the changes

The Financials section is where you will be able to set Reserves, Make Payments, Void Payments, and access the Check Manager section. Managing payments should be done through the Reserves and Payment section rather than the Check Manager section.  A Payment is money going out and a Recovery is money coming in. There are two levels of payments on a claim. The initial payment takes into consideration the deductible. This is the reason, if you are going to void a payment, the pop up asks the question if you want to take into consideration the deductible. The second level authentication is because you are not only affecting the payment but also the reserves when you void the check. 

1. Click on Manage Claims
2. Click on the $ symbol next to the corresponding File #

From the Financials page you can Set Reserves, Make Payments, enter Recovery Amounts and utilize the Check Manager. (See more information on Check Manager later in this document.)

How to set Reserves:

1. Click the dropdown to choose from the list of Contacts on a claim. (All Contacts on a claim will appear in the drop-down list. This allows you to create separate reserves for each contact.)
2. Click the drop-down and select the Reserve Type. (The Reserve Types are pulled from those that were entered on the Settings page. For additional instructions on setting up the Reserve Types scroll to the section named Creating Reserve Types in Settings.)
3. Enter the Incurred Amount of the Reserve. (This would be the expected or approved maximum amount. Payments entered that exceed this amount will not be allowed and the Reserve Amount would need to be reset.)
4. Click on Submit Reserve Changes.

Once a reserve is entered you can now enter payments.

How to enter a Payment:

2. Today’s date will auto populate in the Payment Date field.

3. Enter the Amount to be issued. If you are entering a “Cash Call” select the Cash Call check box.

4. Select who the payment is Payable to.

5. Include the Invoice # if you have one. (This is not a mandatory field.)

6. Include the Tax ID if needed. (This is not a mandatory field.

7. Include the Check #, otherwise *PENDING* will appear on the payment log or “AUTO” will appear if the account is setup to automatically generate the next check #.

8. You may include a Memo to describe what is included in this payment.

9. Check mark “Apply Payment to Deductible” if applicable this payment should be applied to the deductible and mark Generate Check if you would like to generate the check from the system.

10. Click Submit Payment

The payment will show in the payment history section once it has been submitted.

If a check is written and the check # was not available at the time of entering the log, then you will need to go into the Check Manager to enter that Check # later.  This document will walk through these steps later in the Check Manager section below.

How to Print checks:

Checks can be printed from the Financial Payment history screen.  Once the payment has been entered you will then choose either Print or Generate from the Actions column next to the corresponding entry.  In the scenario sample below this account has been setup to populate the Check # at the time the check is generated. If you do not want to auto generate the check # and need to manually enter the number this can be accomplished, but for the purpose of this scenario the check # will auto populate. (For more information on Reserve Account settings see the section for Creating Reserve Accounts in this document.)

Payment #1 - When entering the payment if you marked to Generate the Check the entry will display with the check # which was the next in the sequence (or it will display the check # that was manually entered) and the Actions columns will give you the option to Print the check.  Check needs to be printed on generic corporate Check Stock - Deluxe brand for example. 

Payment #2 - If you did not mark to Generate the Check upon entering the payment the entry will display and the check # will BE shown as *AUTO* if the system is numbering the checks or the check # that was manually entered will be displayed and you will have the option under Actions to Generate or Void the check. 

The ability to Void an entry from this page is only allowed if the check has not yet been generated. To void a payment where a check has already been generated this would need to be accomplished from the Check Manager screen and the check would be voided rather than the entry.   A sample of a voided check is shown in the first row of the screenshot below.  Notice the Actions Column shows Voided and the history shows when the check was voided. (See more on voiding checks below.)

To Generate the check:

1. Click Generate.
2. Select the correct Account from the drop-down.
3. Click the Generate button

A payment entry can only be voided if a check has not yet been generated.  

How to Void a Payment Entry or a Check:

Two pop ups will appear. See the two screenshots below. The first, “Does this Payment also need to be VOIDED under the Deductible?” If you want it to apply to the deductible Click OK. If you do not want it to apply to the deductible click Cancel.

The second pop up, “We have auto-filled the data entry area above with the information for your VOID. Please review and click Submit Payment to save the VOID entry!” This is letting you know that the information has been auto filled based on the information from the selected payment to be voided. It is prompting you to double check your work to make sure you do in fact want to void this payment because this will affect the financials for the claim. Click OK. 

To access the page to setup a Reserve Checking Account you will need to click the link from the Settings page. The Reserve Checking Account creates a mirror image of your actual account but does not link to a live bank account.  Payments made in the financial reserves section of a claim will be reflected in your FileTrac Reserve Checking Account.  From within the Reserve Checking Account, you can set the beginning check number, records deposits, adjustments, record money transfers to this account, and record money transfers from this account.

How to set up your Reserve Checking Accounts:

1. Click on Settings.
2. Click on Reserve Checking Accounts.
3. From within the Reserve Checking Accounts Section, Click Here to Configure the accounts.

4. Check Add New Account.

5. Enter the Company Name.

6. Enter the Bank Name.

7. Enter the Routing #.

8. Enter the Account #.

9. Enter the Address.

10. Include any pertinent info in the Notes section.

11. Click Save Changes at the bottom of the page.

Once the account has been added you will now see where you can enter the first Check # if you would like the system to begin numbering the checks. You can also leave this unchecked and manually enter the check numbers.  You will also notice the link to enter Deposits and Adjustments.

To enter a Deposit, Adjustment or Transfer to or from this reserve account, follow the instructions below:

1. Click on Settings.
2. Click on Reserve Checking Accounts.

5. Click on the Calendar to select the date.

6. Select the Type of Adjustment from the drop-down (Deposit, Adjustment, Transfer TO this Account or Transfer FROM this Account).

7. Enter the Amount.

8. Enter a Note (not a mandatory field).

9. Click Save.

The adjustment will appear in the list of saved adjustments and can be marked Reconciled.  Once the entry has been reconciled the check box will be replaced with the date it was reconciled.  

To Reconcile an adjustment, follow the steps below:

1. Check the box in the Reconcile column of the adjustment that is being reconciled.
2. Click Save Reconciled Transactions.

The Check Manager is found in the Financials section of a claim and exists for the purpose of printing checks and recording Check #’s.  This information feeds directly into the Reserve Checking Account. Currently, Check Manager does not connect to a live bank account but will link to the Reserve Account setup in FileTrac. The Check Manager section is strictly a place that you can manage your finances from within FileTrac, enter a check # if it was unavailable at the time the payment entry was entered and print checks. 

If a payment is entered and the check number is not available at the time of the entry, the check number will need to be entered after that information is received some time later. The instructions below are to add a check number sometime after the original entry. In this example the payment has already been created and is only missing the check number.

1. Click on Manage Claims.
2. Click on the $ symbol next to the corresponding File #.

4. Notice the date will auto populate with today’s date and cannot be changed.

5. Choose the correct Account from the drop-down.

6. Enter the Check #.

7. Choose the Payment or combine payments by choosing more than one.

8. Select the Payee

9. If the check is being mailed and an Address is in the file you will have the option to select the Addressee next to the Payee’s name.

10. Verify the Check Amount.

11. Click Save Check.

The Checkbook Register screen will pop up and you will see the check listed. You can now click the Printer Icon to print the check or if a mistake was made you have the option to Void the check. 

As a TPA Client the Lloyd’s Bordereaux Report is found in your list of reports in the Custom Report Builder section of the Reports page.  

Above the field selection box you will notice two blue links, one for TPA Reporting with Report Builder – LLOYD’S Bordereaux and Contract/Treaty Exception Report.  It’s important to run the Contract/Treaty Exception Report prior to running the Lloyd’s Bordereaux and clear any exceptions prior to running the Lloyd’s Bordereaux. 

How to run the Contract/Treaty Exception Report

The above screenshot provides details provided by the exception report and will list any records not equaling 100%.  All incorrect entries need to be corrected and the exception report should be rerun until no exceptions are shown on the report as depicted in the screenshot above.  

It’s important to understand the fields for the Lloyd’s Bordereaux report, where this data is pulled from.  Please click the link for the TPA Reporting with Report Builder – LLOYD’s Bordereaux for detailed information.   This information can also be accessed by clicking the link from within FileTrac as shown below.

Data Fields for Lloyd’s BDX:

This is a valuable reporting tool available to you that allows you to build various versions of the standard Lloyd’s Bordereau.  To run the Standard report, follow the steps outlined below:

1. Click on the Reports tab

2. In the Custom Reports Builder section, click on Report Builder – LLOYD’S Bordereau

To find out more details about the TPA Reporting with Report Builder, click on the blue link at the top of the page in FileTrac (shown below) in order to evaluate which choices in the report may be right for you. The TPA Reporting with Report Builder-LLOYD’s Bordereau provides a detailed list of the available fields and the information contained in each.

To run the report “As Is”, including “All” for each category, the only thing you will need to do is select the date ranges and then select the format for the report. See the illustration below:

3)  Click the calendar and select the date range

4)  Click the radio button to Select the Report Format

5)  Click on View Report

Creating a Lloyd’s Syndicate Variant on the Standard:

While there is a “Lloyd’s Standard” Bordereau reporting format, each Lloyd’s syndicate wants their own special version or variant on the standard.  If you would like to make your own selections for the report, see the instructions below. Once your selections have been made for the report, you can save the report to be used again in the future.  Follow the instructions below to learn how to limit the search fields and learn more about each field so that you can create an accurate report.

1. Select the Client Company from the drop down. To customize the report, you can select for Client Company.   In selecting, the “All Values” will no longer be selected and the report will only pull information for the companies that are added to the “Selected Values” field.   

2. Click on the company from the list of values.

3. Click Add.

4. Once you have added a company to the list it will appear in the Selected Values field. You can continue selecting additional companies to add them to the report by repeating steps 1-3 for each additional company.

5. Click the dropdown bar to select the Client Rep, otherwise “All” will remain selected.

6. Click the calendar to select the Report Period Start Date.  This field defines the beginning of the “Reporting Period” on which the report is run.

7. Click the calendar to select the Report Period End Date. This field defines the end of the “Reporting Period” on which the report is run.

8. Click the calendar to select the “As of” Date. This field defines the virtual date on which the report is run. In other words, it asks the report to show the figures and information “as of” the selected date. This means that financial transactions - such as changes to a Reserve amount or Reserve Payments against a specific Reserve - will not show if they are dated later than the “As of” Date entered here.

9. Click the dropdown field for Claim Split Type to select how claims should be split regarding their liability in the system, where applicable. There may be multiple rows displayed for each individual claim, depending on how the Claim Share or Underwriter Split is set up for the corresponding claim. See more information for Claim Split Types in the section below.

10. Customize Field Selection:  Making any selection will output ONLY those field selections, in the order that you have them arranged.  To auto fill the standard Lloyd’s BDX fields click the QUICK LOAD:  LLOYD’s Standard BDX and all standard report fields will populate in the Selected Fields.

11. After selecting an available field, click the Add button.

12. The above selection will then appear in the Selected Fields. You can continue to add fields in this manner by repeating steps 10-11 for each desired field. Also, you can change the order of the Selected Fields by clicking on a selection and then opting with the buttons Move UP or Move DN. You can also delete a selection if needed by highlighting the selection and clicking on the Del button.

13. Click the dropdown bar to Customize Sort Order. This allows the user to select in what order the rows of information will output on the report, which are sorted according to the selected field. Making NO selection will output the information in no specific order. To select a field here, it must be included in the selected fields from the Customize Field Selection above or errors may occur!

14. Click the dropdown bar to select a Tab Breakout. This allows the user to select a specific field on which to breakout the report output into multiple tabs of an Excel Workbook. For example, if the output needed to be an Excel Workbook in which the claims on each tab were a different Year of Account, the “Year of Account” selection from this dropdown would be appropriate.

15. Click the Use Filter tab to apply the filters that were chosen in the steps above.

16. Select the Format for your report by clicking on the corresponding radio button.

17. Click the View Report tab

18. And finally, to save these filters so that the report can be run again later, click Save Report at the top right corner of the page. Once a report is saved here, you can click the Load Saved Report to run it again when the time comes.

Claim Split Types

The Claim Split Type field selects how claims should be split regarding their liability in the system, where applicable. Depending on the selection here, there may be multiple rows displayed for each individual claim, based on how the Claim share or Underwriter Split is set up for the corresponding claim. Listed below are the three available selections and a description of each:

Entire Claim – There will only ever be a single row output for the entire claim. All applicable identifiers will be those applicable to the entire claim and all Reserve figures will be 100% of the value for the entire claim.

Claim Share Split – There will be a row output for each party set up on the Claim Share screen for the specific claim. Identifiers, such as Client Claim #, may apply differently to different individual parties on the Claim Share. All Reserve figures will consider the percentage of liability, set up under the Claim Share for the applicable party. For example, if two parties are set up on the Claim Share screen as 65% and 35% and there is a Reserve figure of $100 for the entire claim, then there would be two rows output for the claim.   One row would show a $65 Reserve figure and the other would show a $35 Reserve figure.

Contract/Treaty Syndicate Split – This works similarly to the Claim Share Split, except the split shares are defined on the level of the Contract applied to the claim and not the individual Claim Share itself.

Designer’s Notes: Breakdown of Reserve Figures and Contract/Treaty Syndicate Split

It is possible to associate specific claims in the system with a specific Contract/Treaty for the particular Client Company to which the claim belongs. Each Contract may be set up with one or more Underwriting Companies that share a percentage of the liability for the Reserves and the associated payments on the claims associated with that Contract/Treaty. For example, let’s suppose that a claim is associated with Contract 2014 under its Client Company: Contract 2014 may be set up to have 70% of the responsibility for the Reserves/Payments to “Megacorp Underwriters” and 30% of the responsibility to “XYZ Company”. When certain selections are made to run the Report Builder – Loss Run or Report Builder – Spreadsheet Bordereau, the claim would be listed twice. The first time under “Megacorp” with each of the Reserve/Payment figures computed at 70% of their total value for the claim and again under “XYZ” with each of the Reserve/Payment figures computed at 30% of their total value for the claim.

Designer’s Note: Contract/Treaty Underwriters Setup and the Contract/Treaty Exception Report

A Contract/Treaty can, in theory, by set up with any number of Underwriters. When setting up the Underwriters for a Contract/Treaty, however, one must be sure to set them up so that the total percentages for the entire Contract are equal to 100%. There is no validation currently in place on the screen on which the Underwriters are configured. We have provided a report to allow any Contractors/Treaties on which the total liability between Underwriters is not equal to 100%. This is in the link labeled Contract/Treaty Exception Report, positioned above the selection criteria on the page for the Report Builder – Lloyd’s Bordereau.

Lloyd’s MI Reporting

This report is designed to allow generation of MI metrics for Lloyd’s syndicates.  

1. Click on the Reports tab.

2. Click on LLOYD’s MI Reporting located in the TPA Financial reports section.

To find out more details about Lloyd’s MI Reporting click on the blue link at the top of the page in FileTrac labelled “Reporting with Lloyd’s MI Reporting”.

To run the report as is, which includes “All” for each category, the only thing you will need to do is select the date range and select the format for the report. See the illustration below:

3)  Select the Start Date and End Date.

4)  Select Report Format.

5)  Click on View Report.

To customize the report, follow the instructions below:

1. Click on a Client Company. In selecting, the “All Values” will no longer be selected and the report will only pull information for the companies that are added to the “Selected Values” field (steps 2 and 3, below).

2. Click on the Add button.

3. The selection will be shown in the Selected Values field for Client Company.

4. Use the same method to make selections for the Syndicate by clicking on a Syndicate name.

5. Click the Add button.

6. The selection will be shown in the Selected Values field for Syndicate.

7. Click on the calendar to select the Start Date. This field defines the beginning of the “Reporting Period” on which the report is run.

8. Click on the calendar to select the End Date.  This field defines the end of the “Reporting Period” on which the report is run.

9. Click the dropdown field for Claim Split Type to select how claims should be split regarding their liability in the system, where applicable. Depending on the selection here there may be multiple rows displayed for each individual claim, based on how the Claim Share or Underwriter Split is set up for the corresponding claim. See more information in the section above for Claim Split Types.

10. Select the Format for your report by clicking on the corresponding radio button.

11. Click the View Report tab.

12. To save these filters so that the same report can be run again later, click Save Report at the top right corner of the page. Once a report is saved here you can click the Load Saved Report to run it again when the time comes.