Claims

Managing Agent playbook – phase one

Claims - phase one - Step 1 and Step 2

Step 1: Claims Submission

Actor Broker NoChange

EDI (LIMCLM)

Brokers will be able to submit LIMCLM messages via the Market Gateway (ASG Adept) to ICOS for claim submission (either for FNOL or a movement on an existing claim). 

LIMCLM messages are not expected to change. The EDI specification can be found here.

Actor Central Services DefiniteChange

Market Gateway

EDI messages, such as LIMCLM, must go through the Market Gateway (ASG Adept).

For EDI, portal and gateway changes, please also refer to the phase one summary.

Actor Broker DefiniteChange

ICOS Portal

As an alternative to LIMCLM, brokers also have the option to submit claims through the ICOS portal, which is replacing the ECF portal.

Insurers are able to use the ICOS portal to see the claim submission, contribute to the investigation stages of the claim process, and manage queries. 

Actor Central Services DefiniteChange

ICOS

ICOS is the new claims processing platform replacing ECF and CLASS.

ICOS will cover all of the functionality of ECF/ECF2. There will be no loss of functionality, even though some processes will be changing. For more information, please see What is changing?

Actor Broker NoChange

Claim Documents

Claim documents will continue to be submitted as part of the claim process via two routes:

  • IMR portal

  • DRI

Actor Central Services PotentialChange

IMR and IMR Portal

The IMR will continue to be the platform that will store claim documents. The IMR portal will remain available to use by insurers in phase one and phase two; however, the look and feel of the portal may change. The IMR portal will remain with the same interfaces as today.  Elements of the functionality will be moved to IPOS and ICOS.

A more detailed view of the changes is expected by mid-October 2023.

Step 2: Investigation, Queries (if applicable), Claim Agreement

Actor Broker Insurer DefiniteChange

ICOS Portal

The portal allows users to centralise and digitise their business processes for the claims journey. Both insurers and brokers will be able to submit documents and manage queries during the investigation stages.

Other traditional methods to manage queries, such as email, phone call and any manual workarounds, can also be used in phase one, but it is not recommended because the data related to queries will not be in ICOS and therefore users will not have complete auditable tracked claims records. 

The ICOS portal will orchestrate the process of the agreement parties agreeing the claim. The broker can view the agreement status live in the portal. 

There are currently no dedicated roles in the system for third parties. Therefore, insurers and brokers will be responsible for managing queries and investigation with third parties out of the platform.

Actor Central Services DefiniteChange

Reach Back

The Reach Back service will enable legacy cases to be handled where claim data cannot be found in ICOS. In such situations, Reach Back will pull data from the old systems (e.g. CLASS, ECF, LIDS) into the new systems, IPOS and ICOS.

If Reach Back is required for a claim, it will be used once only:

  1. At FNOL, ICOS will look for premium information in IPOS. If it is not found, Reach Back will pull historical data from LIDS.

  2. If a claim originated in CLASS and a subsequent submission happens in ICOS, then the Reach Back service will the previous claim history from CLASS.

  3. Raw historical LIDS and CLASS data will not be directly accessible by insurers and brokers after the phase one cutover.

If there is a future subsequent submission in ICOS after that, there will be no more Reach Back calls because all the information will already be in IPOS and ICOS.

Actor Central Services DefiniteChange

Market Gateway

EDI messages, Writeback and CWT will go through the Market Gateway (ASG Adept).

For EDI, portal and gateway changes, please also refer to the phase one summary.

Actor Insurer NoChange

Writeback, CWT

Both Writeback and CWT will be available during phase one and phase two, with a plan to sunset these services at some point later in phase two when the market deems them no longer necessary. Specific timelines have not been confirmed.

After the phase one cutover, Writeback and CWT will only be accessible via the Market Gateway (ASG Adept).

Actor Broker Insurer PotentialChange

Standardised EDI

EDI Messaging will remain in place. All messages supported today will exist in phase one, even though they will come from a different portal, the Market Gateway (ASG Adept), and may have some content, but not format changes.

Mainframe end-of-day batches will cease to exist in phase one, the new digital platform operates in a real time. For example, as soon as a claim is processed and signed, it will be immediately written in the system of record. However, EDI messages (including USM and SCM) are scheduled once a day. EDI messages amalgamate all signings during the day into a single data package. The current frequency of EDI messages won’t change in phase one, they will be delivered in the same frequency and time as in today’s systems. 

Please see EDI specifications for detail on changes to EDI messaging.

For EDI, portal and gateway changes, please also refer to the phase one summary.

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