2

Add Participant

2.1

View the desired case.

2.2

Click New in the Participants tab to display the Participant Review window.

2.3

Click Name and specify the desired participant using the Account Participant window.

2.4

Specify diagnosis information as follows

Severity
Specify severity using this drop-down.
Medical Condition
Enter the medical condition in this field.
Diagnosis
Check the box corresponding to the ICD code version you are using to specify diagnosis.
Primary ICD-9
If you checked ICD-9 for diagnosis, click this button and specify the primary diagnosis using the Diagnosis Search window.
Primary ICD-10
If you checked ICD-10 for diagnosis, click this button and specify the primary diagnosis using the Diagnosis Search window.
Secondary ICD-9
If you checked ICD-9 for diagnosis, click this button and specify the secondary diagnosis using the Diagnosis Search window.
Secondary ICD-10
If you checked ICD-10 for diagnosis, click this button and specify the secondary diagnosis using the Diagnosis Search window.
2.5

Specify claims information as follows

TPA Paid in Current Year
Amount paid in the current year on claims by the third-party administrator.
TPA Pended Claims
Pending claim amount owed by the third-party administrator.
TPA Paid in Prior Year
Amount paid in the prior year on claims by the third-party administrator.
Current Lasered Deductible
Current laser deductible for the participant goes here.
2.6

Specify recommendations as follows

Individual Deductible
Check this box if the individual's deductible is the same as the group deductible.
Laser Recommendation
Enter the lasered recommendation amount here. Only available if you leave Same as Group Deductible unchecked.
Conditional Laser
Check if the laser is conditional.
Conditions(s)
If you specified a conditional laser, enter the conditions in this field.
Individual Contract Type
Check Yes if the participant has his or her own contract type. Otherwise check No.
Contract Type
If you checked Yes for Individual Contract Type, specify the contract type from this drop-down.
Individual Coverage Limit
Check Yes if the participant has his or her own coverage limit. Otherwise check No.
Coverage Limit
If you checked Yes for individual coverage limit, enter the coverage limit amount here.
Aggregate Maximum Liability
Check the box corresponding to how aggregate maximum liability is determined.
Explanation
Provide any additional explanation in this text area.
2.7

Detail risk management as follows

Case Management
Check Yes if case management applies. Otherwise check No.
Transplant
Check Yes if the case involves a transplant. Otherwise check No.
Re-Pricing
Check Yes if re-pricing is applicable. Otherwise check No.
Life Risk
Check Yes if risk to life exists. Otherwise check No.
2.8

Specify review status using the Status drop-down.

2.9

Click Save.