Initial Interaction options are available for applying automation to a claim at the time of initial contact with the accountholder. This includes settings for automatic issue of provisional credit, as well as automatically issuing final credit. These settings can be customized, based on transaction type.
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AutoPay
AutoPay can be enabled to automatically pay a claim during the initial interaction with the accountholder. This feature allows you to establish a dollar threshold for claims that should be automatically granted provisional or final credit. When the amount of the claim is below the defined threshold, and does not meet any specific exclusion criteria, a credit is issued and communicated to the accountholder immediately. This frees up users to spend more time on claims with higher loss potential and improves the customer experiencing by streamlining the process and providing a quick resolution to their issue.
Setting Name
Setting Description
Advanced Options
AutoPay Threshold
Upon submission, automatically pay claims that are less than or equal to X dollars AND all disputed transactions are less than X dollars.
Split thresholds for fraud and non-fraud.
Auto-PC Threshold
Upon submission, automatically grant provisional credit to claims that are less than or equal to X dollars.
Split thresholds for fraud and non-fraud.
Auto-PC Non-Regulatory
Grant provisional credit on non-regulatory disputes?
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Exclusions
By default, QFD will not automatically pay or grant provisional credit for:
ATM Missing Deposit claims
Accounts opened in the last 60 days (if this information is made available to QFD)
Claims containing an aged transaction (120 days or more old)
Pending transaction not yet posted*
*The posted transaction will be autopaid if under threshold.
The following settings are available for customizing exclusion criteria.
Setting Name
Options
Potential Claim Abuse
X claims have been filed in the last X days. Pend these items for Fraud Review instead of Provisional Credit Review?
Suspicious Velocity
More than X claims opened within 24 hours.
Previous Denial
One, or more, disputes on the current or another claim by the same customer/member was previously denied.
New Account
A new account has been opened with the same customer/member within X days of the contact date.
Early Transactions
A disputed transaction occurred within X days of the account opening.
Documents Required
One or more disputes require documentation.
Non-Protected Claims AutoPay
Exclude Non Reg protected claims from AutoPay and Auto-PC automation? This includes claims that are not protected by regulation, based on .
Account Takeover
Exclude Account Takeover (ATO) claims from AutoPay and Auto-PC automation?
Proprietary ATM
Exclude Proprietary ATM claims from AutoPay and Auto-PC automation?
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Provisional Credit
If provisional credit was not automatically granted as as a result of the Initial Interaction settings above, the following options apply.
Setting Name
Setting Description
Provisional Credit Review
When Provisional Credit is not automatically granted as as a result of the Initial Interaction settings, do one of the following:
Require user review for all claims to determine if Provisional Credit should be issued
Require user review for regulatory-bound claims only to determine if Provisional Credit should be issued
Skip and proceed to Recovery
Post Reg E 10 Provisional Credit Review
When the deadline to grant provisional credit on a claim covered by Regulation E has expired and provisional credit is automatically issued by the system, do one of the following:
Proceed to Recovery
Remain in Provisional Credit Review to require user review
