Monthly Archives: September 2014

VBA Software August 2014 Release Notes

AUTH SERVICES
  • Added the ‘Type’ column to the Diagnosis Codes section of the Auth update screen
  • The Description column of Procedure Codes and Diagnostic Codes will now display the descriptions of new or changed codes when the screen is saved.
BENEFIT SERVICES
  • Added the ‘Type’ column to the Diagnosis Codes tab on the Plan Benefit Diagnosis Codes section of the Benefit Definition detail screen.
  • Added the ‘Type’ column to the Diagnosis Ex Codes section of the Benefit Ex Codes detail screen.
  • Added the ‘Type’ column to the Diagnosis tab on the Overlap Details section of the Benefit Overlap detail screen.
  • Added the ‘Type’ column to the Diagnosis Age Restriction detail screen.
  • Added the ‘Type’ column to the Benefit Diagnosis Codes section of the Benefit update screen.
  • Updated Benefit Copy process to include the Diagnosis Code Type when copying Diagnosis code to a new Benefit.
  • Added the ‘Type’ column to the Benefit Diagnosis Codes step of the Benefit Add Wizard.
CARE MANAGEMENT SERVICES
  • Moved the definition for custom fields and scorecard to a details window. This allows for more information to be displayed during entry without creating too much clutter on the main care plan screen.
  • Added Care Plan Scorecard Actions to the scorecard definition. This allows recommendations to be made based on the scored result of a particular case.
  • Added the ability to score a base care plan question without having to create a separate care plan rule. This provides a more consistent approach to actionable items on the care plan.
  • Changed the layout of the Case screen to create additional space for recommendations and actions by moving Case Values to a separate tab.
  • Added the ability to attach a case to Provider, Group or Group/Division in addition to Member. During Case creation the user is prompted with the entity for which this case is being assigned.
  • Added the ability to identify a Case as “Do Not Contact”. Flagging a case for no contact will give a notification when the case is opened that this entity is not to be contacted.
  • Added Work Log tracking for a Case. A work log entry holds the following information:
    • Log User – This is the user performing the work. This defaults to the user who is logged in.
    • Log Date – This is the date the work is performed. This defaults to the current time and date when the entry is added.
    • Log Type – This is a user defined drop-down of types that can be used to categorize the work being performed.
    • Hours – This is the number of hours expended for this work log entry.
    • Mins. – This is the number of minutes expended for this work log entry.
    • Billable? – This identifies the work log entry as billable.
  • Added the ability to define medication as part of a case. This allows both the use of the drug code values available in VBA as well as custom entry of medication. Each medication can be defined for a specific dosage and timeframe.
  • Added the ability to assign a custom contact to a case. There are a number of contact details that can be assigned to the member (through case head and PCP assignment) while this new contact area allows for a dynamic contact specific to this case.
  • Added Group ID, Division ID and Provider ID to the Case Search screen. Also added the Groups, GroupDivsion, and Provider tables to Advanced Search for that screen.
  • Added the ability to assign a new case to a Care Manager using the Add Case Wizard. The list will include the user, if they are a care manager, and anyone they are allowed to assign case. If the care manager is not accepting cases, has a full case load, or does not have the available Case Weight Threshold, their name will appear in red with an appropriate message attached.
  • Added new Case Assignment screen. This screen displays the open cases and care managers to whom the user can assign cases. The screen features the ability to auto-assign open cases to care managers for whom the user has update access. The users can also click-and-drag to assign or un- assign cases to allow for more efficient assignment of cases.
CLAIM SERVICES
  • Added the ‘Type’ column to the Claim section of the Processed Claims update screen for all claim types.
  • Added the ‘Type’ column to the Claim section of the Claims in Batch update screen for all claim types.
  • Added the ‘Type’ column to the Claim Header section of the Disability Claims screen.
  • Added the ‘Type’ column to the Disability Claim Information section of the Disability Claim Creator.
  • Added the ‘Type’ column to the Flex Claims section of the Flex Claim screen.
  • Added the ‘Type’ column to the Claim Settings tab on the Life Claim Settings section of the Life Claims screen.
  • Added the ‘Type’ column to the Claim Information section of the Life Payment Creator.
  • Added the ‘Type’ column to the Diagnosis Codes window that displays the diagnosis codes of a Processed Claim when Definition is selected from the pop-up menu of the Diagnosis Code column.
ENROLLMENT SERVICES
  • Added the ‘Type’ column to the Pre-Ex Allow Diagnosis detail screen of the Enrollments update screen.
FEE SCHEDULE SERVICES
  • Added the ‘Type’ column to the Fee Schedule Fees section of the Fee Schedules update screen.
  • Added the ability to configure modifier exclusions globally or by fee schedule. This allows fee schedules to be defined without information modifiers as part of the fee schedule definition. This update allows for a cleaner fee schedule while not needing additional pends during claims adjudication.
GENERAL SERVICES
  • Changed the Drug Code lookup to not pull the entire drug code list when the lookup is called. This lookup is also configured to require criteria be entered before searching for a drug code.
  • Added a window title to the Drug Code lookup.
  • Modified the contact assignment screen to allow contact information to be viewed without having to navigate to the contact. This saves the user a number of clicks when trying to access contact details.
  • Modified the contact assignment screen to allow the user to add a new contact without having to go to System Services. Right-click on the assignment list and select “Create Contact” to create a new contact. Once the new contact is created, it can be selected for assignment from the lookup option.
GROUP SERVICES
  • Added the ‘Type’ column to the Capitation Services section of the Networks update screen.
  • Added the ‘Diag Type’ column to the Group Disenroll Wizard of the Groups update screen.
USER SERVICES
  • Added the ability to subscribe to VBAGateway requests and messages. Subscriptions are tied to a user and can have a notification assigned or have that subscription auto-process when necessary. User can view their outstanding requests and messages based on subscription settings in the “My Gateway” module under VBAGateway Services.
  • Renamed Group Restrictions to User Restrictions as its original intended use has been expanded (Image 42). Also added User Restrictions as a security item to improve security customization.
VBAdjudicate
  • Fee Schedule claim rule updated to take into account Modifier Exclusions. During the adjudication process, when determining what fee schedule to use, modifiers that are excluded will not be taken into account.
  • Modified VBAdjudicate to process Diagnostic Type. This allows the program to distinguish between ICD 9 and ICD 10 codes as well as any future types.
VBAGATEWAY SERVICES
  • Added the ability to subscribe to VBAGateway requests and have the auto-process without user involvement. Subscriptions created at this level must always be for requests and must always be set to auto-process.

VBA Software June 2014 Release Notes

VBA AUTH SERVICES
  • The “Referred By” field on the Auth update screen is now a hyperlink that will open the Provider update screen for that Provider.
  • Performing a lookup on Referred By will now return the First Name and Last Name of the Provider when the Provider has an Entity type of Person.
VBA BILLING SERVICES
  • Removing a payment from an invoice will now update the subscribers Paid Thru dates with the date from their most recent closed invoice.
VBA CARE MANAGEMENT SERVICES
  • ID Codes can now be added to Cases.
  • Scorecards have been added to Care Plans. Users can modify Care Plan Scorecards and all Case Scorecards will be updated (Image 1).
VBA CLAIM SERVICES
  • When adjudicating a claim on the Claim update screen, a message would appear when the claim took longer than a few seconds to process. When this message closed, the Claim screen would not reflect the adjudicated information. This message will now allow the user to wait until the claim has been adjudicated and the claim screen will be updated.
VBA ENROLLMENT SERVICES
  • • Modified the PCP Auto-Assignment logic to determine whether the providers are Accepting Patients. Also, on the last attempt to assign a Provider, previously checked Specialties will be removed from the list of available Providers so as not to assign a Provider not meeting the age requirements of those Specialties.
VBA GROUP SERVICES
  • Added the ability to define the OOP values that are carried over as part of the 4th Quarter Carryover settings. OOP can be defined to carry over both deductible and coinsurance into the OOP bucket (default activity) or have the deductible only or coinsurance only carried over.
VBA REINSURANCE SERVICES
  • The Generate Transaction wizard was not picking up transactions when using Reins Levels. The process was incorrectly expecting the Specific Deductible to not be NULL.

VBA May 2014 Release Notes

ACCOUNTING SERVICES
  • Increased the visible area of the Ex Code dropdown on the Refund Wizard. Also added a horizontal scroll bar to allow the user to view the entire description.
  • Extended the Units field on Professional and Institutional claims screens to allow 5 digits before the decimal. Units will allow entry up to 99999.99.
AUTH SERVICES
  • Added the ability to set Request and Approved Units per Procedure Code defined on the Authorization. This allows the user to limit the Authorization to specific codes within the total units approved without the need to create additional Authorizations.
BILLING SERVICES
  • Added the ability to assign unassigned Invoice Adjustments to an open invoice. This functionally was needed because unassigned adjustments may never get picked up if new invoices are not generated (only one member in the division).
  • The Calculate Distribution process will now limit distributions for a payee that has a Reinsurance Level distribution type by the amount received. This will prevent distributions from being generated until amounts are received for payees with the Reinsurance Level distribution type.
CARE MANAGEMENT SERVICES
  • Added new Case Assignment screen. This screen displays the open cases and care managers to whom the user has access. The screen features the ability to auto-assign open cases to care managers for whom the user has update access. The users can also click-and-drag to assign or un- assign cases to allow for more efficient assignment of cases.
CLAIM SERVICES
  • Changed Diagnosis Pointer to allow 5010 compliant alpha values (A, B, C, etc.) on Professional and Institutional claim screens. Diagnosis pointer will still allow numeric pointers or a combination of both numeric and alpha.
  • Extended the Units field on Professional and Institutional claims screens to allow 5 digits before the decimal. Units will allow entry up to 99999.99.
  • Added the ability to define Disability Event Settings by Group. This allows more flexibility when defining disability options and Ex Codes.
  • Added a screen to inform the user of the usage of an Ex Code before allowing the user to delete it (Image 7). This screen shows the tables having an entry with the Ex Code and the number of occurrences within each table.
  • Increased the number of Diagnosis codes possible on a Professional claim to twelve to meet the new CMS requirement.
ENROLLMENT SERVICES
  • Added an option to Riders as part of Enrollment. When setting a Rider you have the option to “Override Member Sequence” which identifies which member’s Age and Initial Volume are used when calculating Volume using the “Percent of Initial Volume” option under Group Volume settings.
  • Added an option for “Initial Volume” and “Initial Volume Percent of Salary”. These options work in tandem with the Group Volume settings “Percent of Initial Volume”.
GROUP SERVICES
  • Added logic to the Group Contract Add Wizard to copy the External IDs when adding a contract.
  • Added a new Volume option for “Percent of Initial Volume”. This new setting will calculate volume based on the Initial Volume set on the individual member.
REPORT SERVICES
  • Added the Insured First Name and the Insured Last Name columns to the criteria screen for EOB Reports. This will allow the user to sort families that have members with different last names together for mailing purposes.
VBA Control Panel
  • Added a new Ex Code for when a specific procedure code exceeds the units approved on an authorization. This code is applied to the service line that has the selected authorization and the procedure that has exceeded the approved unit total.
  • Added an option to auto-pay capitated claims. This option is on by default (to maintain existing functionality) but can be disabled to allow capitated claims to move through claim processing in the same manner as non-capitated claims.
VBAdjudicate
  • Modified the Diagnosis Pointer claim rule to allow 5010 compliant alpha values.
  • Modified the Benefit matching process to use more than the first 4 diagnosis codes when determining a benefit. Benefit matching will now use all diagnosis codes that are referenced on each service line regardless of diagnosis position.
  • Modified the Pricing claim rule to check the Use First Match Pricing from the VBA Control Panel (Image 2) to determine if the Fee Schedule selected has to match all modifiers or just the first match found.
  • Adjudication will now read the auto-pay capitation option from the control panel to determine whether claims should be auto-paid during processing. By default, claims auto-pay until disabled on the control panel.
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