- Modified the Amount field on the Rate Payee screen to have four digits after the decimal point for better accuracy when applying a percentage.
- Updated the Detail option of a Check to display details for Distribution checks.
- Added Claim Timeline to the Claim Details Go option on “Processed Claims” and “Claims in Batch” screens. This timeline gives a historical account of all activity for the selected claim in an easy to read graphical format. In addition, the user can click on an icon in the Claim Timeline and get details about that particular transaction based on the type of transaction being selected.
- Changes to a template commission rate now update the rate settings for all subordinate rates.
- Increased the size of the Bill Seq Override column on the Enrollment Management screen, Enrollment Rider section. This makes the sequence number visible at the end of the name without having to activate the drop down.
- Added an edit to the Enrollment Add Wizard to prevent a Start Date earlier than the Contract Start Date and the End Date from being greater than the Contract End Date.
- The Plan Years detail screen now checks for claims with the Plan Year if the Plan Year, From Date, or Thru Date columns are changed. This prevents leaving the claims without a valid Plan Year
- Added the following columns to the Group Search screen:
- Groups.Address Groups.Address2 Groups.State
- Updated the security objects in the Object List on the Security Area Maintenance screen.
- Wizards opened from the explorer will only open when the user has at least view access and will only allow the user to complete the wizard when the user has at least update access.
- Added Error Termed Provider flag and Error Termed Provider Ex Code to the General Ex Codes section of the Control Panel.
- Added logic to check the Error Termed Provider flag on the Control Panel to determine whether to error or apply the Error Termed Provider Ex Code when a terminated Provider is found.
- Workflow Services is an exciting and powerful new component to the VBA application. Please contact VBA for training on setting up and configuring your own workflows!
– The Workflow Management screen allows the user to setup and configure Workflows. A Workflow is defined by a criteria and one or more associated tasks. A Workflow criteria is defined as any selection of claims using the standard VBA criteria interface. A task is made up of users who are responsible for that task as well as the options available to those users for that task.
MY CLAIMS WORKFLOW
- Set Criteria – this option brings up the standard VBA criteria selection screen. The user can either choose an existing criteria or create a new criteria to apply to this workflow.
- Workflow definition:
- Pre-Req. – This option lets the user identify if a prerequisite workflow must be completed before this workflow will pick up claims. This allows workflows to be daisy-chained through varying criteria before the claim is processed.
- Description – This is the description of the workflow.
- Type – This is the Workflow Type. Currently the only Workflow Type available is “Claim Batch Workflow” but there are plans to expand workflow into other areas such as Authorizations, Eligibility and Providers.
- Disabled – This option allows the user to disable this workflow. The system prevents disabling a workflow that is the prerequisite to another active workflow.
- Workflow Tasks – This is a list of tasks that must be completed in order to move the claim through this workflow. Completing the final task in a workflow completes that workflow.
- Workflow Task Users – This is a list of users responsible for the selected task. This allows for swift movement of responsibilities within workflow without mass reassignment while giving the flexibility to bind specific workflows to individual users.
- Workflow Task Options – This is a list of options the assigned users can perform for the selected task:
- Review Claims – This allows the assigned user(s) to only review claims. No update. No Adjudicate. No Process.
- Update Claims – This allows the assigned user(s) to review and update claims. No Adjudicate. No Process.
- Adjudicate Claims – This allows the assigned user(s) to adjudicate claims. No Process.
- Process Claims – This allows the assigned user(s) to process claims.
- *** Auto-Process Claims – This is a unique option that is performed by the VBA application. No users can be assigned to a task that has a system option assigned. This option will auto-process claims that move to this task within workflow without user involvement.
– The My Claims Workflow screen allows individual users to manage claims that have been assigned to them through the Workflow process. This screen allows the user to work claims (given the appropriate options on the selected task) and then set that claim as completed or rejected based on the results of the review.
CLAIMS WORKFLOW MANAGER
- My Claims in Workflow – This is a treeview list of claims currently assigned to the active user within VBA. Included on this list are claims that have been directly assigned by a workflow manager and are not specifically part of a defined workflow. Selecting an item in the treeview will return the list of claims associated with that workflow.
- Search List – This list is similar to “Claims in Batch” within Claim Services in that it allows the user to work claims based on the options assigned to this task.
- Set Complete and Set Reject – Right-Clicking on the search list allows the user to complete or reject the claim and move it through the workflow task list. Rejecting a claim either moves the claim out of this workflow (when rejecting the first task in a workflow) or moves it to a previous task defined for this workflow. Completing a claim moves the claim to a subsequent task when one is defined for this workflow or moves it out of this workflow when it is the last defined task.
– The Claims Workflow Manager allows a user to manage the claims that are in workflow, find aging claims and determine the workload of individual users that are part of workflow. A workflow manager can manage unassigned claims that are not picked up through workflow and assign those to specific users, complete/reject claims in workflow or simply evaluate the claims workload.
- Claims in Workflow – This is a treeview list of claims that are currently assigned to any user in workflow or unassigned. Clicking on a workflow, task or user will bring up claims based on that selection. Selecting a workflow will bring up all claims in that workflow regardless of task, selecting a task will bring up claims for that task while selecting a user will bring up all claims assigned to that user regardless of workflow and task.
- Workflow Claims – This is the list of claims found based on the item selected in the tree view. From this list the manager can complete, reject or assign claims.
- Workflow Summary – The Workflow Summary gives the manager a snapshot of activity for the selected item in the treeview. For a Workflow, Task or User the summary will identify claims assigned, completed or rejected today, yesterday, this week or this month. In addition, the summary will report aging information on currently assigned claims identifying how long the claim has been in workflow. For unassigned claims, the aging identifies how long the claim has been in the backlog.