- Added the ability to track In Network and Out of Network Payable Annual/Lifetime Maximums. Previously this definition only allowed for Total Annual/Lifetime Maximum. There will be no impact to existing plans within VBA with this change. (Image 1)
- Added the ability to track In Network and Out of Network Payable Annual/Lifetime Maximums for Added Accumulators. (Image 2)
- Added the Add Selection option to the pop-up menu of the Included Benefits Code column in the Benefit Max Included Benefit section on the Benefit Maximums screen. This option will open a screen that allows the user to select multiple benefits to include at once. (Image 4)
FEE SCHEDULE SERVICES
- Added the Allowed Over Billed column to Fee Schedules. This allows the user to define encounter rates that will increase the Billed Amount during adjudication. (Image 5)
- Added the not equal operator (<>) to the operator drop down on the Provider Rate Criteria section of the Provider Rate screen. This will make it easier to define rates where only a few exceptions are needed. (Image 6)
- Updated the VBA Control Panel to allow setting of Ex Codes for new In and Out of Network Lifetime/Annual Max definitions on the Plan and PlanBenefit. (Image 3)
- Added the ability to remove a Division from a registered Employer login that is Division only access. This allows the Employer login to be opened up to full group access rather than a specific division access.
- Added an edit to prevent adding additional Division access to an Employer login that is Division only.
- Modified the payable claim rule to take into account new Annual/Lifetime maximum settings on the Plan and Added Accumulator. This rule now accounts for the In/Out of Network maximum definition and acts accordingly.
Image 1 – Plan Annual/Lifetime In/Out of Network Max
Image 2 – Added Accum Annual/Lifetime In/Out of Network Max
Image 3 – In Network and OON Max Ex Code for Lifetime/Annual Max
Image 4 – Add Selection
Image 5 – Allowed Over Billed
Image 6 – Not Equal Operator
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