- Fixed an issue where defining a Benefit Code Procedure would only allow entry of five (5)
characters. The From and Thru Procedure fields now allow up to eight (8) characters when
defining a procedure code.
- Modified the Generate Invoices logic for Enrollment Anniversary and Group Anniversary Age
Types. Birthdays occurring after the anniversary date will have one year added to the birth year.
- Deleting a PremRate will now remove any associated PremRateMinMaxDetail records.
- Fixed an issue on the Invoice Adjustments screen. Searching by Group Name would return an
- Added the ability to adjust or refund a re-entry claim from a prior adjustment/refund.
- Fixed an issue with Retro Adjustments where the age and sex of the subscriber were being used
instead of the member’s when the Billing Seq. Override was set.
- Added the Copy Division Wizard (Image 1). To run the wizard, click the Copy Division button on
the toolbar of the Group update screen. This wizard will create a new division with the settings of
an existing division. The wizard gives the following as options to copy over to the new division:
- Additional/COBRA Settings
- Class Options
- Disability Options
- Plan Years
- Self-Admin Settings
- Student Age Settings
- Volume Details
- Added a new location for defining enrollment waiting periods (Image 2) within the VBA
application. Enrollment Waiting Period definitions can be defined at various levels to allow
flexibility in start date resolution. Based on the precision of the defined waiting period, various
rules can be resolved during the enrollment process. An Enrollment Waiting Period can be defined
with 4 different calculations (Image 3):
- As of Hire Date – The enrollment start date will be based on the Date Employed entered
when the Subscriber was added or whatever the current Date Employed is for the active
- 1st of Month Following – The enrollment start will be the first of the month following the
- 1st of Month after X Days – The enrollment start will be the first of the month following a
defined number of days after the Date Employed.
- X Days after Date of Hire – The enrollment start will be a number of days after the Date
- Modified the “Add Subscriber” wizard to capture the Group/Division this Subscriber will be
enrolled in as well as the original hire date. If no Enrollment Waiting Period has been defined,
the Add Subscriber wizard will work as it does today (Image 4).
- Modified the “Enrollment Add” wizard to take into account all rules associated with Waiting
Period definitions. This wizard will function as it always has if you have no defined Waiting
- Modified the Manage Enrollments screen so that when Plans are added the system will recognize
a defined Plan specific Enrollment Waiting Period. If there are no defined Waiting Period rules,
this function will operate as it always has.
- Modified the network matching logic in adjudication to accept network values assigned to the
member. These “Member Overrides” are treated as the highest priority GroupNetwork when
matching with Provider Networks for network determination on the claim.
- Modified the Diagnosis Age restriction claim rule to take into account only the primary diagnosis
when the “Use First Diag Reference” option is selected on the Control Panel. Clients who do not
use this option are not affected by this change.
Image 1 – Copy Division Wizard
Image 2 – Enrollment Waiting Period Configuration
Image 3 – Waiting Period definition
Image 4 – Add Subscriber Wizard Updates
- Mobile Enhancements
- The Employer Claims > Claims grid is now formatted to better display its information on mobile resolutions
- The Employer Census charts are now formatted to better display their information on mobile resolutions
- New Admin Configuration Options Available
- The Employer Accordion tab title text can now be customized based on config settings
- The Employer Accordion tabs can now be individually hidden based on config settings
- The Employer Trigger Diagnosis section can now be hidden based on config settings
- Employer Claims > Paid Claims Turnaround can now be hidden based on config settings
- Employer Claims > Claims Paid Per Member can now be hidden based on config settings
- Columns in the Employer Claims > Claims grid can now be hidden based on config settings
- Columns in the Employer Top 5 Benefit Utilization + Remaining grid can now be hidden based on config settings
- Columns in the Employer Top 5 Benefit Category Utilization + Remaining grid can now be hidden based on config settings
- The default Employer ‘Current Insured/Member Count by Plan Type’ chart can now be replaced with a ‘Census By Plan Tier’ chart based on config settings
- The Employer Utilization charts can now show percentage values instead of currency values based on config settings
- The Employer Claims charts and grids can now be replaced by Claim Count charts based on config settings. The titles of these charts can also be customized based on config settings
- The title of the ‘Top 5 Benefit Utilization + Remaining’ chart can now be customized based on config settings
- The title of the ‘Top 5 Benefit Category Utilization + Remaining’ chart can now be customized based on config settings
- Grid columns in the Employer Invoice Details Grid can now be hidden based on config settings
- Intuitive help has been added to the Employer Click the “Help” icon on the side menu to get started!
- Census Screen Revamp
- The Census screen has been overhauled and optimized for use on
- To use the new Census screen, select an Employee from the Employee Lookup grid on the left side of the Census The Employee Lookup grid can be grouped and sorted for ease of use.
- Once you have selected an Employee, the Census PODs on the right side of the screen will populate – Employee Information, Family Details, Enrollment History, Other Insurance, PCP Details, and Accumulator Details PODs all remain from the previous Census The Requests and Badges PODs have been removed.
- A new POD has been added to the Census screen – Create a Users can now create Requests for an Employee directly from the Census screen. Additionally, the default functionality of creating a Request through the side menu remains.
VBAGateway Global (All Terminals)
- On the Benefit Maximums detail screen, the dropdown of Included Benefits only displays benefits on the Plan.
- Added the Smoker field to the Demographic Settings section of Premium Rates. This field allows rate to be selected based on the enrollment Smoker field. Options include:
- Yes – Smoker field on enrollment record is checked.
- No – Smoker field on enrollment record is not checked.
- Both or N/A – The state of the Smoker field is not used.
- The Payment search screen now has Advanced Search. Available tables to search include:
- Added an option for defining a Minimum/Maximum for rates attached to invoices. Defining a Min/Max can be done by Group or Group/Division and on a single or multiple rates attached to an invoice.
- Description – Provide a brief description of the Min/Max being defined. This description is then stored in the Comment field on the Adjustment being created when a Min/Max adjustment is applied to an invoice.
- Group/Division – Identifies the Group or Group/Division that this Min/Max applies.
- Eff./Term. Date – Identifies the effectiveness of the Min/Max rule. The effective dates for this Min/Max are compared against the Invoice Date of the invoice being generated.
- Min/Max – Select whether this rule is a Minimum or a Maximum and what is the amount for that Min/Max.Reason – Identifies the reason code that would be attached to the Min/Max on the invoice. The adjustment is attached to the header of the invoice and given this specific reason.
- Rate List – The rate list identifies what rates make up the Min/Max. This allows flexibility in what rate or rates make up the Min/Max. The rate(s) in the list are summed together during the invoice generation process to assure the Min/Max rule is met and an adjustment is generated when necessary to meet that Min/Max.
- Increased the visible area of the Diagnosis Codes on Professional and Institutional claims to accommodate the input and display of all eight characters.
- Enabled the Override Amounts and Clear Overrides options for Flex claims.
- Added the Smoker field to the Member Detail section of the Enrollment update screen.
- On the Federal COBRA Election Form, the Group ID has been added to the title and the last page displays “(END)” beside the page number in the footer.
- Added the option to include Plan information as part of the criteria when creating Workflow. This allows workflow to be defined by Plan Type as well as any other items that are Plan specific.
- Added Received Date to the “Claims Workflow Manager” claims list. This allows the claims list to be sorted by Received Date when necessary.
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