Monthly Archives: July 2016

VBA Included in 2016 Gartner Market Guide for Healthcare Payers Core Administrative Processing Systems

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Inside your Gartner Market Guide for Healthcare Payers’ Core Administrative Processing Systems you will find recommendations and market information regarding the Healthcare Administration Software industry. This guide will help your team as you decide on a benfits administration system.

Disclaimer for Report:
Gartner, Inc., Market Guide for Healthcare Payers’ Core Administrative Processing Systems, Constance Sjoquist, 18 June 2016.
Gartner does not endorse any vendor, product or service depicted in its research publications, and does not advise technology users to select only those vendors with the highest ratings or other designation. Gartner research publications consist of the opinions of Gartner’s research organization and should not be construed as statements of fact. Gartner disclaims all warranties, expressed or implied, with respect to this research, including any warranties of merchantability or fitness for a particular purpose.

VBA Software July 2016 Release Notes

BILLING SERVICES

  • Added the ability to “Finalize” an invoice. This option will flag the invoice as Finalized and remove the ability to Delete or Regenerate the invoice (all other functions continue to work as expected). This is NOT a required step in the invoicing process and is completely optional (Image 5).
  • Added a configuration option to globally Finalize or Un-Finalize an invoice (Image 6). The Finalize invoice option can only be undone through the Finalized Invoices maintenance screen (Image 7).
  • Added Refund option to the Invoice Subscribers section of the Invoice update screen (Image 1). This option opens the Refund screen (Image 2) allowing the user to select rates and adjustments to refund to the group, division, or subscriber. This process creates adjustments and distributions and will look for or create a payee for the selected level of payee. New ID Codes BILLREFUNDGROUP, BILLREFUNDDIV, and BILLREFUNDSUB will identify created payees and prevent the creation of multiple payees for an entity.
  • Added the option to Delete Distributions at the Check Preview level. Prior to the creation of a Distribution Check you can now delete all generated distribution transactions for a selected Check so they can be recalculated (Image 9).

CLAIM SERVICES

  • Fixed an issue where Auth Actuals were not properly being updated when Return to Batch was being called from the Claim Search list. Returning claims to batch will now properly update actuals in all instances.
  • Increased size of Modifiers in the pop up window on the Batch Claim Details section of Claims in Batch update screen (Image 3).
  • Added “Processed Date” as a field available for search within Processed Claims.

GROUP SERVICES

  • Added the Set Paid Through option to the Additional Division Settings area of the Additional/COBRA Settings detail screen. This flag will only be used to determine whether the Paid Through date is set when the Set Paid Through flag on Company Data is off (Image 4).
  • Added Age Range to the existing Volume Types of “Percent of Gross Salary” and “Percent of Net Salary” on the Group Volume update screen. Existing Volume Types of Percent of Gross Salary and Percent of Net Salary will have the Age Range set to 0 – 199 by default (Image 11).

REINSURANCE SERVICES

  • Fixed an issue where Reinsurance Levels were not properly splitting based on configured values. In some instances, the Reins Level would double the responsibility and cause an invalid Spec Transaction to be created. The only impacted users are those who setup and utilized the Reinsurance Level options on the Reins Contract.

REPORT SERVICES

  • Void/Refund Detail by Division
  • Claims Detail (Incurred/Paid/Network/Tax/Type)
  • Claims Summary Report

SECURITY SERVICES

  • Added new functionality to quickly view and modify Security Areas for Users or Groups (Image 10). This option allows for cross Security Area updates to a single User or Group without hunting for them within the Security Area treeview.

PROCESS AUTOMATION

  • Added new triggers for Check Processing. Each trigger is fired based on the data within a single check run:
    • Check Process by Check Batch – This trigger will fire once at the completion of the Check Process Wizard and will contain data for the entire check batch.
    • Check Process by Payor/Account – This trigger will fire once for each unique Payor/Account combination that is in the check run at the completion of the Check Process Wizard.
    • Check Process by Pay To – This trigger will fire once for each unique Pay To that is on this check run at the completion of the Check Process Wizard.
    • Added the appropriate validation and edits to assure all required information is properly entered for Step Type “Report File”.
    • Added a new Process Automation Step Type “Publish to Gateway”. This new option will allow those clients who have VBAGateway to automatically post reports and letters to the Gateway site to be viewed by VBAGateway users (Image 8). If you would like to learn more about VBAGateway please contact us through your support email and schedule a demonstration.
    • Made a modification to the Process Automation Trigger “Add Subscriber Enrollment” for what date is used for triggering the process. Previously the current date was used which would cause an issue for enrollments that happened in the future. The trigger now uses the Start Date identified on the Subenrollment record as the basis for the trigger. This is a more accurate representation of when the process should trigger.

    VBAGATEWAY SERVICES

    • Added the ability to confirm Flex Claim Submissions entered on the VBAGateway Member Terminal. This entry will now automatically go into a daily “Web Batch” from Gateway where Flex claims can be reviewed. The attachment sent as part of the Flex Claim request will be captured as a note on the newly entered claim so the examiner can review.
    • Fixed an issue when confirming Open Enrollment “Add Subscriber” requests. This confirmation will now properly add and update all the entered information from the request into VBA.

    Image 1 – Refund Option

    Image 2 – Refund

    Image 3 – Modifiers

    Image 4 – Set Paid Through

    Image 5 – Finalize Invoice option

    Image 6 – Finalized Invoices Config

    Image 7 – Finalized Invoices Maintenance

    Image 8 – Publish to Gateway Process Automation Option

    Image 9 – Delete Distribution Check

    Image 10 – Security Area Update

    Image 11 – Age Range for Volume Type

VBAGateway July 2016 Release Notes

MEMBER TERMINAL

  • New Request: The ability to submit Flex Receipts has been added. Members can now fill out a Flex Receipt submission form, and upload the receipt as an attachment (Image 6)
  • Fixed a bug that occurred in Internet Explorer 11 that caused Password Reset from the Member Information Card to freeze. The password reset now functions correctly.

PROVIDER TERMINAL

  • No changes

EMPLOYER TERMINAL

  • The full power of the HTML Editor in the Open Enrollment Config Screen has been unleashed! Power up your Open Enrollment Welcome Screen with font sizes, colors, and font styles. Also includes tables, HTML view, printing, and more! (Image 1)
  • Plan Type has been added to the Enrollment History POD on the Census Screen.
  • The Manage Announcements POD has been updated with wider columns in the grid.
  • The option to remove uploaded Documents from the Plan Document Uploads POD has been added. This allows the user to delete previously uploaded plan documents (Image 2)
  • The option to delete Open Enrollment links has been added to the Links POD on the Open Enrollment Configuration Screen (Image 3)
  • The option to delete uploaded documents has been added to the Open Enrollment Documents POD (Image 4)
  • The “Hyperlink” field in the Links POD on the Open Enrollment Configuration screen now displays as a link that will now bring up the linked site. Great for testing how your links will show up in the Open Enrollment Terminal (Image 3)
  • The Trigger Diagnosis POD now uses a pager and is limited to 5 records per page.
  • The Census Screen Employee Lookup POD can now be exported to Excel (Image 5)
  • Loading indicators (spinning icons) have been added to the PODs on the Config Screen to show when data is still being loaded.
  • The Add Coverage step of the Add Employee Wizard will now display a message when there are no plans available.

OPEN ENROLLMENT

  • An issue has been fixed where the “Choose a Different Plan” button on the Add Coverage step of the Open Enrollment Wizard was not displaying additional plans for selection. All plans for a plan type will now show when clicking this button.
  • Fixed an issue on the Add Coverage step of the Open Enrollment Wizard where Plan IDs with nonalpha-numerical characters would cause plans other than the Selected Plan to be visible.
  • Fixed an issue where the “View Plan Summary” button would not display the uploaded plan document.
  • Fixed an issue where the “Finish Later” button on the Open Enrollment Wizard would not refresh the Open Enrollment Home Page.
  • The Add Coverage step of the Open Enrollment Wizard will now display a message when there are no plans available.

VBAGateway Global (All Terminals)

  • The ability to hide top level menu items has been added for all Terminals. If you need assistance configuring your menus, please contact the Help Desk.
  • All file upload modals have had their “Cancel” buttons modified to reflect the current status of the upload. If a file has not been uploaded yet, the button will say “Cancel”. If a file has been uploaded, the button will say “OK”.
  • A bug has been fixed where the Activation Screen would sometimes not appear when clicking the activation email link (instead the login screen would appear). The Activation Screen will now always appear when clicking the link.

Image 1 – Open Enrollment Welcome Screen HTML Editor

Image 2 – Upload Plan Documents Delete Button

Image 3 – Open Enrollment Links Delete Button

Image 4 – Open Enrollment Documents Delete Button

Image 5 – Census Employee Lookup – Export to Excel

Image 6 – Member Submit Flex Receipt

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