- Added the ability to define a Benefit Level of “Exact Modifier”. This new Benefit Level will look
for precisely the Modifiers entered with no wildcard entries or additional modifiers on the claim
- Under Benefit Ex Codes within Diagnosis Ex Codes and Procedure Ex Codes, added the ability to
have a range of diagnosis codes and a range of procedure codes instead of having to list them
separately (Image 5).
- Fixed a visual issue on the Premium Rates screen where a grey box would float over information
on certain resolutions.
- Added a new Age Type for Premium Rate definitions of “As of 1st of Month”. This new Age Type
will calculate the age of the Subscriber as of the 1st of the Month selected in the “Month” field that appears when this Age Type is selected (Image 9).
- Added the ability to assign a custom “Expense Type” to a distribution record. This is an
information field used for custom reports (Image 11).
- Added “Expense Type” configuration to Billing Services (Image 10).
- Added Rate Copy Wizard. You can choose to change or keep the existing values for Plan, Rate
Category, Rate Basis, Group, and Division. Saves time when building rates for groups that offer
the same benefits. More efficient way of building age rated rates and allows for a faster
turnaround time during renewal periods (Image 6).
- Added an option to transfer funds at a global level and independent of a receipt. This process
will still create a negative amount on the source account and a positive amount in the destination
account but is not be bound to an original receipt. This new process creates additional flexibility
to the funds transfer process (Image 12).
- Added an edit to “Network Maintenance” to prevent the Network ID from being modified after
being saved. This creates consistency across other maintenance areas to prevent key values from
- Added the ability to track aggregate tier factors by plan. Plan ID is now included in the Contract Factors section of Reinsurance Contracts. Existing Contract Factors will have an empty Plan ID and process as normal (Image 7).
- Added ability to edit and delete notes based on User Security. Created a new window to setup
what Note Types the user is able to Edit, user can either update their own notes or all notes based
on Note Type. When Note Type is blank, the user can update all notes at the access selected
(Image 1) (Image 2) (Image 3) (Image 4).
- Created an adjudication rule for COB based on the primary/secondary flag of other insurance in the member record. The combination of Claim Type and Plan Type on the claim being
adjudicated, against the Plan Type defined on the Member Insurance record will drive a userdefined
explanation code. This rule is optional and requires some custom setup by VBA. If you
are interested in adding this edit to your processing, please contact the help desk.
Image 1 – Note Access window on User Update
Image 2 – Note Access configuration option under User Configuration
Image 3 – Note Access configuration window under User Configuration
Image 4 – New Update and Delete actions in Note Review and Maintenance
Image 5 – New Thru option for Diagnostic and Procedure Codes
Image 6 – Rate Copy Options
Image 7 – Added Plan ID to Contract Factors
Image 8 – Benefit Level: Exact Modifier
Image 9 – Age Type: As of 1st of Month
Image 10 – Expense Type Configuration
Image 11 – Expense Type Entry on Distribution
Image 12 – Transfer Funds (Global)
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