- Added the ability to make a benefit apply only if the member is assigned to a PCP on the claim being adjudicated (Image 4). You can define the explanation code for this rule in the VBA Control Panel.
- Added the ability to define Benefit Maximums to the Member or Family level (Image 1). All defined Benefit Maximums to this point were member level and this change allows that to be optional to the family. This change does not impact any regular Plan or Benefit Limit definitions such as Deductible, Co-Ins or OOP which were already Member/Family specific.
- Added the ability to define a rate as “Auto-Adjust” (Image 5). This setting will allow a rate to be calculated during the normal invoice generation process and then automatically adjust that premium with a negative adjustment. This zeroes out the rate while maintaining financial integrity.
- Flex claims will now auto-split. As contributions are added, claims will be created for flex services with outstanding amounts, up to the new amount available.
- Added the Group table to Member Search -> Advanced Search (Image 2).
- Added the ability to assign federal IDs to capitation service requirements (Image 3).
- Fixed an issue where selecting a Gateway User during the “Send to Gateway” process would send to the wrong user if multiple users were registered against the same Group ID. The registered User Name will now display in the drop down list and prevent invalid selection.
Image 1 – Member Family option.
Image 2 – Group table option Advanced Member Search
Image 3 – Capitation option, add Federal IDs
Image 4 – Plan Benefits, PCP Only
Image 5 – Auto-Adjust Rates
- Claim grids now have a link to the default Gateway Provider EOB. Contact Support if you would like to have a custom EOB created.
- Users of the Add Employee Wizard can now waive coverage by Plan Type. See the Open Enrollment section for more information.
- PODs and Screens can now be hidden based on the logged in user’s Group. The ability to globally hide PODs and Screens also remains.
- Custom Links can now be added for Members. The Network Links capability remains unchanged.
- Custom Documents can now be added for Members. The Summary Plan Document capability remains unchanged.
- Users can now waive coverage by Plan Type. On the Add Coverage step (Step 3) of the Open Enrollment Wizard, a button has been added to initiate waiving coverage for the selected Plan Type (Image 1)
- Clicking the “Waive [Plan Type] Coverage” button will bring up a modal to fill out information regarding waiving coverage. To waive coverage for the selected Plan Type, fill out and submit this form (Image 2). Once successfully waived, users will see a message confirming that the coverage has been waived for the Plan Type
- To unwaive coverage for the selected Plan Type, click the “Unwaive [Plan Type] Coverage” button (Image 3). This will immediately unwaive coverage, and allow the user to once again select Plans.
- Medical, Dental, and Vision Coverage Selection (step 3 of the Open Enrollment Wizard) now allows selection of which family members are covered. In addition, a PCP can be assigned to the selected family member.
- Life Coverage Selection (step 3 of the Open Enrollment Wizard) now allows selection of beneficiaries, including allocation percentage.
- Disability Coverage Selection (step 3 of the Open Enrollment Wizard) now allows for entry of STD Weekly Benefit, or LTD Monthly Benefit.
- Flex Coverage Selection (step 3 of the Open Enrollment Wizard) now allows for entry of Member’s election.
- A summary page has been added to the Open Enrollment Wizard so that users can verify that their data is correct before submitting their Open Enrollment record.
VBAGATEWAY GLOBAL (ALL TERMINALS)
- Integration with Redcard for ID Cards, in addition to EOBs, is now complete! Please contact Support to configure this integration. This integration is available for Member Terminal and Employer Terminal.
Image 1 – Waive Coverage by Plan Type
Image 2 – Waive Coverage Form
Image 3 – Unwaive Coverage Button
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