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Gartner Research Note: How U.S. Healthcare Payers Can Optimize Costs by Choosing the Best Core Administration Vendors

Get your Gartner Research Note – How U.S. Healthcare Payers Can Optimize Costs by Choosing the Best Core Administration Vendors today: click here to download your guide.

Inside your How U.S. Healthcare Payers Can Optimize Costs by Choosing the Best Core Administration Vendors you will find market information regarding Core Administration Vendors. This guide will help your team as you decide on a benefits administration system.

Disclaimer for Report:
Gartner. How U.S. Healthcare Payers Can Optimize Costs by Choosing the Best Core Administration Vendors, Bryan Cole, 6 October 2017
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. GARTNER is a registered trademark and service mark of Gartner, Inc. and/or its affiliates in the U.S. and internationally, and is used herein with permission. All rights reserved.

Virtual Benefits Administrator and Context4 Healthcare, Inc. Announce Real-Time Medicare Pricing Automation Capability

Real-time pricing during claim adjudication allows payors to become more powerful in the Real-time Health System

NAPERVILLE, IL, (September 18, 2017) – Virtual Benefits Administrator and Context4 Healthcare, Inc. are pleased to announce the release of real-time Medicare + UCR pricing. This latest addition expands VBA’s process automation in Real-Time Claims Payment (RTCP).

Available to VBA clients today, this solution provides real-time Medicare prospective payment system (PPS) pricing during claims processing. Direct PPS pricing ensures compliance with the Centers for Medicare and Medicaid Services (CMS). It eliminates complexity and the need to utilize less accurate substitutes like RBRVS.

The real-time Medicare pricing feature eliminates wasteful, manual processes that drive cost and human error. Automated NPI to CCN reconciliation significantly simplifies institutional pricing. Built in PPS intelligence automatically chooses which of the 16 PPS best fits each and every line in a claim without human intervention.

The Medicare solution also integrates Context4 Healthcare’s industry-leading Usual, Customary & Reasonable (UCR) fee data. This ensures VBA clients have Medicare gap fill pricing for the ~800 procedures not priced by CMS. This comprehensive solution is one of a kind in the health payer industry.

David Lung, VP at Context4 Healthcare, stated: “VBA is known for innovation in employee benefit administration. Medicare pricing is complex and time consuming. Context is proud to be a part of this advancement in automation and payer value.”

Tom Witter, President of Virtual Benefits Administrator, stated: “VBA is deeply committed to process automation that drives ROI. Real-time Medicare pricing expands our relationship beyond advanced claims editing with Context. It illustrates our agility in integrating best of breed features to maximize value for our customers.”

About VBA. Headquartered in Germantown, WI, VBA has over 20 years of experience in software development for health benefits administration. Our mission of providing Flexibility, Functionality, and Technology for our clients’ business solutions ensures they will optimize their daily business processes and deliver the highest level of customer satisfaction. www.vbasoftware.com. For more information, call (414) 946-1210.

About Context4 Healthcare, Inc. Headquartered in Naperville, IL, Context4 Healthcare has nearly 30 years of experience in software and data product development. Context is a leading provider of cloud based healthcare compliance and payment integrity solutions. These solutions serve hundreds of payer and provider clients, positively impacting millions of lives globally. www.context4.com.

VBA Software July 2017 Release Notes

ACCOUNTING SERVICES

  • Added a verification “Are you sure” message when using Undo from within Funding Requests.

AUTH SERVICES

  • Added the Auth Claims screen to the Auth update screen. This screen opens from the new Claims button on the toolbar. This screen displays claims linked to the Auth and allows navigation to those claims (Image 3).
  • Added Received Date and Urgent checkbox to Auth update screen (Image 3).

BENEFIT SERVICES

  • Added new Benefit Levels of Billing Taxonomy, Rendering Taxonomy, and Service Facility Taxonomy (Image 5).

BILLING SERVICES

  • Added Rate Category to the Rate Payee pop up screen on a Premium Rate. This column is used for informational purposes only (Image 2).

CLAIM SERVICES

  • Added the PPO Discount column to the Claim Details section of Processed Claims and Claims in Batch (Image 6).
  • Disability Claims will now properly carry over deductions when copying a claim.

ENROLLMENT SERVICES

  • When utilizing the Add Subscriber Wizard, the system will now propagate the Email Address entered during creation to the appropriate Member Address record. This will save manual data entry time for all users.

GROUP SERVICES

  • Added the ACH Account column to the Additional/COBRA Settings detail screen (Image 7).

PROCESS AUTOMATION

  • Added a new tag for use during the “Paid Claim” trigger:
    • ReportArg_ClaimNumber – this tag can be used for reports selected on a Report Series that are based on Claim_Number.

REPORT SERVICES

  • The criteria screen for the Historical Census by Group, under Enrollment Reports, has been modified to allow the input of multiple Plan Types (Image 1).
  • Added the ability to run the Enrollment Address Listing by Group, Coverage Type, and As of Date (Image 4).
  • Changed report names to reflect the type of claims on the report.
    • Claim Incurred/Paid per Tier by Group renamed to Medical Claim Incurred/Paid per Tier by Group
    • Claim Paid per Benefit by Group renamed to Medical Claim Paid per Benefit by Group
    • Claims Paid per Plan Type by Group renamed to Medical Claims Paid per Plan Type by Group
    • Claims Paid per Plan Type by Group with Vision/Flex renamed to Medical Claims Paid per Plan Type by Group with Vision/Flex
    • Claim Paid per Relationship and Gender by Group renamed to Medical Claim Paid per Relationship and Gender by Group
    • Claim Paid per Tier All Groups renamed to Medical Claim Paid per Tier All Groups
    • Claim Paid per Tier by Group renamed to Medical Claim Paid per Tier by Group
    • Claim Paid per Tier per Month All Groups renamed to Medical Claim Paid per Tier per Month All Groups
    • Claim Paid per Tier per Month by Group renamed to Medical Claim Paid per Tier per Month by Group
    • User Activity Report. This new report will display each user’s login time during the user specified dates as well as which actions the user has taken and how many times they’ve done the action. (Image 8).
    • Credit Report. This new report under Claim Audit Reports will show claim completed by user and group. (Image 9).

SYSTEM SERVICES

  • Reorganized the Application Settings on the VBA Control Panel to more accurately reflect the areas affected by various settings (Image 10). This should improve the overall understanding and impact of configuration options.
  • Added a new option to the VBA Control Panel: “Allow OOP Max on Override”. This new option will allow the user to override Deductible, Co-Insurance and/or Co-Pay on a claim while still enforcing the OOP limits defined by the plan. By default, if any of these fields are overridden, the OOP limit is ignored.

Image 1 – Added the ability to select multiple Plan Types.

Image 2 -Added Rate Category to Rate Payee.

Image 3 – Added Urgent, Received Date, and Auth Claims screen

Image 4 – New options to for Enrollment Address Listing.

Image 5 – Added new Benefit Levels

Image 6 – Added PPO Discount to Claim Detail

Image 7 – Added ACH Account

Image 8 – User Activity Report

Image 9 – Credit Report

Image 10 – VBA Control Panel

VBAGateway July 2017 Release Notes

MEMBER TERMINAL

  • New Screen – Message Center: The Messaging, Requests and Announcements PODs have been moved to a new Message Center Screen. The Screen can be found by clicking the “Message Center” link in the side menu (Image 1)
  • New POD – Contact Information: A new Contact Information POD has been added to the top menu (Image 8). This POD lists the administrator contact information. This contact information is saved in the Gateway config settings. Please contact the Help Desk with any configuration questions.
  • A new Config setting has been added that will hide the EOB link on the Claims Grid prior to the Claim being in “Paid” status. If this setting is off (which is default), the EOB link will always appear, regardless of the status.

PROVIDER TERMINAL

  • New Screen – Message Center: The Messaging, Requests and Announcements PODs have been moved to a new Message Center Screen. The Screen can be found by clicking the “Message Center” link in the side menu (Image 1)
  • New POD – Contact Information: A new Contact Information POD has been added to the top menu (Image 8). This POD lists the administrator contact information. This contact information is saved in the Gateway config settings. Please contact the Help Desk with any configuration questions.
  • A new Config setting has been added that will hide the EOB link on the Claims Grid prior to the Claim being in “Paid” status. If this setting is off (which is default), the EOB link will always appear, regardless of the status.

EMPLOYER TERMINAL

  • New Screen – Message Center: The Messaging, Requests and Announcements PODs have been moved to a new Message Center Screen. The Screen can be found by clicking the “Message Center” link in the side menu (Image 1)
  • New POD – Contact Information: A new Contact Information POD has been added to the top menu (Image 8). This POD lists the administrator contact information. This contact information is saved in the Gateway config settings. Please contact the Help Desk with any configuration questions.
  • A new Config setting has been added that will hide the EOB link on the Claims Grid prior to the Claim being in “Paid” status. If this setting is off (which is default), the EOB link will always appear, regardless of the status.
  • The Open Enrollment/Add Employee Wizard has been updated (these updates apply to the Open Enrollment Terminal and the Employer Terminal) (Images 2-7):
    • Fixed an issue on the Open Enrollment Wizard – Step 3: Add Coverage where Life Volume would be checked for, even when the Life Volume option was not enabled for a Plan, preventing a Plan from being selected.
    • Fixed an issue where selecting the “Back” button on Step 2 of the Open Enrollment Wizard would not load the Pay Rate field on Step 1. The Pay Rate field will now always load properly.
    • Fixed an issue where going back and forth between Step 1 and Step 2 of the Open Enrollment Wizard would sometimes cause the Dependents list on Step 2 not to load.
    • Updated the helper text on the Provider Lookup modal to match the modal’s function.
    • Updated the helper text (‘Click “Select this Plan” to choose this plan’) so that it will update with better instructions depending on the current status of the user’s plan selection.
    • Updated the Life and Flex plan types on the Open Enrollment Wizard to display the min and max for volume. Additionally, if amounts are entered that are greater than the max or less than the min allowed values, the textboxes will update to show the max or the min as appropriate.
    • Life Volume labels have been updated to remove cents and an “Enter volume” label has been added.
    • Minor cosmetic changes have been made to the “Apply” and “Select this Plan” labels
    • The Life Volume Edit pencil icon has been moved to the right side of the Volume. Clicking this icon allows the user to edit their Volume entry.
    • An issue has been fixed on Life Plans with Volume disabled: After clicking Select, then clicking “I don’t want this plan” the label would fail to switch back to “Select this Plan”. The label now displays properly for these plans.
    • The Flex Election entry box has been moved below the information labels to match the location of similar fields on other plan types.
    • Flex Election can now be edited using the pencil icon, which functions identically to the Life Volume edit.
    • When there is no Life Volume or Flex Election entry on a Life or Flex plan, there is now an empty space between the “You have selected this plan” label and the option buttons so that the plan boxes will line up properly. This results in all plan boxes being the same height at all times, which prevents display issues.
    • Dollar signs have been added to the dropdown list for Life Volume, and the values are now right aligned.
    • The “View Plan Summary” button has been moved to the plan box header, and will now display as a PDF icon for plans with a plan summary document uploaded.
    • Some borders in the plan boxes have been updated to fix a graphical issue. All borders have been gerrymandered and will now display correctly!
    • The Back button on the Add Coverage Screen will now walk back through the plan types instead of going directly to Step 2. Users will only be taken back to Step 2 when pressing Back from the first plan type listed.
    • Step 5: Confirm will now refresh its data every time the screen is browsed to.
    • An issue was fixed where the Dependents grid on Step 2: Add Dependents was occasionally not loading the dependents when you returned to the screen from Step 3: Add Coverage.
    • The dependents added to each plan on Step 3: Add Coverage are now listed on Step 5: Confirm
  • Fixed an issue where the Division Dropdown on the Employer Terminal Subscriber Lookup modal was returning the Group and Division instead of only the Division. This was preventing Subscriber lookup by Division.
  • The Enrollment History grid on the Census Screen is now sortable by clicking on grid header fields.
  • The “Plan Name” field on the Plans POD of the Open Enrollment Configuration Wizard now wraps its text and will show the full Plan Name instead of cutting off.

OPEN ENROLLMENT TERMINAL

  • New Screen – Message Center: The Messaging, Requests and Announcements PODs have been moved to a new Message Center Screen. The Screen can be found by clicking the “Message Center” link in the side menu (Image 1)
  • New POD – Contact Information: A new Contact Information POD has been added to the top menu (Image 8). This POD lists the administrator contact information. This contact information is saved in the Gateway config settings. Please contact the Help Desk with any configuration questions.
  • A new Config setting has been added that will hide the EOB link on the Claims Grid prior to the Claim being in “Paid” status. If this setting is off (which is default), the EOB link will always appear, regardless of the status.
  • The Open Enrollment/Add Employee Wizard has been updated (these updates apply to the Open Enrollment Terminal and the Employer Terminal) (Images 2-7):
    • Fixed an issue on the Open Enrollment Wizard – Step 3: Add Coverage where Life Volume would be checked for, even when the Life Volume option was not enabled for a Plan, preventing a Plan from being selected.
    • Fixed an issue where selecting the “Back” button on Step 2 of the Open Enrollment Wizard would not load the Pay Rate field on Step 1. The Pay Rate field will now always load properly.
    • Fixed an issue where going back and forth between Step 1 and Step 2 of the Open Enrollment Wizard would sometimes cause the Dependents list on Step 2 not to load.
    • Updated the helper text on the Provider Lookup modal to match the modal’s function.
    • Updated the helper text (‘Click “Select this Plan” to choose this plan’) so that it will update with better instructions depending on the current status of the user’s plan selection.
    • Updated the Life and Flex plan types on the Open Enrollment Wizard to display the min and max for volume. Additionally, if amounts are entered that are greater than the max or less than the min allowed values, the textboxes will update to show the max or the min as appropriate.
    • Life Volume labels have been updated to remove cents and an “Enter volume” label has been added.
    • Minor cosmetic changes have been made to the “Apply” and “Select this Plan” labels
    • The Life Volume Edit pencil icon has been moved to the right side of the Volume. Clicking this icon allows the user to edit their Volume entry.
    • An issue has been fixed on Life Plans with Volume disabled: After clicking Select, then clicking “I don’t want this plan” the label would fail to switch back to “Select this Plan”. The label now displays properly for these plans.
    • The Flex Election entry box has been moved below the information labels to match the location of similar fields on other plan types.
    • Flex Election can now be edited using the pencil icon, which functions identically to the Life Volume edit.
    • When there is no Life Volume or Flex Election entry on a Life or Flex plan, there is now an empty space between the “You have selected this plan” label and the option buttons so that the plan boxes will line up properly. This results in all plan boxes being the same height at all times, which prevents display issues.
    • Dollar signs have been added to the dropdown list for Life Volume, and the values are now right aligned.
    • The “View Plan Summary” button has been moved to the plan box header, and will now display as a PDF icon for plans with a plan summary document uploaded.
    • Some borders in the plan boxes have been updated to fix a graphical issue. All borders have been gerrymandered and will now display correctly!
    • The Back button on the Add Coverage Screen will now walk back through the plan types instead of going directly to Step 2. Users will only be taken back to Step 2 when pressing Back from the first plan type listed.
    • Step 5: Confirm will now refresh its data every time the screen is browsed to.
    • An issue was fixed where the Dependents grid on Step 2: Add Dependents was occasionally not loading the dependents when you returned to the screen from Step 3: Add Coverage.
    • The dependents added to each plan on Step 3: Add Coverage are now listed on Step 5: Confirm

VBAGateway Global (All Terminals)

  • Fixed an issue where no notification was sent to the user when Registration failed on certain errors. Notifications will now be sent for all Registration messages.

Image 1 – Message Center menu item

Image 2 – Open Enrollment Wizard – Step 1: Employee Information

Image 3 – Open Enrollment Wizard – Step 2: Add Dependents

Image 4 – Open Enrollment Wizard – Step 3: Add Coverage (Life & Disability)

Image 5 – Open Enrollment Wizard – Step 3: Add Coverage (Flex)

Image 6 – Open Enrollment Wizard – Step 4: Other Insurance

Image 7 – Open Enrollment Wizard – Step 5: Confirm

Image 8 – Contact Us POD

VBA Software May 2017 Release Notes

BILLING SERVICES

  • Added Group ID column to the results of the Finalized Invoices configuration item (Image 1).
  • Added Finalized column to the Invoice Search screen (Image 2).

CARE MANAGEMENT SERVICES

  • Fixed an issue where questions would not properly sort after being moved up or down in the list.
  • Fixed an issue where Custom Case Values were not being transported over when a new Case was built from an existing Care Plan. These custom values will now properly display for edit on the Case when available.

CLAIM SERVICES

  • Added the ability to add a note to all adjusted claims when using the Claim Adjustment Wizard (Image 3) (Image 4).
  • Ex Codes added during the Life Claim creator will now properly move to batch.

ENROLLMENT SERVICES

  • Improved functionality of the COBRA Premium Rate Selection screen of the Enrollment Disenroll Wizard (Image 5).
    • Added the Rate Category column.
    • Added the Sort and Filter options.
  • Added the 1st of Month After X Months option to the Waiting Period Type list box on the Enrollment Waiting Period Details screen (Image 6). This option will allow the Enrollment Wizard to determine the date of enrollment as the 1st of the month after the entered number of months.
  • Added the option to define custom Member Plan Years in the Member Detail section of the Enrollment Update screen (Image 7). Selecting Custom in the Member Plan Year list box will display a button that will open the
  • In the Enrollment Management window, the data is now sorted by Date, Plan ID with the latest Plan/Rider at the top of the list (Image 9).
  • In the Add Enrollment Wizard there are new entry options for E-mail, Suffix and Middle Initial (Image 10) (Image 11).
  • When adding an Enrollment Plan the application will now prevent the entry of a Start Date prior to the Members Date Enrolled or the Members Birth Date.
  • When prompted with Retro-Adjustments you can now apply the Adjustment Reason set on the first Adjustment to all Adjustments. Click the “Set Reason” button after you enter the Adjustment Reason on the first record and that Reason will be applied across all Retro-Adjustments being entered (Image 12).

NOTE SERVICES

  • Added the ability to drag-and-drop files from Windows Explorer into the Note Attachment section of the Note Update screen.

PROVIDER SERVICES

  • Added Payee NPI column to the Provider Search screen (Image 8).

Image 1 – Added Group ID

Image 2 – Added Finalized to Invoice Search

Image 3 – Add Note option

Image 4 – Add Note screen

Image 5 – Added Rate category column and the Sort and Filter options.

Image 6 – Added the 1st of Month After X Months option.

Image 7 – Member Pan Year

Image 8 – Added Payee NPI

Image 9 – Enrollment Management sort

Image 10 & 11 – Add Enrollment Wizard Suffix, E-Mail and Middle Initial

Image 10 & 11 – Add Enrollment Wizard Suffix, E-Mail and Middle Initial

Image 12 – Set Adjustment Reason on All Adjustments

VBAGateway May 2017 Release Notes

MEMBER TERMINAL

  • No changes

PROVIDER TERMINAL

  • No changes

EMPLOYER TERMINAL

  • The Review Open Enrollment Submissions Screen has been updated (Image 5)
    • The Review Open Enrollment Submissions Screen now matches the Open Enrollment Confirmation page in appearance and displayed data (see Open Enrollment Terminal below)
    • Occupation, Pay Rate, and Pay Frequency fields have been added
    • The Selected Coverage section has been revamped to display Coverage grouped by Plan Type
    • Each section of the Review Screen now links to an editable version of the Open Enrollment Wizard – clicking the Edit button (pencil icon) will take the user directly to the step associated with that section. For example, clicking Edit on “Selected Coverage” will take the user directly to Step 3 – Add Coverage of the Open Enrollment Wizard
  • New Screen: Advice to Pay (Voucher Claims)
    • A new Advice to Pay Claims option has been added to the Claims menu. Clicking “Voucher Claims” will take the user to the Vouchers Screen (Image 4). This POD can be relabeled if necessary to reflect AtP claims.
    • To view Claims on the Advice to Pay (Vouchers) Screen, select the search button (magnifying glass icon) at the top right of the screen. Enter search criteria to return a set of Voucher Claims
    • Single EOBs can be viewed per Claim by clicking on the Claim ID link
    • Advice to Pay (Voucher) EOBs can also be exported as a batch – click the report export button (page icon) on the bottom left of the Advice to Pay (Vouchers) POD to generate a multi-EOB report for all EOBs that were returned by the search
    • Export to Excel is enabled on this Screen – click the Excel icon on the bottom left of the Advice to Pay (Vouchers) POD

OPEN ENROLLMENT

  • The Open Enrollment Confirmation Screen has been updated (Images 1 and 2)
    • The Review Open Enrollment Submissions Screen has been updated to better display the added data in an easier to read format
    • Occupation, Pay Rate, and Pay Frequency fields have been added
    • The Selected Coverage section has been revamped to display Coverage grouped by Plan Type

VBAGateway Global (All Terminals)

  • The Terminal dropdown list on the Register Screen now reads “Open Enrollment/New Hire” instead of “Open Enrollment” for the Open Enrollment Terminal option (Image 3)

Image 1 – Open Enrollment Confirmation

Image 2 – Open Enrollment Confirmation

Image 3 – Registration Terminal Text

Image 4 – Voucher/Advice to Pay Claims

Image 5 – Employer Terminal Enrollment Confirmation

VBAGateway April 2017 Release Notes

MEMBER TERMINAL

  • The Member Accumulator POD has been redesigned and updated to include more information and is now easier to read! (Image 1)

PROVIDER TERMINAL

  • No changes

EMPLOYER TERMINAL

  • Clicking on an Add Employee Request in the Requests POD will now take you to the Add Employee Wizard where you can edit the Request.
  • The missing icon for New Open Enrollment Requests has been located and returned to the Requests POD.
  • A “Finish” button has been added to the final step of the Enrollment Configuration Wizard (Config>Enrollment) so that finalizing enrollment settings is more intuitive.
  • Fixed an issue that caused the “Create a Member Request” dropdown on ET Census to be hidden. The dropdown will now display correctly.
  • The Add Employee Wizard has been updated!
    • Add Employee Wizard>Employee Information (Step 1): Marital Status is now required and cannot be left blank.
    • Add Employee Wizard>Employee Information (Step 1): The Email, Work Phone, and Home Phone fields are no longer required.
    • Add Employee Wizard>Add Dependents (Step 2): Gender and Relationship are now required and cannot be left unselected.
    • Add Employee Wizard>Add Coverage (Step 3): The “Waive Medical Coverage” button on Step 3 (Add Coverage) of the Add Employee Wizard can now be hidden based on configuration settings. Please contact Help Desk if you wish to configure this setting.
    • Add Employee Wizard>Confirmation (Step 5): Occupation, Pay Rate, and Pay Rate Frequency have been added to the Review Information Screen (Image 2)
    • Add Employee Wizard>Confirmation (Step 5): The Selected Coverage POD now displays the selected Tier’s description, instead of the single character Tier code.
    • Add Employee Wizard>Confirmation (Step 5): The Dependents POD now displays the full Relationship description, instead of the single character Relationship code.
    • Add Employee Wizard>Confirmation (Step 5): The Other Insurance POD now displays the full Member Name, instead of only the Member Sequence.
    • Add Employee Wizard>Confirmation (Step 5): The Other Insurance POD now displays the full Plan Type description, instead of the Plan Type code.
  • The document names in the My Docs and My Member Docs PODS (Config>Settings) are now hyperlinked to the uploaded document. Users can click these links to review the uploaded documents (Image 3)

OPEN ENROLLMENT

  • The Open Enrollment Wizard has been updated!
    • Open Enrollment Wizard>Employee Information (Step 1): Marital Status is now required and cannot be left blank.
    • Open Enrollment Wizard>Employee Information (Step 1): The Email, Work Phone, and Home Phone fields are no longer required.
    • Open Enrollment Wizard>Add Dependents (Step 2): Gender and Relationship are now required and cannot be left unselected.
    • Open Enrollment Wizard>Add Coverage (Step 3): The “Waive Medical Coverage” button on Step 3 (Add Coverage) of the Open Enrollment Wizard can now be hidden based on configuration settings. Please contact Help Desk if you wish to configure this setting.
    • Open Enrollment Wizard>Confirmation (Step 5): Occupation, Pay Rate, and Pay Rate Frequency have been added to the Review Information Screen.
    • Open Enrollment Wizard>Confirmation (Step 5): The Selected Coverage POD now displays the selected Tier’s description, instead of the single character Tier code.
    • Open Enrollment Wizard>Confirmation (Step 5): The Dependents POD now displays the full Relationship description, instead of the single character Relationship code.
    • Open Enrollment Wizard>Confirmation (Step 5): The Other Insurance POD now displays the full Member Name, instead of only the Member Sequence.
    • Open Enrollment Wizard>Confirmation (Step 5): The Other Insurance POD now displays the full Plan Type description, instead of the Plan Type code.

VBAGATEWAY GLOBAL (ALL TERMINALS)

  • No changes

Image 1 – Member Accumulators

Image 2 – Add Employee Review: Occupation and Pay information

Image 3 – My Docs Hyperlink

VBA Software April 2017 Release Notes

CLAIM SERVICES

  • Copy Disability Claims will now queue all claims that are created so that using the navigation buttons will cycle through the new claims (Image 1).
  • Flex claims that are automatically created by the system will now link to the medical claim in the Referenced Claims screen.
  • Display the Pricing Method on Processed Claims. This data will be shown on the More Information screen (Image 4).
  • Hovering over the COB field on processed claims will now show the COB detail information including the Other Insurance Paid, Other Insurance Member Responsibility, COB Savings applied and COB Savings used (Image 5).
  • Claim Audits can now be scheduled using a defined Event. When entering your Claim Audit and defining your criteria and sample size, you will have to option to select a “Claim Audit Event” that will be used to fire this Audit on the defined schedule (Image 8).

ENROLLMENT SERVICES

  • Disenroll and Reenroll buttons are now disabled for users with View Access.

EVENT SERVICES

  • Searching Events can now be searched by the indicator defining that Event as a “Process Automation Event” or a “Claim Audit Event” (Image 6).
  • Events can now be defined as a “Claim Audit Event”. A “Claim Audit Event” is used when defining a Claim Audit that needs to be run on a schedule (Image 7).

REPORT SERVICES

  • New report, Census Summary Med/Den by Tier under Enrollment, that counts the member/dependents based on the Tier assignment or the Member Enrollment records (Image 3).

SECURITY SERVICES

  • The Report List and Applied Report sections of the Security Area Maintenance screen are now sorted alphabetically (Image 2).

Image 1 – Copies will now queue for navigation

Image 2 – Report List sort

Image 3 – Census Summary Med/Den by Tier

Image 4 – Display Pricing Method on Processed Claims

Image 5 – COB Details on Processed Claims

Image 6 – Search Events by Process Automation or Claim Audit

Image 7 – Claim Audit Event

Image 8 – Automated Audit options

VBAGateway March 2017 Release Notes

MEMBER TERMINAL

  • Member Accumulators will now show additional years even if there is no Claim data associated with that year.

PROVIDER TERMINAL

  • No changes

EMPLOYER TERMINAL

  • Enrollment Periods can now be marked as “New Hire Only.” Enrollment Periods that are marked as “New Hire Only” will only be available for Registration. These Periods will not prompt Members that they are in an Open Enrollment Period. To set a Period as “New Hire Only,” use the Enrollment Settings Screen (Config>Enrollment) (Image 1).
  • Plan Options have been expanded (Config>Plan Settings) (Image 2).
    • Allow Flex Election Entry
      1. Flex Election Minimum
      2. Flex Election Maximum
    • Allow Life Volume Entry
      1. Life Volume Minimum
      2. Life Volume Maximum
      3. Life Volume Increment
        • The increment by which Life Volume increments in Open Enrollment.
  • Plan Description Override
    1. Text in this field will be used in Gateway instead of the traditional Plan Name. To use the traditional Plan Name, leave this field blank.
  • Hide on Employer Terminal
    1. Check this box to hide this Plan in Plan lists on the Employer Terminal. An example is the Census Employee Information POD.
  • Hide on Member Terminal
    1. Check this box to hide this Plan in Plan lists on the Member Terminal. An example is the Employee Information POD, and the Member Information Card.
  • Changed the “Paid” column header to “Payable” on the Employer Home Screen>Top 5 Benefit Category Utilization + Remaining POD to better describe the data in that column.

OPEN ENROLLMENT

  • No changes

VBAGATEWAY GLOBAL (ALL TERMINALS)

  • No changes

Image 1 – New Hire Only Option

Image 2 – Expanded Plan Options

VBA Included in 2017 Gartner Market Guide for Healthcare Payers Core Administrative Processing Systems

Get your 2017 Gartner Market Guide for Healthcare Payers Core Administrative Processing Systems today: click here to download your guide.

Inside your 2017 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 benefits administration system.

Disclaimer for Report:
Gartner, Inc., Market Guide for Healthcare Payers’ Core Administrative Processing Systems, Constance Sjoquist, 10 March 2017.
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.

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