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VBA New Client Update – Employee Benefit Systems

I am proud to announce that Employee Benefit Systems (EBS), which was established as a Third Party Administrator (TPA) in 1984 in Burlington Iowa, is now a member of the Virtual Benefits Administrator (VBA) family of clients.


Employee Benefit Systems (EBS), established as a Third Party Administrator (TPA) in 1984, prides itself on providing a full range of high-value insurance and administrative services to meet our customer’s needs.  EBS creates customized plans for your organization allowing for affordable benefits to your employees while controlling your costs and keeping your benefits running smoothly.

EBS has the capability to tap into the expertise and resources of our affiliated entities as needed to provide our customers with superior services at maximum value. EBS is a flexible, low-cost, high integrity, responsive firm eager to build a relationship with your organization while Helping Administer Your Success!

Because of the VBA Application’s features like process automation, hyperlink navigation, and offline auto-adjudication, EBS has gained a significant increase in efficiency!

They have also chosen the VBAGateway as their web portal. VBAGateway features the latest web technologies and architecture like SPA (Single Page Application), Responsive Design, Gamification, Intuitive Help, and POD (Personalized Object Data).

You can efficiently administer Life and Disability, Medical, Dental, FSA, HSA, HRA, COBRA, Vision and Medicaid/Medicare lines of business on one software system with VBA.

For more information on VBA and VBAGateway, visit our website at http://vbasoftware.com or call me directly at 262-946-1210 or send me an email at twitter@vbasoftware.com.

Sincerely,
Virtual Benefits Administrator
Thomas W. Witter
President

P.S. For more information about EBS, see their website at http://www.ebs-tpa.com

VBAGateway November 2015 Release Notes

MEMBER TERMINAL

  • No Changes
   

PROVIDER TERMINAL

  • No Changes
   

EMPLOYER TERMINAL

  • 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)

  • No Changes

VBA Software November 2015 Release Notes

BENEFIT SERVICES
      • 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.
BILLING SERVICES
      • The Payment search screen now has Advanced Search. Available tables to search include:
        • PremPayment
        • PremInvoicePayment
        • PremInvoice
      • 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.
CLAIM SERVICES
      • 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.
ENROLLMENT SERVICES
      • Added the Smoker field to the Member Detail section of the Enrollment update screen.
REPORT SERVICES
      • 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.
WORKFLOW SERVICES
      • 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.
 

VBAGateway September 2015 Release Notes

PROVIDER TERMINAL

  • Enrollment POD – The Enrollment POD has been updated to be friendly for tablets and small desktop resolutions.

EMPLOYER TERMINAL

  • Tablet & Mobile
    • Open Enrollment Config – The Open Enrollment Config screen is now tablet (and small desktop resolution) friendly!
    • Census – Employee Information – The Employee Information screen is now tablet (and small desktop resolution) friendly!
    • Invoice – The Invoice screen is now tablet (and small desktop resolution) friendly!

VBAGateway Global (All Terminals)

  • Message Center
    • The Message Center can now be If hidden, a window appears in its place that shows contact information for your company. (Image 1)

VBA Software September 2015 Release Notes

ACCOUNTING SERVICES
  • Added additional configuration items:
    • ID Codes
    • Currency
AUTH SERVICES
  • Added additional configuration items:
    • ID Codes
    • Procedure Codes o Diagnostic Codes o Modifiers
    • Note Types
    • Note Category Types
BENEFIT SERVICES
  • When adding rates using the Quick Add wizard, the list of benefits that display will only be benefits offered by the plan previously chosen. If no plan is chosen, all benefits will appear as options to choose.
  • Added additional configuration items:
      • ID Codes
      • Currency
      • Coverage Type
      • Modifiers
      • Relationships
      • Networks
      • Note Types
      • Note Category Types
BILLING SERVICES
  • Added additional configuration items:
    • Payees
    • Note Types
    • Note Category Types
CALL TRACKING SERVICES
  • Added additional configuration items:
    • Note Types
    • Note Category Types
CARE MANAGEMENT SERVICES
  • Added additional configuration items:
    • ID Codes
    • Note Types
    • Note Category Types
CLAIM SERVICES
  • Fixed an issue where returning multiple claims to batch in a single process would not track that transaction in the Claim Timeline. This issue was also affecting Suspended Claims that were returned to batch. All instances of claims being returned to batch will now properly track in the Claim Timeline.
  • Added ProviderNetwork to the criteria options for Suspending claims. This allows the user to suspend claims by fee schedule.
  • Added a Filter option to Suspended Claims. This allows the user to further refine the list of claims within a specific Suspense Type.
  • Added the option to “Save As” on the Suspended Claims List. This will allow the user to export the list of suspended claims in the standard formats such as XML, Excel, Text, etc.
  • Fee_Sched to the suspended claim list for purposes of utilizing the Filter and to be displayed on the outbound “Save As” option.
  • Claim Status will now only show values appropriate to the search screen.
    • Claims in Batch:
      • Payable
      • Denied
      • Denied Partial
      • Pended
      • Error
    • Processed Claims:
      • Payable
      • Denied
      • Denied Partial
    • Claim and Claim Batch:
      • Payable
      • Denied
      • Denied Partial
      • Pended
      • Error
  • Claim Funded Status will now only show values appropriate to the search screen.
    • Processed Claims:
      • Candidate for Funding
      • Funded Claim
      • Ready for Funding
      • Funds Requested
      • Claim Suspended
    • Claim and Claim Batch:
      • Candidate for Funding
      • Funded Claim
      • Ready for Funding
      • Funds Requested
      • Claim Suspended
  • Added additional configuration items:
    • ID Codes
    • Note Types
    • Note Category Types
    • Currency
    • Error Codes
COMMISSION SEVICES
  • Added additional configuration item:
    • ID Codes
CREDENTIALING SEVICES
  • Added additional configuration item:
    • States
ENROLLMENT SERVICES
  • Added additional configuration items:
    • ID Codes
    • Note Types
    • Note Category Types
    • Ex Codes
    • Billing Cycle
    • Colleges
    • College Types
    • States
FEE SCHEDULE SERVICES
  • Added a new option for maintaining Fee Schedule records. The Fee Schedule Detail List will allow you to search any specific rate across multiple fee schedules for maintenance. For clients with extremely large fee schedules (1.5 – 2 million records) this approach to maintenance will be significantly more efficient. (Image 1)
GENERAL SERVICES
  • Added the ability to maintain EDI Code Map values under the Systems Services EDI Code Map menu option. These values are used on inbound and outbound EDI transactions for various mapped attributes. Changing these values can negatively affect your EDI data, please contact your systems administrator before manipulating these values.
GRIEVANCE SEVICES
  • Added the ability to track Patient Account # as part of a filed grievance. This is used for reporting and has no functional impact.
  • Added additional configuration items:
    • ID Codes
    • Note Types
    • Note Category Types
GROUP SERVICES
  • Added additional configuration items:
    • ID Codes
    • Note Types
    • Note Category Types
    • Accounts
    • Payor Accounts
    • Billing Cycle
    • Class
    • States
PROVIDER SERVICES
  • Added additional configuration items:
    • ID Codes
    • Suffix
    • States
REINSURANCE SERVICES
  • Added additional configuration items:
    • Note Types
    • Note Category Types
    • Insurance Carriers
    • Insurance Carrier Types
    • Tiers
    • Ex Codes
REPORT SERVICES
  • Fixed a performance issue when opening the Report Viewer. Clients who were attaching reports to specific security areas would experience a delay when opening the report list. The Report Viewer now opens more rapidly under that specific scenario.
  • Fixed an issue with some of the Reinsurance reports where diagnosis codes that are defined as both ICD-9 and ICD-10 would display as two lines on the reports. This caused duplicate values in the totals.
USER SERVICES
  • Added a sort to all User Restriction screens.
  • Added additional configuration item:
    • ID Codes
WORKFLOW SERVICES
  • Added the ability to specify a user who is responsible for managing a particular workflow. This allows the Claims Workflow Manager to be user specific. When no user is specified for a particular workflow, all users can see that workflow under Claims Workflow Manager.
  • Fixed an oversight where Workflow Criteria was editable directly on the Workflow Management screen. Workflow Criteria can only be set and modified through the “Set Criteria” button.
  • Changed how workflow assignment is done. Previously, all users who were attached to a task within workflow would be assigned that task. This caused some confusion as multiple people could potentially be working the same claim. The current process evenly distributes and assigns claims to the users attached to a task. This allows a single user to own a claim during a particular task until it is completed or rejected.
  • As part of creating specific assignments, the workflow definition is no longer dynamic. This means when a workflow is updated (users attached or removed), existing assignments need to be reevaluated. To do this you can use the “Reset” button on the Workflow Management screen which will reassign claims in that workflow based on the new user settings.
  • Fixed an issue with the Unassigned claims list in workflow. This list will now properly pull back all claims that are not currently assigned by workflow while still maintaining security for restricted group definitions.
  • Modified the “Assign” process on the Claims Workflow Manager screen. For any claim being assigned from the Unassigned list, the assign process will function as it does today by creating a new workflow entry for the user being assigned. For a claim that is currently assigned (part of workflow), the “Assign” process will act as a reassign by changing the user responsible for that entry. This change maintains the integrity of the workflow list by assuring a claim is only assigned to a single individual.
VBAdjudicate
    • Improved performance on Fee Schedule scans during adjudication. Fee Schedules with over 2 million detail records were not performing to our standard and have been significantly improved to alleviate burden on claims in the queue.

VBA New Client Update – Allegeant, LLC

I’m happy to announce that Allegeant, LLC, which is a risk management firm located in Timonium, MD, has joined the Virtual Benefits Administrator (VBA) family of clients.

Allegeant can now take advantage of VBA’s Flexibility, Functionality, and Technology to create much new efficiency. By using features like our process automation tool, hyperlink navigation, and offline auto-adjudication, VBA clients have experienced a reduction in variable overhead of over 50%!

FREE monthly updates and the flexibility of user–definable fields will allow Allegeant to easily adjust to any market changes they may encounter. VBA’s software platform, which has been built with an eye on the future and is ICD 10 compliant, meets Allegeant’s current needs and anticipated future needs.

You can now efficiently administer Life and Disability, Medical, Dental, FSA, HSA, HRA, COBRA, Vision and Medicaid/Medicare lines of business on one software system with VBA. For more information on VBA, visit our WEBSITE at http://vbasoftware.com or call me directly at 262-946-1210 or send me an email at twitter@vbasoftware.com.

Sincerely,
Virtual Benefits Administrator
Thomas W. Witter
President

P.S. For more information about Allegeant, see their website at http://allegeant.net

VBAGateway August 2015 Release Notes

LOGIN AND REGISTRATION
  • Login Screen Update – The login screen has been updated with new icons for a better graphical experience.
  • Registration – Online Enrollment – Online Enrollment added to Registration options.
MEMBER TERMINAL
  • Accumulator – Added grids with detail information to the Accumulator POD.
    • The data behind the Accumulator pie charts is now readily available inside the detail grids without the need to hover over the pie charts.
PROVIDER TERMINAL
  • No changes
EMPLOYER TERMINAL
  • Claims by Claim Type – Added detail grids to “Number of Claims by Claim Type” and “Paid Claims by Claim Type” pie charts on the front page of Employer Terminal.
    • The data behind the Claims pie charts is now readily available inside the detail grids without the need to hover over the pie charts.
  • Open Enrollment Options Added to Config Menu – Menu items for “Open Enrollment Configuration” and “Review and Confirm Open Enrollment” screens have been added to the Config menu.
  • Open Enrollment Configuration– Use the Open Enrollment Configuration screen to configure Open Enrollment settings.
    • To begin using the Open Enrollment Configuration screen, select “Enroll.” from the Employer Terminal Config menu. Once the screen has loaded, please select a division from the dropdown list to configure options for that Division.
    • After you have selected a Division, you will see the full Open Enrollment Configuration Screen. There are 4 PODs on this screen.
        • Open Enrollment Settings – Open Enrollment Settings includes:
            • Open Enrollment Active – Use this checkbox to activate Open Enrollment for this Division.
            • Active Through – If “Open Enrollment Active” is checked, Active Through is the date through which Open Enrollment is active for this division.
            • Registration Code – Define the Registration Code that the Members can use to register on the registration screen for Open Enrollment. The Members will need this code in order to register.
            • Welcome Page – Define the HTML for your custom Open Enrollment Welcome Page. You can insert your own links and images to customize the screen to suit your needs! This is displayed on the Open Enrollment Terminal home page.
      • Links – Use the Links POD to define the hyperlinks the member will see in the Links section of the Open Enrollment Terminal.
      • Downloads – Use the Downloads POD to define the available downloadable documents in the Downloads section of the Open Enrollment Terminal.
      • Plan Options – Use the Plan Options POD to define the Plan Options for this Division.
    • Open Enrollment Confirmation – Use the Open Enrollment Confirmation screen to review and confirm Open Enrollment requests. The Open Enrollment Confirmation screen consists of 3 PODS:
      • Review Open Enrollment Submissions – Select an Open Enrollment Request to review by clicking on the record you wish to view. This will load the Open Enrollment Request Details POD (see below), where you can confirm or reject Open Enrollment Requests.
      • Waived Coverage – Use this POD to un-waive coverage for members who have used the Open Enrollment Terminal to waive coverage.
      • Open Enrollment Request Details – Use this POD to review the details of a specific Open Enrollment Request. You can confirm or reject the request using this POD.
OPEN ENROLLMENT TERMINAL
  • New Terminal – The Open Enrollment Terminal is now live! Members can register for Open Enrollment using this terminal.
    • Once Open Enrollment has been configured using the Employer Terminal (see Employer Terminal section for details on configuration) employees can register a VBAGateway account using the Open Enrollment Registration Code and other basic information on the Registration screen.
      o Once the user has created their account, they can log in to the Open Enrollment Terminal from the log in screen. This will take them to the Welcome Screen of the Open Enrollment Terminal.
      o From the Welcome Screen the employee can navigate to specified links, download documents, and decide whether to “Get Started” registering for Open Enrollment, or “Waive Coverage.” (Image 8)
      o If the user decides to waive coverage (by clicking the intuitively named “Waive Coverage” button), they will be taken to a small form to fill out basic information such as their full name, and verify that they wish to waive coverage.
      o If the user wishes to register during open enrollment (by clicking the “Get Started” button) the Add Employee Wizard will appear. (Image 9) This is the same Add Employee Wizard used in the Employer Terminal. The Wizard is “smart” and knows if it has been triggered by the Open Enrollment Terminal or Employer Terminal, and hides or shows fields depending on where it was launched from.
      o The user can complete the Add Employee Wizard to create an Open Enrollment Request that can be reviewed, and confirmed or rejected, from the Open Enrollment Confirmation screen (Image 10) in the Employer Terminal.
    o To Confirm or Reject an Open Enrollment Request, browse to the Open Enrollment Confirmation screen in the Employer Terminal by selecting Config>Confirm from the left side menu (Image 5). Select the Request you wish to review from the list in the Review Open Enrollment Submissions POD (Image 10) on the left, review the Request on the right, and select either Confirm or Reject to process the Request.
VBAGateway Global (All Terminals)
  • No changes

VBA NEW CLIENT UPDATE: KG Administrative Services

KG Administrative Services (KGA), which is located in Chesterland, OH has joined the Virtual Benefits Administrator (VBA) family of clients.

KGAcan now take advantage of VBA’s Flexibility, Functionality, and Technology to create much new efficiency. By using features like our process automation tool, hyperlink navigation, and offline auto-adjudication, VBA clients have experienced a reduction in variable overhead of over 50%!

KGA  has also chosen VBAGateway as their Web Portal. VBAGateway is an enterprise web application that has been designed, from the ground up, with a focus on user engagement while sticking with the core VBA philosophy of Flexibility, Functionality and Technology. VBAGateway uses SPA (Single Page Application) and Responsive Design to provide a fluid and dynamic user experience akin to desktop applications.

VBAGateway communicates, in real-time, with the core VBA application. This level of instant communication between Member/Provider/Group Rep. and Administrator provides a unique level of engagement that will keep users coming back.

FREE monthly updates and the flexibility of user–definable fields will allow KG Administrative Services to easily adjust to any market changes they may encounter. VBA’s software platform, which has been built with an eye on the future and is ICD 10 compliant, meets KGA’s current needs and anticipated future needs.

You can now efficiently administer Life and Disability, Medical, Dental, FSA, HSA, HRA, COBRA, Vision and Medicaid/Medicare lines of business on one software system with VBA. For more information on VBA, visit our Website at http://vbasoftware.com or call me directly at 262-946-1210 or send me an email at twitter@vbasoftware.com.

Sincerely,
Virtual Benefits Administrator
Thomas W. Witter
President

P.S. For more information about KG Administrative Services, see their website at www.KGAdminTPA.com

VBA Software August 2015 Release Notes

BENEFIT SERVICES

  • Added the Benefit Rate detail screen to the Plan Benefit update screen. Users can define an amount or percentage of billed and their effective dates to be used during adjudication to determine benefits. If you use this functionality, you will need to test your EOB’s to ensure data is displaying as you would
  • Added InNet and OON to labels to the appropriate columns on the Co-Insurance Details and Co- Pay Details sections of the Benefit Place detail screen.

CLAIM SERVICES

  • Added all Present On Admission and Diagnosis Codes to the Claim Form created on the Claim and Claims in Batch update screens .
  • Added a Log Errors section to the Cost Contain – Context4 detail screen of the Claim update This section displays errors returned from Context 4 Healthcare.

ENROLLMENT SERVICES

  • Added InNet and OON to labels to the appropriate columns on the Plan Benefit Place Details section of the SPD Matrix detail screen.

PROVIDER SERVICES

  • Payee Maintenance screen :
    • Increased size of Payee Name to 50
    • Increased the visible area and allowed the input to exceed the visible area of all City
  • Added the Current option checkbox to Provider Search.

REPORT SERVICES

  • Added the Not Covered column to the Member Loss (Include Reimburse) Reinsurance The Balance Due column will now calculate less this amount.

SECURITY SERVICES

  • Added Claim Timeline security object.

VBAdjudicate

  • Added logic to use the Plan Benefit Rate
  • Modified the Cost Contain logic to store the Batch ID for each Previously, the Batch ID returned from the Context 4 Healthcare service was only stored by Batch Number. When claims in a batch had different Plans with different settings, the service would error.
  • Added logic to set the Discharge Date on Institutional claims. The date will be the Statement Through Date, unless an Occurrence Code equals 42, in which case the date will be the Occurrence

VBA Software July 2015 Release Notes

VBA BENEFIT SERVICES

  • Added the ability to include or exclude claims from being sent to Context4 Healthcare by Network. Entries into the screen should be all includes or all excludes as mixing the two will result in the included Networks being used while the excluded entries will be ignored.
   

VBA BILLING SERVICES

  • Added the ability to add a Premrate Key and Volume to invoice adjustments.
   

VBA CLAIM SERVICES

  • Added a new tab with the Referring Provider information on the EDI Details screen.
   

VBA COMMISSION SERVICES

  • Added a sort by last name then first name to Rate Subscribers
   

VBA ENROLLMENT SERVICES

  • Added the ability to add Volume to Retro Adjustments.
   

VBA REPORT SERVICES

  • New report: Claims Paid by Relationship and Gender.
  • New report: Claims Benefit Utilization by Division (Paid).
  • The ‘Claims Benefit Category Utilization by Group’ report now has a criteria screen allowing the user to choose groups and a date
   

VBAdjudicate

  • Added logic to include or exclude claims from being sent to Context4 Healthcare by Network.
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