Summer 2017 Adjudicare Release Notes

Transcription

1 Summer 2017 Adjudicare Release Notes AUGUST Adjudicare Version Document Version 1.0 Aug 2, 2017

2 Table of Contents 1) Features and Enhancements... 2 a) New Features... 2 i. [SH-8650], [SH-8651], [SH-8652] Tracking and Adjudicating Dr. Referrals for any Procedure Code at the Certificate and Benefit Plan Levels ii. [SH-4927] - Adding Formulary to Class Level... 3 iii. [SH-6090] [SH-8649] - Show 'Notes' Section on Pending Claims List and Claims Processing Page 4 iv. [SH-8970] [SH-6088] Enhanced Create and Manage multiple claimant exceptions... 5 b) System Enhancements... 6 i. [SH-5829] - Payments - Show Plan Member's Info on Payment Screen... 6 ii. [SH-6094] - E-Dental - Pre-Determination Setting - Return Generic Message for All Pre- Determinations... 7 iii. [SH-6284] Added EOB code for Invalid Surface Code... 7 iv. [SH-8053] - Electronic Submissions for Dental Hygienist... 8 v. [SH-7066] Online Claims Access Plan Administrator - Warning if Selecting Family Coverage with No Dependents... 8 vi. [SH-7485] [SH-8328] - Show More records from Navigation Tree and Autocomplete Dropdown Lists 8 c) Reporting Enhancements... 9 i. [SH-8365] - Claims Count By User - Add Claims breakdown back into the Report ii. [SH-6093] - When Rejected Claims are Processed Notifications Should be sent to Online Claims Access / BenefitsXchange Users iii. [SH-6091] - Active Online Claims Access Certificate Listing Easier to sort and now Filterable 10 2) Tax Changes in Adjudicare ) Member Web and Mobile Apps a) Enhancements i. Dashboard for All Patients ii. Making Login and Support of MemberApp Easier iii. HCSA Only Plans iv. Time period for Notifications to stay in Notification List v. Sorting of Recent Claims vi. Configure Claim Submission process to skip Select Provider step...13 b) Resolved Bugs Symbility Solutions Inc. 1

3 1) Features and Enhancements a) New Features i. [SH-8650], [SH-8651], [SH-8652] Tracking and Adjudicating Dr. Referrals for any Procedure Code at the Certificate and Benefit Plan Levels. Adjudicare users can now keep track of all doctor referrals for a claimant including member and each dependent. Each referral entered can have an expiry date and include an uploaded copy of the referral (PDF, MS Word Document, or Image) along with notes. Adjudicare users can configure a benefit plan to indicate a doctor referral is required for adjudication of certain procedures. When a claim is rejected due to a missing required doctor referral, the explanation of adjudication section will include the following note "Doctor referral is required" Symbility Solutions Inc. 2

4 ii. [SH-4927] - Adding Formulary to Class Level Adjudicare users can now apply a formulary to the class level the same way a formulary is applied to a block or group level. A formulary set at the class level will override the group and block level formularies. This enhancement allows for different classes within the same group to have different formulary settings. The logic is similar to how the block and group relationship works but extended to Block the class level. o If a formulary is not set at the Group A Group B group or class level, the formulary set at the level above prevails. Class A1 Class A2 Class B1 Class B2 Class B3 o Users can also remove the formulary on a lower level that is inherited from above. For example, if the Block is set to use a formulary they may choose to have no formulary set on a specific Group/Class within that Block. Class coverage date rules will also apply to the formulary. o If the partner removes a formulary as of a specific coverage date, the adjudication would automatically reflect the change Symbility Solutions Inc. 3

5 iii. [SH-6090] [SH-8649] - Show 'Notes' Section on Pending Claims List and Claims Processing Page Based on feedback from Symbility partners, notes in Adjudicare are now visible on the pending claims list and claims processing pages. This enhancement helps to highlight notes within the Adjudication workflow by placing them on the screens used by Adjudicators to process claims in Adjudicare. Claims Processing Pending Claims 2016 Symbility Solutions Inc. 4

6 iv. [SH-8970] [SH-6088] Enhanced Create and Manage multiple claimant exceptions An Adjudicare user is now able to see all the claimant exceptions being applied from the certificate or dependent page. On the claimant screen, the user can create a new claimant exception or select a claimant exception created previously within this same partner. New claimant exceptions are created by selecting Create New Claimant Exception in the pop-up above and then completing the information shown below. After exceptions are added to a claimant, Adjudicare users can easily view or remove exceptions directly from the claimant edit page Symbility Solutions Inc. 5

7 All claimant exceptions are shared across a partner in Adjudicare. These claimant exceptions can be created or managed in the Claimant Exceptions screen shown below. b) System Enhancements i. [SH-5829] - Payments - Show Plan Member's Info on Payment Screen Added group and claimant name on the standard claim payment details screens. Eligible EFT Screen Eligible Cheque Screen 2016 Symbility Solutions Inc. 6

8 ii. [SH-6094] - E-Dental - Pre-Determination Setting - Return Generic Message for All Pre-Determinations The E-Dental service can now be configured to respond to the pre determination requests from the dental office software with an immediate acknowledgment along with a generic message instead of a real time adjudication response. Adjudicare administrators can now configure the pre-determination response message that is returned to the dental office. SH-6294SH iii. [SH-6284] Added EOB code for Invalid Surface Code Added New EOB code ( 035: Invalid surface code ) that is automatically selected when any of the following surface codes are invalid for both manual and E-Dental claims. This new message will help highlight to an adjudicator or dental office errors in inputted surface codes. Surface Codes: "Missing surface code" "Invalid surface code letter" "Surface code does not belong to a procedure" "Surface code does not belong to a tooth code" "A procedure should not have a surface code" "Surface [tooth surface code] has already been claimed on tooth [tooth code] within the constraint period." 2016 Symbility Solutions Inc. 7

9 iv. [SH-8053] - Electronic Submissions for Dental Hygienist E-Dental service can now process claims and predeterminations for dental hygienists the same way as is currently done for Dentists. v. [SH-7066] Online Claims Access Plan Administrator - Warning if Selecting Family Coverage with No Dependents Group plan Administrator in Online Claims Access will now receive a warning message if at least one Dependent is not included when 'Family' coverage status is selected. The User will see a warning if coverage status is set to single and active dependants exist. The warning message will not prevent changes from being saved, but it will require the user to click OK to continue. vi. [SH-7485] [SH-8328] - Show More records from Navigation Tree and Autocomplete Dropdown Lists The Block/Group/Certificate dropdown lists and navigation tree in the search panel can now show more than 100 records. If a user wants to see more records, he/she can click on a show more link that appears at the bottom of the dropdown list or navigation tree when there are more than 100 records. The user can keep expanding any long list until they can see the last record Symbility Solutions Inc. 8

10 c) Reporting Enhancements i. [SH-8365] - Claims Count By User - Add Claims breakdown back into the Report. Based on feedback from Adjudicare partners the Claim Count By User report has been enhanced to include the number of E-Dental and E-Drug claims and have the totals per adjudicator broken down by Dental, Health, and Vision. These new metrics could help measure adjudicators workload based on each benefit type and help managers determine when to hire more adjudicators. Summary Report Version Detailed Report Version 2016 Symbility Solutions Inc. 9

11 ii. [SH-6093] - When Rejected Claims are Processed Notifications Should be sent to Online Claims Access / BenefitsXchange Users By default now the rejected claims report will not print for any payee that has registered for online access (Web portal or mobile app) since they can view documents online. The process to print positive cheques and layout remains the same. iii. [SH-6091] - Active Online Claims Access Certificate Listing Easier to sort and now Filterable The Active OCA Certificate Listings report has been enhanced to allow for easy sorting in excel and the option to filter groups included in report. Using a searchable Group selector tree, users can specify which groups to include when the report is generated. Report can be generated as shown below with the group name as a separate column by unchecking the Subtotal by group box Symbility Solutions Inc. 10

12 2) Tax Changes in Adjudicare Affected Province Changes in Adjudicare Update Applied Quebec Saskatchewan SH Revert of previous tax change to comply with Quebec s extension of the Premium tax value of 3.48% until SH PST of 6% will apply to insurance premiums for all group insurance benefits in Saskatchewan. July 1 st, 2017 (Effective April 1 st, 2017) Effective August 1 st, ) Member Web and Mobile Apps a) Enhancements i. Dashboard for All Patients Users can now switch the dashboard to show the favourite cards for all patients (members and all dependants). The favourite cards selected are the same for both the member and all dependants Symbility Solutions Inc. 11

13 ii. Making Login and Support of MemberApp Easier A. Account Locked Login Error Messages Users will now receive an account locked message Your account is now locked. Please contact your Benefits Provider for assistance. for the following reasons o o o o Blocked Account - after 3 failed login attempts. Not setup for Online Claims Access accounts exists but Allow online claims access is unchecked on the class screen. Terminated or Inactive online access account Terminated group, class, division, or certificate B. Automatically Save Username of last successful login on Login screen C. Added mobile app version number to the login screen and profile screen iii. HCSA Only Plans HCSA Only plans can now access the benefit booklet in the My Benefits section. In addition, the percentage reimbursement coverage has been added to the HCSA dashboard. iv. Time period for Notifications to stay in Notification List After a notification on a member app has been read, the notification now stays in the list for 30 days, instead of only 7 days. v. Sorting of Recent Claims Sorting of the Recent claims list on the dashboard was changed to make it easier for users to find claims they have been recently working with. The Recent claims list now sorts by processed/submitted date, with the most recent at the top. The Claims history list remains the same, sorted by most recent service date at the top. Both claims lists continue to display the service date to the user Symbility Solutions Inc. 12

14 vi. Configure Claim Submission process to skip Select Provider step Symbility Partners now have the option to configure the claim submission process so members skip the Select Provider step while making a dental, health, or drug claim. Please contact your Account Manager if you would like to have this changed. b) Resolved Bugs [SH-9120] - Status Returned to MemberApp is not aligned with status of claim 2016 Symbility Solutions Inc. 13