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Type:
Bug
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Status: Production Complete
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Priority:
Medium
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Resolution: Done
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Affects Version/s: None
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Fix Version/s: None
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Component/s: None
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Labels:None
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Environment:Production
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Bug Severity:Medium
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Module:BenAdmin - Report
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Reported by:Client
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Company:County of Sutter
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Item State:Production Complete - Closed
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Sprint:WT Sprint 38 - Bugs
Hello,
Per the client: County of Sutter has notified BCC they are having an issue with the billing adjustments on their August invoice (please see attached).
We have looked into the issue with Harminder Dosanjh:
1. Beginning May 1, 2017 when BCC begins administration of COSR, Employee is enrolled in the Anthem PPO 500 plan as Employee + 1 Child (Rate $1,463.00)
2. On June 20, 2017 QE Add Newborn occurs, takes the Anthem PPO 500 plan enrollment to Employee + 2 Children (Rate $2,072.00)
3. Billing rule is Free In/Pay Out and is built in the Billing Period Policies on the General Plan Design page as follows:
a. Billing Period Adds = Premiums Waived After the Cut-Off Day; Day of Billing Period = 1
b. Billing Period Changes/Terminations = Bill for Entire Month; Day of Billing Period = 0
4. The August invoice incorrectly credits the June premium.
5. The August invoice does correctly credit and bill the July adjustments
6. The August invoice does correctly bill for the month of August
Kenya Olivas is having the exact same issue as Harminder Dosanjh
a. EE has been effective since 5/1/17 on the Anthem PPO 1000 plan with EE + SP + 2+ Children on the plan (Rate $1,698.00)
b. On 6/23/17 QE Add Newborn was initiated for a baby born 5/24/17. This has no effect on the enrollment level as the EE already has 2+ Children on the plan
c. Billing rule is Free In/Pay Out and is built in the Billing Period Policies on the General Plan Design page as follows:
i. Billing Period Adds = Premiums Waived After the Cut-Off Day; Day of Billing Period = 1
ii. Billing Period Changes/Terminations = Bill for Entire Month; Day of Billing Period = 0
d. The August invoice incorrectly credits the May premium
e. The August invoice does correctly credit and bill the June and July adjustments
f. The August invoice does correctly bill for the month of August
Could you please have your development team look into this ASAP, the group is extremely unhappy with their invoices.
Thank you,
Kira
Debbie Kulling
Hi Debbie Kulling,
We are working on this issue.
Have found the root cause.
Currently, scanning the data for more such records. Will provide you an update in half an hour.
Thank you!
cc: Gaurav Sodani
Hi Debbie Kulling,
Before generating the August invoice, with tier changes, self insured components cost was also changed.
Mentioned 2 employees have different scenarios. One is fixed where as issue for one scenario still persist.
We have analysed the scenarios for mentioned employees. Have scanned the invoices generated till Oct 2017 for this company, to check if any more incorrect records exists with these scenarios. We also tried regenerating the August 2017 invoice again on HSPL copy to check if the issue still persist in the system or not.
Following are the findings:
#1.
Employee : Harminder Dosanjh
Plan Name: Anthem PPO 500
Effective Date: 5/1/2017
Termination Date: 6/5/2017
Extra credits appearing for Tier: Employee + 1 Child
Scenario: Election effective date and termination date fall in different months.
During this span cost changes for components Anthem and SISC Claim Fund under rate Anthem PPO 500 also happened.
System calculated 2 retro terms(credits) for this:
one for component cost change which is correct and other for Tier change which is incorrect as per the plan billing term policy.
System calculated 1 retro add (debit) for this:
one add for cost change which is correct.
While displaying the final adjustments, 1 retro add and 1 retro term cancelled each other and only 1 retro term was remaining which appeared on invoice.
Following employees are also affected in August 2017 invoice:
| First Name | Last Name | Plan Name | Effective Date | Term Date | Adjustment Month | Tier |
| KIRN | JOHAL | Anthem PPO 250 | 5/1/2017 | 6/9/2017 | June 2017 | Employee + Spouse |
| BRITTANY | SCHIES | Anthem PPO 1000 | 5/1/2017 | 6/18/2017 | June 2017 | Employee |
When we regenerated August 2017 invoice, we got credit and debit adjustment for the month of June 2017 which is correct, as component cost changes happened.
Hence, issue related to this scenario is resolved and not in system any more.
#2.
Employee : Kenya Olivas
Plan Name: Anthem PPO 1000
Effective Date: 5/1/2017
Termination Date: 5/24/2017
Extra credits appearing for Tier: Employee, Spouse + 2+ Children
Scenario: Election effective date and termination date fall in same month.
During this span cost changes for components Anthem and SISC Claim Fund under rate Anthem PPO 1000 also happened.
As stated above.
System calculated 2 retro terms(credits) for this:
One for component cost change which is correct and other for coverage change (though tier change did not happened but system treats coverage changes as separate elections). Credits related to coverage changes were calculated incorrectly by the system.
System calculated 1 retro add (debit) for this:
One for cost change which is correct.
While displaying the final adjustments, 1 retro add and 1 retro term cancelled each other and only 1 retro term was remaining which appeared on invoice.
We did not found any other affected employee for this scenario.
But, when we regenerated August 2017, found that this issue still persist and needs to be fixed.
Following needs to be worked up on:
1. Issue fix for same month scenario. We will need 2-3 days to fix the issue, as change is required in adjustment logic which involves lot of scenario verification.
2. Scanning these 2 scenarios for other BCC companies for invoices generated till now. This will be done by 26-Sep-2017.
3. Providing adjustments i.e. retro add costs, for affected elections in upcoming invoices to be generated. We will have to manipulate billing data for this. Please confirm if data manipulation needs to be done or not?
Please update on #3 (data manipulation point) and let us know if any thing more is required.
Thank you!
cc: Kira Hamilton, Gaurav Sodani, Satya, Samir
Below are 3C's :-
Concern :-
When election ,tier change and cost change happens in same month and the addition or removal of dependents doesnt really affect tier, then adjustment shows no retro add(due to cost change) for the month in which changes occurred.
Example :- An employee is enrolled with tier EE+Spouse+2+child effective from 1/1/2017. Invoice is generated for Jan 2017.
On 1/15/17 he adds one more child. Tier remains same with EE+Spouse+2+child but there is enrollment change. He makes cost change too. Generates invoice for February
Expected Adjustment :- Retro add and term cost for January as there is cost change.
Actual :- Only retro term appears in invoice for January
Cause :- Such scenario were not handled when there is coverage change for Health plan but tier remains same and simultaneously cost is also changed.
Correction :- Handled above scenario
Affected file :- OES_SP_GetRetroBillingDetails_InvoiceBenefitWise
Affected Area :- Adjustement part of invoice
Tested Scenarios :-
1) Health benefits
a)Self Insured rate - Change in cost and tier, when change in tier doesnt really effect tier id
Tier change and cost change in same month of enrollment
Tier change and cost change in different month of enrollment
b) Billed rate
Tier change and cost change in same month of enrollment
Tier change and cost change in different month of enrollment
2)Non health benefits :-
Coverage change and cost change in same month
Coverage change and cost change in diff month
Jyoti Agrawal (Inactive)
added a comment - Below are 3C's :-
Concern :-
When election ,tier change and cost change happens in same month and the addition or removal of dependents doesnt really affect tier, then adjustment shows no retro add(due to cost change) for the month in which changes occurred.
Example :- An employee is enrolled with tier EE+Spouse+2+child effective from 1/1/2017. Invoice is generated for Jan 2017.
On 1/15/17 he adds one more child. Tier remains same with EE+Spouse+2+child but there is enrollment change. He makes cost change too. Generates invoice for February
Expected Adjustment :- Retro add and term cost for January as there is cost change.
Actual :- Only retro term appears in invoice for January
Cause :- Such scenario were not handled when there is coverage change for Health plan but tier remains same and simultaneously cost is also changed.
Correction :- Handled above scenario
Affected file :- OES_SP_GetRetroBillingDetails_InvoiceBenefitWise
Affected Area :- Adjustement part of invoice
Tested Scenarios :-
1) Health benefits
a)Self Insured rate - Change in cost and tier, when change in tier doesnt really effect tier id
Tier change and cost change in same month of enrollment
Tier change and cost change in different month of enrollment
b) Billed rate
Tier change and cost change in same month of enrollment
Tier change and cost change in different month of enrollment
2)Non health benefits :-
Coverage change and cost change in same month
Coverage change and cost change in diff month 
Sachin Hingole (Inactive)
added a comment - Venkatesh Pujari Hi Debbie Kulling,
Following are the updates:
#1. Issue fix:
We have fixed the issue and it is deployed in our local test environment. After QA verification it will be deployed further. As Jyoti Agrawal mentioned in her comments above, issue was due to following actions that happened simultaneously / in same span:
- Mid month coverage change
- Coverage change happened but it did not impacted the health tier. Implies, health tier before and after coverage change remained same.
- Self insured component cost was also changed
We had verified coverage change scenarios but not with such combination.
#2. Data scan
We have scanned these 2 scenarios for other BCC companies for invoices generated till now.
No other BCC company is affected with this. We did not got any records apart from following four that we mentioned earlier:
- Harminder Dosanjh
- KIRN JOHAL
- BRITTANY SCHIES
- Kenya Olivas
#3. Bringing adjustments on upcoming invoice:
Providing adjustments i.e. retro add costs, for affected elections in upcoming invoice to be generated. We will have to manipulate billing data for this so that adjustments appear for the month in which coverage change happened. Please confirm if data manipulation needs to be done or not?
We are keeping this JIRA with us as QA testing is in progress.
Please update us on #3 so that data can be manipulated before Nov 2016 invoice generation.
Thank you!
cc: Kira Hamilton, Jyoti Agrawal, Gaurav Sodani, Venkatesh Pujari
Hello,
Regarding "Please confirm if data manipulation needs to be done or not" Susan at BCC emailed on Sept 28 stating "Yes, I am confirming that this does need to happen."
Thank you,
Kira Hamilton
Debbie Kulling
Hi Kira Hamilton,
We will add these adjustments and verify the Nov 2017 invoice on HSPL copy at our end by 3-Oct-2017.
Thank you!
Hi Kira Hamilton,
Have done the required corrections for mentioned 4 employees. Their adjustments will appear in Nov 2017 invoice that will be generated.
Below are the details:
| First Name | Last Name | Plan Name | Effective Date | Term Date | Adjustment Expected for Month | Tier |
| HARMINDER | DOSANJH | Anthem PPO 500 | 5/1/2017 | 6/5/2017 | June 2017 | Employee + 1 Child |
| KIRN | JOHAL | Anthem PPO 250 | 5/1/2017 | 6/9/2017 | June 2017 | Employee + Spouse |
| BRITTANY | SCHIES | Anthem PPO 1000 | 5/1/2017 | 6/18/2017 | June 2017 | Employee |
| KENYA | OLIVAS | Anthem PPO 1000 | 5/1/2017 | 5/24/2017 | May 2017 | Employee, Spouse + 2+ Children |
We verified these corrections at our end.
Please confirm at your end once.
Thank you!
Hi Sachin Hingole,
As per discussion with Jyoti and Prasanna this ticket needs database testing hence assigning this jira to Venkatesh.
Amita Sangani (Inactive)
added a comment - Hi Sachin Hingole ,
As per discussion with Jyoti and Prasanna this ticket needs database testing hence assigning this jira to Venkatesh.
CC: Sachin Hingole , Prasad Pise , Rakesh Roy Hi Jyoti Agrawal,
This is tested on LB on For QA ASML company. The issue has been resolved for policy free in pay out only. Correct adjustments are displayed in the invoices.
This is ready for Stage
Thanks,
Venkatesh
Hi Jyoti Agrawal,
This is tested on Stage on AFI For Hspl company. The issue has been resolved for policy free in pay out only. Correct adjustments are displayed in the invoices.
This is ready for Production
Thanks,
Venkatesh
Hi Kira Hamilton,
The issue has been resolved and also tested on Production on COSB For Hspl company. The issue has been resolved for policy free in pay out only. Correct adjustments are displayed in the invoices. Please could you verify and close this ticket.
Thanks,
Venkatesh
Hello,
Per email received from Susan at BCC on 10/15/17 this ticket can be closed.
Thank you,
Kira Hamilton
Debbie Kulling
Hi Prasanna,
Can you please get this checked on priority?
Regards,
Satya Prakash
Cc: Gaurav Sodani Rakesh Roy Samir