greetings - hope all is well. can i get a status please?

Amit Thorve | Mandar Kulkarni | Pallavi Kulkarni | Prajakta Belhe | Yogita Bhadane | Vinayak Kulkarni | Amanda Hagan | Deborah Larue | Robyn Adkison

Vinayak Kulkarni When this change is going to get picked up and whether all other LFG feeds will be affected by this change?

Hi All,

This is not yet scheduled, we will pick this up from 23rd Oct 2017, and this change will not affect other LFG file as we need to do customization changes after this change.

Hi Amit Thorve and Abhay Patil

As Gaurav mailed you, we have frozen all enhancements until 2017 end
It would be great if you could have a word internally and get us a development approval for this in order to take it forward. Thanks.

Hi Nagini Indugula

As discussed in call yesterday, We would like to update you that we are done with development of this ticket.

Kindly let us know that when should this be deployed on further environments? during OE or after OE? Thanks.

Vinayak Kulkarni - I looked at the analysis document, however, it would be clearer if you could expand on the following lines where I have attempted to state is as I understand.

This enhancement adds two new fields. Existing Member Enrolled In is supplemented with Spouse Enrolled In and Child Enrolled In. Question: If this is a field in the rule engine that tests validity, why was it leading rolling out of a blank record? (Wouldn't it just populate the value based on the condition?)

Usage examples:
IF Enrollment Member Enrolled IN equal to <Plan Name> THEN
IF Enrollment Spouse Enrolled IN equal to <Plan Name> THEN
IF Enrollment Child Enrolled IN equal to <Plan Name> THEN

Are these fields restricted to the specific sub templates - or can they be used in any sub template? (E,g. is "Member enrolled in" to be used only in subscriber sub template and one for spouse only in spouse sub template?)

Do these fields work for health plans?

For life plans that are for spouse and children (e.g. "Whole Life - Spouse" and "Whole Life - Child" ) - who is actually enrolled? Do they carry SSN (or id) of both the member (employee) and spouse/ child (as the case may be)?

Suppose an employee has opted for "Whole Life - Spouse" - in that case, what is the difference between following two conditions?
Enrollment Member Enrolled IN equal to Whole Life - Spouse
Enrollment Spouse Enrolled IN equal to Whole Life - Spouse

Abhay Patil Vinayak is on leave for this entire week.

Rohan J Khandave or Ganesh Sadawarte Can you please answer Abhay's question above?

Hi Abhay Patil,

Please find below details

Question: If this is a field in the rule engine that tests validity, why was it leading rolling out of a blank record? (Wouldn't it just populate the value based on the condition?)
Comments: We have added three new fields under this enhancement Employee Enrolled In, Spouse Enrolled In and Child Enrolled In. Yes this field is uses in rule engine only, Now suppose Employee is enrolled in one plan but spouse is not enrolled,in this case if we create rule on spouse sub-template using 'Member Enrolled In' field then it will roll out blank value for configure rule field on exported file because spouse is not enrolled in that specific plan and if there is no other condition matches.But if employee is enrolled in that plan then it should check for employee,though it is spouse sub template.

Question: Are these fields restricted to the specific sub templates - or can they be used in any sub template? (E,g. is "Member enrolled in" to be used only in subscriber sub template and one for spouse only in spouse sub template?)
Comments: This field is not restricted to any specific sub templates. We can use this field in any sub template to configure rule. As above scenario is falling as it checking for spouse in enrolled or not when we use Member Enrolled In field into spouse sub template, so we can use Employee Enrolled In field to the spouse sub template so value will not be blank on file.

Question: Do these fields work for health plans?
Comments: Yes, This field work those plans with are selected into template.

Question: For life plans that are for spouse and children (e.g. "Whole Life - Spouse" and "Whole Life - Child" ) - who is actually enrolled? Do they carry SSN (or id) of both the member (employee) and spouse/ child (as the case may be)?
Comments: Only spouse and children were actually enrolled into life plan. This will check againts MemberID and MemberType.

Question: Suppose an employee has opted for "Whole Life - Spouse" - in that case, what is the difference between following two conditions?
Comments:

If rule is configure in Spouse sub template with below fields
Enrollment Member Enrolled IN equal to Whole Life - Spouse Result = Yes:
Enrollment Spouse Enrolled IN equal to Whole Life - Spouse Result = Yes:

If rule is configure in Employee sub template with below fields
Enrollment Member Enrolled IN equal to Whole Life - Spouse Result = No:
Enrollment Spouse Enrolled IN equal to Whole Life - Spouse Result = Yes:

Please let us know if you require more details.

CC-Amit Thorve,Vinayak Kulkarni,Rohan J Khandave

Thanks,
Ganesh

Hi Abhay Patil and Kevin Hale, the client is asking about this file again and would like to know when we are sending a new test file. Do we have an estimate of when we will be sending another test file?

Robin Valdelamar Yamilka Coca Deborah Larue

Ganesh Sadawarte, Vinayak Kulkarni - we need to get this to work in one way or the other. CC Jennifer Reed Amit Thorve Chris Ellenberger

While I find the explanation and resolution redundant (please see note below) - we need to move on. Are these enhancements in place? When will they be available on prod?

Note: We can discuss this separately - but
When an employee has opted for "Whole Life - Spouse" -
in that case "Enrollment Member Enrolled IN equal to Whole Life - Spouse" should always have Result = Yes - no matter whether it is in Employee sub template or spouse sub template.

Hi All,

Attaching the development approval email for your reference

Regards
Gaurav

Hi ,

Detailed Test Cases are updated in the attached 'Test Cases_GSM Lincoln_WT-11449 sheet' . We will start testing of this implementation from tomorrow.

CC:Hrishikesh Deshpande Vinayak Kulkarni

Regards,
Aniruddha Dev

Jennifer Reed, Gaurav Sodani,Vinayak Kulkarni
Can we expedite the release of this fix? We cannot get one carrier file approved without this fix released on the production.

CC-Yamilka Coca

Just for record I am adding a note based on my discussion with Vinayak.

How a template is considered "employee" or "spouse" or "child" is dictated by a secret (i.e. undocumented) way. If a child demographics field is mapped anywhere it is a child one. if not, if spouse field mapped, then spouse one - otherwise employee sub template. If you want to treat sub template as employee one no matter what, there is a special indicator for that. (Which one?).

So "member" in rule field "member enrolled in" is treated as employee or spouse of child based on what sub template it is. If we want to check for employee in spouse template, currently it is not possible. Therefore this enhancement is required.

Completed testing for Rowsie Templates on LB .Testing is in progress for columnwise template type after today's LB patch.
Will complete the LB testing on Monday (18th Dec) EOD.

Verified this implementation along with all its bug fixes on LB with attached test cases for different conditional rule combinations

• Rowise Template
• Columnwise Template
• XML template

Scenarios are working as expected . Ready for Stage deployment

Hi All,

This ticket has been approved for stage deployment on 12/21/17.

Regards
Gaurav

Verified basic implementation for columnwise and rowise templates on stage. Testing is in progress for Lincoln file . Will update once its done

Hi Rakesh Shahane,

Verified this implementation on GSM and LHP company lincoln files and observed the below issue only for Lincoln files.

Crated Rule as per below

The rule is still getting executed even if employee is not enrolled in the mentioned plans . As per above created rule PASS Plan CODE and PASS Class CODE are still getting exported for employees even when they are not enrolled in the plan.
When randomly checked view history details for the records having above issue and records having else statement executed on the export file , I observed that Employees those never enrolled in the plan got else statement on export file and the employees who were enrolled previously but not now got above mentioned value on export file.

Please check this with the Lincoln file once at your end and update accordingly.

CC:Vinayak Kulkarni Hrishikesh Deshpande Ganesh Sadawarte

Hi Aniruddha Dev,
Please find 3C's as below.
Concern: The rule is still getting executed even if employee is not enrolled in plan.

Cause: We have checked this and found that Retro term election scenario were not handled in the UDF, Because of this Rule engine not working properly.This scenario is observed only for the column wise template.

Correction: We have handled this scenario as of now, in future this will not cause for an issue.

Please let us know if you required more details on this.

CC-Ganesh Sadawarte, Vinayak Kulkarni.

Verified the above fix on LB for Column wise Templates with retro termination. Working as expected . Ready for stage deployment .

Verified this implementation on stage on Row wsie , Column wise and Lincoln templates . Working as expected .

Ready For Production Deployment

Hi Yogita Bhadane,

We have deployed and verified this implementation on production today.
Can you please check this at your end on Lincoln file which you're working on and take this forward from EDI side ?

CC: Vinayak Kulkarni Hrishikesh Deshpande

Hi All,

Attaching the production deployment approval email for reference

Regards
Gaurav

Checked this enhancement on GSM lincoln template. Plan code and class code are rolling out for all eligible employees.

It is working as expected. hence, Closing this ticket.

Thanks,
Yogita

CC - Prajakta Belhe