Hi Debbie Kulling,

As per initial analysis, cost appearing was correct as both the components defined for rate "Retiree NM Anthem PPO 1000 2 " are billable. Whenever there is billable component defined we do not consider Billed Rate.

We are verifying the records and our analysis is in progress.
Will provide complete update to you tomorrow on 12-Oct-2017.

Thank you!

cc: Gaurav Sodani, Jyoti Agrawal, Venkatesh Pujari

That does not make sense that was the whole reason for the billed rate. So we can override the other rate

Hi Debbie Kulling,

Our analysis related to cost appearing on Invoice are complete.

Following is the update:
Self insured components created for rate "Retiree NM Anthem PPO 1000 2":

• Non Billable
• SISC Claim Fund

Both are Billable.
In our Self Insured Rates tracking table, IsBillable flag for component named "Non Billable" is saved 0 implies that this is not a Billable component and do not consider for Invoice. Hence this component was not considered in any of the previously generated invoices.
We did not get the exact cause as how the value went 0, was it due to data migration or was there any issue when this data got inserted in tracking table. We will analyze further to track the exact root cause for this.

For newly created sub rate "Retiree NM Anthem PPO 1000 0-4" for rate "Retiree NM Anthem PPO 1000 2" below is the component cost split up:

• Non Billable (601)
• SISC Claim Fund (0)

For this subrate, IsBillable flag went correct in our Self Insured Rates tracking table.

As per cost calculation implementation for Health Plans on Invoice -

• When there are billable components defined, priority is given to them.
• When components are defined but all are non billable / component is not defined then Billed Rate is considered
• When Billed rate is also not defined then 0 cost is considered

As per implementation, cost 601 that appeared on Invoice was correct as both the components are Billable.
Have checked the cost defined for subrate Retiree NM Anthem PPO 1000 0-4.
Assigning all cost to component named "Non Billable" does not mean that cost will not appear on Invoice.Though the name is Non Billable, component is created with IsBillable flag set to yes. In earlier invoices, this component was not appearing due to incorrect IsBillable flag that went in tracking table, which we need to correct. Also, please note that on all previously generated invoices, cost went as Component Cost for component "SISC Claim Fund" and not as Billed Rate.

While analyzing the data, we have found data discrepancies for Self Insured Components in our Self Insured Rates tracking table.
Please refer WT-11542_ComponentDiscrepancies.xlsx for below points.
Following are the details
Scenario 1:
Billable components that are stored as Non Billable in tracking table. Detailed discrepancy mentioned in Tab "Should be Billable" of attached excel.
Companies affected: 2
Rates affected for Sutter: 5
Self Insured Rates affected for Sutter: 450
Toatl records affected across all invoices for Sutter: 287. Detailed discrepancy mentioned in Tab "County of Sutter - 1" of attached excel..

Scenario 2:
Non Billable components that are stored as Billable in tracking table. Detailed discrepancy mentioned in Tab "Should be Non Billable" of attached excel.
Companies affected: 1
Rates affected for Sutter: 2
Self Insured Rates affected for Sutter: 163
Toatl records affected across all invoices for Sutter: 7. Detailed discrepancy mentioned in Tab "County of Sutter - 2" of attached excel..

Have following queries regarding already generated invoices:
1. All the cost for previous generated invoices went to component "SISC Claim Fund" which has provider "SISC". Was it correct?
2. Do we need to correct the data for all the previously generated invoices?
If yes, then old cost against "SISC Claim Fund" will be credited and new cost "SISC Claim Fund" + "Non Billable" will be debited in next invoice that will be generated.
If no, then whenever there is retro termination or cost changes against these records, credits will appear only for component SISC Claim Fund.

Please update us on above queries and what action needs to be taken next.

Thank you!

cc: Gaurav Sodani, Jyoti Agrawal

Hi Debbie Kulling,

Today we analyzed root cause for incorrect IsBillable flag that exists in Self Insured Rates tracking table.

Following are the 3Cs:
Concern:
Value for billable self insured component is stored as non billable in Self Insured Rates Tracking table though the component is currently billable.

Cause:
Following explanation is w.r.t. component named "Non Billable" created for rate "Retiree NM Anthem PPO 1000 2":
When this component was built, it was non billable. Later it was changed to billable.
Our earlier tracking logic related to update of Self Insured Rates Tracking table had some issues. QA had logged the issues in WT-7195. Appropriate fixes were also done and deployed in our local environment in month of Jan 2017. While sending the patch ahead in Stage and Production environment, few code check-ins were missed. One of the missing code check-in was related to fix done to handle billable / non billable self insured component change appropriately. As the incorrect logic existed, when the component was changed from non billable to billable, the tracking table did not got update appropriately.

Correction:
We have already done the missing code check-in for WT-7195 in last month i.e. Sep 2017. Hence, this issue will not arise any more.
But we will have to correct such data. Detailed information related to this is already provided in our yesterday's update in WT-11542_ComponentDiscrepancies.xlsx.
It will be helpful if queries mentioned in our yesterday's comment are answered.

Waiting for your reply.

Thank you!

cc: Gaurav Sodani, Jyoti Agrawal

Hi Debbie Kulling,

Gentle Reminder!

We need an update from you on this issue. We cannot keep the data inconsistent as it will have impact in future too.

Adding Kira Hamilton as well.
Waiting for your reply.

Thank you!

cc: Gaurav Sodani, Kira Hamilton, Jyoti Agrawal

Hello,

We would like to set up a call with the Dev, Debbie, and the client. Do you have any availability for the morning of Friday October 20? Time frame of 9am -10 am CST? Also, please advise who from Dev should attend this call so we can add them to the meeting request invite.

Thank you,
Kira Hamilton
Debbie Kulling

Hi Kira Hamilton,

This Friday is not possible as we are having holiday over here.
Can we schedule call next week on Monday at 8.30 am CST?

Please send the invite to following people:
prasanna@harbingergroup.com
jyoti.agrawal@harbingergroup.com
lalit.kumar@harbingergroup.com
venkatesh.pujari@harbingergroup.com
gaurav.sodani@harbingergroup.com

Thank you!

cc: Gaurav Sodani, Jyoti Agrawal, Lalit Kumar, Venkatesh Pujari

Hello,

Per the client:

Is DEV available Tuesday October 24 anytime between 9am EST - 11am EST?

Thank you,
Kira Hamilton
Debbie Kulling

Hi Kira Hamilton,

Will confirm with other members attending the call and will provide you an update by your Monday i.e. 23-Oct-2017 morning.
Hope this is fine.

Thank you!

cc: Gaurav Sodani, Jyoti Agrawal, Lalit Kumar, Venkatesh Pujari

Hi Kira Hamilton,

Tuesday October 24 at 9am EST is fine with us.
Thank you for adjusting the time.

cc: Gaurav Sodani, Jyoti Agrawal, Lalit Kumar, Venkatesh Pujari

Following needs to be done for this JIRA:
1. Update Billable flag value in tracking table appropriately for ATC company - Complete
2. Manipulate Billable flag value in tracking table for County of Sutter - Script complete. Execution pending.
3. Need to scan companies which are using self insured components. - Script ready. Scanning is pending.
4. Email to Enrollment team for following change on Rates Matrics screen: -
If self insured components are defined then:
i. Monthly cost = Billable components + Non Billable components (Current implementation: only Billable components are considered)
ii. Billed Rate = Sum of Billable components (Current implementation: no check is there for Billed Rate) - Pending. Will be done after #3

Currently this JIRA is on hold. Will resume work on this after completion of WT-11849 and WT-11573.

Thank you!

cc: Gaurav Sodani, Jyoti Agrawal

Hi Sachin Hingole,

We have done corrections to manipulate IsBillable flag on HSPL copy. December invoice needs to regenerated and verification needs to be done for component named "Non Billable". This component's cost defined in subrate Retiree NM Anthem PPO 1000 0-4 for the Retiree NM Anthem PPO 1000 2 rate should not appear on Invoice.

Please verify and let us know at earliest so that script can be executed on main copy.

Thank you!

cc: Gaurav Sodani, Jyoti Agrawal, Venkatesh Pujari

Hi Kira Hamilton,

Following are the updates regarding pending Billable flag manipulation for County of Sutter:
1. As discussed, we have manipulated IsBillable flag value as 0 for component named "Non Billable" in our tracking table. This has no impact on any other module of the system except for Invoice. Impacted employee was "SAIGEON JANELLE". Due to this manipulation, cost for component named "Non Billable" is not appearing on Invoice for this employee.

2. There was also a scenario, where a Non Billable component was stored as Billable in the tracking table. Due to this instead of Billed Rate, Self Insured Component was getting considered. Impacted employee was "ANNE WESTLAKE". We have done corrections for this too. This will have no impact on Invoice as well as Provider wise export as:

• Component Cost is same as Billed Rate cost
• Plan Provider is same as Component Provider
  We have done this correction for data consistency.

After correction we have regenerated and verified the changes for Dec-2017 invoice on HSPL copy.
Cost appearing on Invoice seems to be fine.

Kindly regenerate the Dec 2017 invoice and confirm the changes related to component named Non Billable.
Do let us know, if anything more is required.

Thank you!

cc: Debbie Kulling, Jyoti Agrawal, Gaurav Sodani, Venkatesh Pujari, Lalit Kumar

No fix / correction related to this JIRA is pending.
We have not done any fix against this JIRA. Mentioned issue was handled by backend data manipulation.
We had a call with BCC on 24-Oct-2017, in which changes on Rates Matrics screen related to self insured component were discussed. Please refer Call_24OCT2017_MOM.oft for MOM.
Discussion related to changes on Rates Matrics screen is in progress on email for which new JIRA will be created once the change is finalized.

Thank you!

cc: Debbie Kulling, Kira Hamilton, Gaurav Sodani, Jyoti Agrawal, Venkatesh Pujari

Satya Prasanna Karlekar

Adding comments for clarification:
This issue was fixed when bug WT-7195 (which was discovered by QA team) was resolved. Therefore this issue is no longer occurring and will not occur moving forward.
For this client, the data was corrected, therefore this ticket needs to be closed. Since the issue was initially found in ticket WT-7195, this one should be closed as a duplicate.

Let me know if I misunderstood or if there is another reason why this ticket is still open.

Hi Jennifer Reed,

Yes, you are correct. The issue was fixed with WT-7195 and will no longer occur.
Also, this JIRA can be closed as duplicate.

But at the same time, please note that, for one scenario client needs incorrect data to reside in our component tracking table. For this scenario, we have manipulated the data which was correct. Proper fix for this, will be change on Rates Matrics screen related to self insured component, that is shared in Call_24OCT2017_MOM.oft email for which new JIRA will be created and worked up on.

Do let us know if you need any more inputs on this. Also closing this JIRA.

Thank you!

cc: Satya, Gaurav Sodani, Jyoti Agrawal

Closing the ticket. marking it as duplicate

CC: Kira HamiltonDebbie KullingJennifer ReedPrasanna KarlekarSatya