Hi Kira Hamilton,

We will look into this and will update you the details as soon as possible.

Regards,
Santosh

Cc: Samir, Satya, Umesh Kadam, Ganesh Sadawarte

Prasanna Karlekar , Could you please look into this issue.

Hi Kira Hamilton,

Thank you for reporting this issue.This requires code fix to be done which will take time to get scheduled, analyzed, fixed and verified.

Following is the scenario:
If we check the View History of this employee, 4-5 times mid month election changes have happened for Critical Illness and Accident plans. Plus both these plans have Prorated Billing Add/Term policy set. The logic to calculate proper returns(in mentioned scenario no returns) is failing for this scenario. For now, we do not want to handle this by doing any backend data manipulation.
Could you please once confirm with client that, this time can they do these corrections by editing the invoice?
Do let us know.

Thank you!

cc: Debbie Kulling, Gaurav Sodani, Jyoti Agrawal

Hi Kira Hamilton,

Kindly update on, whether it is possible for BCC to do these corrections by editing the generated invoice, only this time?

Thank you!

Hi Prasanna Karlekar,

Per an email from Jamie at BCC received 12/12/17, "our team will make these corrections on the December invoice."

Thank you,
Kira Hamilton
Debbie Kulling

Kira Hamilton -

Thank you for the update. Also, many thanks to BCC team for helping to handle this situation by editing Invoice.

Following are the 3 Cs:
Concern:
Incorrect adjustments appearing for mid month coverage changes done multiple times for plan having Prorated policy set

Cause:
Detailed analysis needs to be done.
As per initial analysis, 4-5 times mid month election changes have happened for Critical Illness and Accident plans. Plus both these plans have Prorated Billing Add/Term policy set. The logic to calculate proper returns(in mentioned scenario no returns) is failing for this scenario.

Correction:
Fix needs to be done once detailed analysis are done.
Currently, work around suggested, to manipulate the cost using edit invoice feature.

Below are details :-

Affected Files :

• Database Objects/MasterCompanyDB/01_DDL/727_WT-13053_WTB_Report_ModTable_InvoiceBenefitwiseBilling.sql
• Database Objects/MasterCompanyDB/04_Stored Procedures/OES_SP_GetBillingDetails_InvoiceBenefitWise.sql
• Database Objects/MasterCompanyDB/04_Stored Procedures/OES_SP_GetRetroBillingDetails_InvoiceBenefitWise.sql
• Database Objects/MasterCompanyDB/04_Stored Procedures/OES_SP_Report_GetBillingDetailsColumnWise_InvoiceBenefitWise.sql

Affected Area :

• InvoiceBenefitwiseBilling table structure
• Adjustment section for plans with prorated Add/Term policy

Tested Scenarios :

Plans Considered :
1) Health - Plan with Billed Rate
Plan With Self Insured Component rate
2 )Non Health

Billing Policies Combination for above plans :
1) Add - Prorated Term -Prorated
2)Add - Entire Term - Entire
3)Add - Entire Term - Prorated
4)Add - Prorated Term -Entire
5)Add - Entire Term - Waived Cut off
6) Add - Waived Cut off Term - Entire
7) Add - Waived Cut off Term - Waived Cut off

• For all above plans and billing policies combination, verified whether proper adjustments are being displayed on invoice when 2-3 times mid month election changes are done.
• Also considered plans with multiple rate with different effective dates

3 C's :
Concern : Incorrect adjustments appearing for mid month coverage changes done multiple times for plan having Prorated policy set

Cause: When 4-5 times mid month election changes happens for plans having prorated billing Add/Term policy set, the logic to calculate proper returns is failing for this scenario. The failure happened as there is no track of the original monthly cost and last term date.

Correction: Store monthly cost and previous election termination date for every record in the invoice tracking table.
For calculating returns, consider monthly cost from last term date for plans with prorated add/term policy.

Known Issue :
Once the -ve cost is adjusted out in invoice, and further retro term is done in the same enrollment then the invoice will not adjust out any returns. This is because, system currently considers that nothing is left to be returned for that plan.
Example :

• Benefit Plan ‘Blue Shield HMO’ has billing policies for add/term set as “Prorated Premiums”.
• Monthly cost for this benefit plan is $120, which comes out to $4/day.
• An employee Daniel has enrolled in the plan from 01/01/2017 to 11/29/2017.

• For invoices till October Daniel pays $120 every month.
• For November invoice Daniel is enrolled for only 29 days. Hence cost for 29 days $116 (29*4) is charged in invoice.

• After November invoice is sent out, following change happens.
  Termination date is changed from 11/29/2017 to 11/16/2017 i.e. 13 days are reduced.

• Daniel was billed for these 13 days so cost for these 13 days (13*4 =$52) is adjusted in December’s invoice. Invoice shows $-52

• After December invoice is sent out, again termination date is changed from 11/16/2017 to 11/11/2017 i.e. 5 days are reduced.

• 5 days cost (5*4=20) should be adjusted out in invoice. But currently system has stored $-52 as last return cost.
  The -ve cost implies that nothing is left to be return more. Hence, invoice does not give return for those 4 days.

The above issue mentioned requires major changes in core logic. This may affect existing adjustment logic. We need regression for this scenario. It will be better if we take this once test company is complete.

Hi Venkatesh Pujari,

Assigning this ticket to you as it is LB deployed.

cc:Sachin Hingole

Hi Jyoti Agrawal,

Tested this fix on LB on City of Durham For HSPL company. All the scenarios worked as per expectation. This is ready for Stage.

Prasanna Karlekar,Sachin Hingole

Thanks,
Venkatesh

Hi Jyoti Agrawal,

Tested this fix on Stage on 2018 CHMC For Hspl company. All the scenarios worked as per expectation. This is ready for Production.

Prasanna Karlekar,Sachin Hingole

Thanks,
Venkatesh

Testing is in progress

Hi Kira Hamilton,

The issue has been fixed and also tested on AFI For Hspl company on Production. All the scenarios worked as per expectation. Please could you verify at your end and close this ticket.

Hrishikesh Deshpande,Sachin Hingole,Jyoti Agrawal

Thanks,
Venkatesh