WORKTERRAProject Type: software

WORKTERRA

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  1. WORKTERRA
  2. WT-13446

GFC > UMR 1500 > Unexpected Health Tier Policy No Effective Date

    Details

    • Type: Support Activity
    • Status: Closed
    • Priority: Medium
    • Resolution: System Behaviour
    • Affects Version/s: None
    • Fix Version/s: None
    • Component/s: BenAdmin
    • Labels:
      None
    • Support Task Type:
      Query Resolution
    • Environment:
      Production
    • Reported by:
      EDI
    • Company:
      GFC
    • Module:
      BenAdmin - Export
    • Severity:
      Simple
    • Provider & Benefits:
      UMR-Medical

      Description

      Hello,

      Health tier policy No for UMR medical plans uses rules based on the Yes/No response to the Disease Managment page. The file seems to be picking up the date following the effective date of the change used for the disease management response. instead of the actual date.

      Examples:

      Kara Freymiller
      Cari Griffiths
      Jeffrey Howatt
      Jeanette Leach
      Holly Miller
      Donald Rapp
      Anna Wos Kolodziejczy

      Admin QE event was used to make these changes and per Jennifer Mitchell review, the effective date should have been date of event. I checked health tier mapping records and there are no rules defined, so i am unclear why these records are receiving day after event date.

      Thanks,
      Chris

        Attachments

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          Prashant.samal Prashant Samal (Inactive) added a comment -

          Hi Rajendra Pawar ,

          Please look into this

          __________________________
          Vinayak Kulkarni Satya

          Show
          Prashant.samal Prashant Samal (Inactive) added a comment - Hi Rajendra Pawar , Please look into this __________________________ Vinayak Kulkarni Satya
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          rakesh.shahane Rakesh Shahane (Inactive) added a comment -

          Hi Chris Ellenberger,
          Please find 3C's as below.

          Concern: The file seems to be picking up the date following the effective date of the change.

          Cause: We have checked this and as per analysis, If there is no rule set for the effective date on health tier mapping records, Then rule which is set on Company level is considered for the effective date.In this scenario, Effective date rule set on company level is Use Waiting Period-XX days from the date of change(1) as attached
          , Because of this date following the effective date of the change rolled out on file.

          Correction: Either we need to set effective date rule on Policy no mapping level or change the effective date rule on company level, Please get it updated from CE.

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

          CC-Vinayak Kulkarni

          Show
          rakesh.shahane Rakesh Shahane (Inactive) added a comment - Hi Chris Ellenberger , Please find 3C's as below. Concern: The file seems to be picking up the date following the effective date of the change. Cause: We have checked this and as per analysis, If there is no rule set for the effective date on health tier mapping records, Then rule which is set on Company level is considered for the effective date.In this scenario, Effective date rule set on company level is Use Waiting Period-XX days from the date of change(1) as attached , Because of this date following the effective date of the change rolled out on file. Correction: Either we need to set effective date rule on Policy no mapping level or change the effective date rule on company level, Please get it updated from CE. Please let us know if you required more details on this. CC- Vinayak Kulkarni

            People

            Assignee:
            Chris.ellenberger Chris Ellenberger
            Reporter:
            Chris.ellenberger Chris Ellenberger
            Account Executive:
            Jennifer Mitchell (Inactive)
            EDI Analyst 1:
            Chris Ellenberger
            Votes:
            0 Vote for this issue
            Watchers:
            3 Start watching this issue

              Dates

              Created:
              Updated:
              Resolved:

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