WHAT’S NEW IN THIS RELEASE
| Feature | QL | SL |
| Add Domestic Reduction Claim Visibility |  |
|
| Add Fields to the RMT Claim & Eligibility Import Layout | |
OVERVIEW
Add Domestic Reduction Claim Visibility
Smart-LinQ users need the ability to search claims that have Domestic Reduction applied.
1. Added a new field to the Claims Records labeled "Domestic Reduction Applied".
- Available in the column selector (not a default column)
- The values are "Yes" and "No"
- This field can be sorted and filtered upon
2. Added "Original Amt" to the Claim Summary level. This provides visibility into the paid amount that was passed to Smart-LinQ and what the Claim Amt was reduced to.
Add Fields to the RMT Claim & Eligibility Import Layout
As a Stop-Loss Administrator, I want additional data elements in the claim records so that I can avoid manually adding ancillary information in an accompanying file needed for reimbursement. In addition I need the ability to group reporting over subgroups of members.
The Ringmaster import format has been updated to include the following fields:
Eligibility Import
- Layout Additions
| Field Name | Required | Notes |
| Subgroup | No |
This field accepts updates. Clients may use this to group member reporting over; such as location or are they on cobra. |
- Member Records (UI)
| Field Name | Position | Filter / Sort Support | Default Column |
|
Subgroup |
insert before “Employment Status” |
Yes |
No |
Claim Import
- Layout Additions
| Field Name | Required | Notes |
|
Place of Service |
No |
two digit code with leading zeros so treat as text |
|
Diagnosis Related Group |
No |
if passed it we will accepted but will remain null if not provided |
|
Discount Amount |
No |
|
|
DenIal / Reason Code |
No |
may be multiple codes in alpha-numeric format |
|
Network Code |
No |
|
|
Network Code Description |
No |
|
|
Claim Process Date |
No |
|
- Claim Records (UI)
| Field Name | Claim Line Position | Claim Position | Filter / Sort Support | Add to Claim Summary | Default Column |
|
Place of Service |
insert before “Svc Code” |
n/a claim line only |
n/a |
No |
|
|
Diagnosis Related Group |
insert before “Diagnosis Codes |
n/a claim line only |
n/a |
No |
|
|
Discount Amt |
insert before “Unit Ct” |
n/a claim line only |
n/a |
No |
|
|
DenIal / Reason Code |
insert after “Discount Amt” |
n/a claim line only |
n/a |
No |
|
|
Network Code |
Insert after “Denial / Reason Code” |
n/a claim line only |
n/a |
No |
|
|
Network Code Description |
insert after “Network Code” |
n/a claim line only |
n/a |
No |
|
|
Claim Receipt Date |
insert before Payment Date |
Insert before “Payment Date” |
Yes |
Yes |
No |
|
Claim Process Date |
insert after Claim Receipt Date |
n/a claim line only |
n/a |
No |
|
- Member Claim Detail file
| Field Name | Position (field to follow) |
|
Place of Service |
insert before “Service Code” |
|
Diagnosis Related Group |
insert before “NDC Code” |
|
Discount Amt |
insert before “Units” |
|
DenIal / Reason Code |
insert after “Discount Amt” |
|
Network Code |
Insert after “Denial / Reason Code” |
|
Network Code Description |
insert after “Network Code” |
|
Claim Receipt Date |
insert before Payment Date |
|
Claim Process Date |
insert after Claim Receipt Date |
Comments
0 comments
Please sign in to leave a comment.