Segment Level Service Benefits Prototype
This feature provides the ability in OIPA to store various Services for which coverages/benefit values can be defined. It provides a provision for hierarchical grouping of the services described above called Service Group.Benefits and are defined for the services for each segment.
Prerequisites
N/A
New Items
- Master level Service Groups and Service tables are created in Palette with Various Services and Groups applicable to Vision benefits and Dental Benefits.
- AsCode Values are added as defined in feature document for Service Level, Service Category and Service Status . These codevalues are also listed below. Additionally, two new segment types in AsCodeSegmentType with Code value 79 and 78 for Vision and Dental Supplemental are also added.
ServiceGroupCategoryCode
01 Medical 02 Dental 03 Vision 04 Pharmacy 05 Accidents 06 Supplemental ServiceStatusCode
01 New 02 Pending 03 Pending Approval 04 Expired ServiceLevel
01 All 02 Facility 03 Professional
- The data added in the tables relevant to Vision Care and Dental are also listed below: The Columns ServiceGroupCategory, ServiceStatus Code stores corresponding AsCodevalues
- Guid columns and other system generated data columns are not included in the document.
ServiceGroup Table
ServiceGroupDescription ServiceGroupCode ServiceGroupCategoryCode Diagnostic and Preventive Services GPA 2 Vision Exam VEA 3 Lenses VLA 3 Contact Lenses PLKM 3 General (Adjunctive) Services POLK 2 Service Table
ServiceCode ServiceDescription ServiceGroupCategoryCode OVA Oral Evaluation 3 XRY XRAY 3 UYT Cleaning 3 OPI Space Maintainers 3 VEAB Vision Exam 3 KPLM Single Vision 3 HJUK Bifoccal 3 PUYT Progressive 3 TRER TriFocal 3 NMBV Elective 3 XCVF Non elective 3 GMP General anesthesia 3 EMT Emergency palliative treatment 3 JKL Consultations 3
- Security is provided for Benefit Screen Rule for the user group under the company.
Existing Items
None
Configuration Details
- BenefitScreen Business rule is added under screen rules at Global Level. Benefit Screen rule includes configuration for Dental and Vision care segments and their Service Benefit Fields for Palette and OIPA.
- The two segments VisionCare and Dental are added in Group Prototype Product under Prototype Group Child Company. Any plan created under this product in OIPA group can add VisionCare and Dental to the respective plan.
- Service Benefits are created for the two segments Vision Care and Dental through Palette Administration ServiceBenefit Node.
- Refer benefit data set up below for VisionCare for each of the Services created in the AsServiceTable. The Benefit Data is stored in AsSegmentNameBnft and AsSegmentNameBnftField table for corresponding segment.
- Refer benefit data set up below for Dental Care for each of the Dental Services added in AsService Table. The Benefit Data is stored in AsSegmentNameBnft and AsSegmentNameBnftField table for corresponding segment.