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

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

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

Existing Items

None

Configuration Details

     
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