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TRANSCRIPT
Copyright 2012, Bizmatics, Inc. 4010 Moorpark Avenue, Suite 222, San Jose, CA 95117
User Quick Guide Insurance Eligibility Demographic Updates
Contents Document conventions............................................................................................................................ 1
Intended audiences ................................................................................................................................. 1
Introduction ............................................................................................... Error! Bookmark not defined.
Pre-requisite ........................................................................................................................................... 3
Authorizing user role ............................................................................................................................... 4
Screen accessibility .................................................................................................................................. 5
Functionality of feature ........................................................................................................................... 7
Different Senarios ................................................................................................................................... 8
Fields Supported for the Comparison..................................................................................................... 12
Mapping for Subscriber Relation Fields .................................................................................................. 13
Button ‘update’ .................................................................................................................................... 14
Button ‘cancel’ ...................................................................................................................................... 16
Button ‘ignore’ ...................................................................................................................................... 16
History Log and Audit Trail..................................................................................................................... 17
Tabular Report ...................................................................................................................................... 19
Upcoming Enhancement ....................................................................................................................... 20
Document conventions Icon Description
Note: To create awareness about the fact.
To emphasize about aspects which are critically important and should be adhered to instruction.
Intended audiences Intended audiences for this document are:
Front-end Implementers
Technical support
QA department
Important:
Copyright 2012, Bizmatics, Inc. 4010 Moorpark Avenue, Suite 222, San Jose, CA 95117
User Quick Guide Insurance Eligibility Demographic Updates
Training Department
Marketing and Sales Departments
Introduction
This document provides information on how to use the ‘Demographic Updates’ functionality
using Insurance Eligibility data. This document will also help us to understand how mismatch
between Insurance Eligibility info and PrognoCIS info is detected and updated in PrognoCIS.
This feature is an extension to Insurance Eligibility functionality and is applicable for clinics
which have Insurance Eligibility Feature Turned ON.
Using Patient Demographic information received from Eligibility, now it will be possible to
populate or update the equivalent fields in PrognoCIS.
When Insurance Eligibility is fetched, the Patient Demographics information from Eligibility file
is compared with the PrognoCIS information. In case mismatch is observed then it is highlighted
in icon on the Patient Insurance Screen , Insurance Eligibility ‘details’ button
on Patient Insurance screen and hyperlink on Tabular Report. In addition, Patient and
Subscriber Information will also be available for updates, but Provider and Insurance Details will
not be available for updates. Further, user will decide whether they wish to update each
PrognoCIS field with Eligibility Information based on whether the user has the rights to do the
updates (‘No Access’ Role). The updated information can be tracked in Patient Demographics
Update History, Patient Insurance History and in Audit trail, along with the user details, like who
updated it and when.
Currently, there are 4 clearing houses supporting Insurance Eligibility Feature. This new feature
of Demographic Updates based on Eligibility will be supported for all these clearing houses.
Gateway
Navicure
Assurtus
Inmediata
Copyright 2012, Bizmatics, Inc. 4010 Moorpark Avenue, Suite 222, San Jose, CA 95117
User Quick Guide Insurance Eligibility Demographic Updates
Pre-Requisites for using Demographic Updates Feature in PrognoCIS The Demographic Updates feature will be available by default for all clients who have Insurance
Eligibility import already turned ON. The property ‘inseligibility.demographic.update’ will be ON
by default. If a user doesn’t want this feature to be turned ON, they can request Tech Support
to turn this property OFF. If the property is ON, an Icon of Demographic Updates will be
displayed on Patient Insurance screen next to Eligibility ‘Check’ and ‘Details’ button and also
inside ‘Details’ button, provided the User has appropriate Role ‘EligibilityDemographicsUpdate’
assigned from User Role screen. Further, when the property is turned OFF, then the
Demographics Updates icon will not be displayed on Patient Insurance and Eligibility Details
screens.
Note: Latest Eligibility fetched for a patient after this feature is added qualifies for this
Demographic Comparison and mismatch Updates. If latest eligibility for a patient was fetched
before this feature upgrade, the Demographic Updates icon will be shown disabled.
Note 2: If the latest Eligibility record fetched for a patient is an error, the Demographic Updates
icon will be shown disabled.
Fig: Two New Properties governing the Feature
Copyright 2012, Bizmatics, Inc. 4010 Moorpark Avenue, Suite 222, San Jose, CA 95117
User Quick Guide Insurance Eligibility Demographic Updates
Another new property ‘ins.eligibility.patient.info.comparison.fields’ has been introduced. This
property accepts Comma separated numeric values for 32 fields defined in the program. If
comparison of Eligibility and corresponding PrognoCIS Patient Demographics field has to be
done, then that field number has to be present in the comma separated list. The sequence of
these numbers doesn’t matter. When the property ‘EligibilityDemographicsUpdate’ is set to ‘Y’
and property ins.eligibility.patient.info.comparison.fields left blank, then by default the value of
the property is considered as all 32 fields comma separated i.e.
1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32.
The field name for each number is given in a table below.
After V3B3, this property will have a list to choose these options from instead of a Text Box
which accepts comma separated numbers. This List accepts multiple values in any sequence. Its
called MVALSET data type.
Authorizing User Role for updating Demographics:
Settings>Configuration>User Roles: EligibilityDemographicsUpdate- this is a ‘No Access’ Role
introduced.
By default, the Demographic Updates icon will be viewed by all PrognoCIS Users if the feature is
turned ‘On’ and there is a mismatch, but, not all users will be able to see the buttons ‘update’
and ‘ignore’ enabled from this Demographic Updates Icon. Only those users, who have the User
Role checkbox for new role EligibilityDemographicsUpdate checked, will be able to update the
Demographics or ignore mismatch. By default only Admin user will have this role assigned. The
Clinic Manager should appropriately assign it for Clinic employees.
For Users with above Role Assigned following will be observed on Demographic Updates pop-
up:
• The check boxes with mismatch rows will show enabled.
• Button ‘update’ will get enabled when first check box is checked.
• Buttons ‘ignore’ and ‘cancel’ buttons will be always enabled.
For users with above Role not Assigned:
• The check boxes with mismatch will be enabled.
• Even after check boxes are checked, ‘update’ and ‘ignore’ buttons will remain disabled.
• On clicking any mismatch check box following message will be displayed - 'Sorry! You do not
have Role “EligibilityDemographicsUpdate" assigned.'
Copyright 2012, Bizmatics, Inc. 4010 Moorpark Avenue, Suite 222, San Jose, CA 95117
User Quick Guide Insurance Eligibility Demographic Updates
• Button ‘cancel’ will be always enabled.
4 places from where Demographic Updates screen is accessible:
The icon ‘Patient Demographics and Eligibility Mismatch and Updates’ pop-up will be made
available from three options:
A new icon on Patient > Insurance Pop-Up
Fig: Showing Demographic Updates Icon on Insurance Pop-Up (Tooltip shown)
A new icon on Patient Insurance > Eligibility: “Details” - Pop-up
Copyright 2012, Bizmatics, Inc. 4010 Moorpark Avenue, Suite 222, San Jose, CA 95117
User Quick Guide Insurance Eligibility Demographic Updates
Fig: Insurance Eligibility Details pop-up with new icon for Demographic Updates
Hyperlink ‘Ins Elig Details’ and ‘Ins Elig Demo Updates’ on new Tabular Report
(TELIG304) named ‘Patient Eligibility Demographic Mismatch List’.
Fig: Showing Hyperlink on Tabular Report TELIG304
Hyperlink ‘Ins Elig Details’ and ‘Ins Elig Demo Updates’ on existing Tabular Report
(TELIG301) named ‘Eligibility Report for patients on schedule.
Copyright 2012, Bizmatics, Inc. 4010 Moorpark Avenue, Suite 222, San Jose, CA 95117
User Quick Guide Insurance Eligibility Demographic Updates
Functionality of feature ‘Demographic Updates using Insurance Eligibility’:
Insurance Eligibility Response can either be run at night using a scheduled process ‘Get
Insurance Eligibility for Scheduled Appts’. Else, the eligibility can be explicitly fetched using
button ‘check’ on Patient Insurance screen.
Now, after the Eligibility info is fetched, it will be compared with Patient Demographics info in
PrognoCIS and if there are any differences found then they will be available for mismatch
updates. Latest successful Eligibility info for a patient will be considered for comparison and
stored. Further, whenever any user comes to Patient Insurance or ‘details…’ pop-up, the
demographic updates icon will be shown enabled only if there is atleast one mismatch
found. On the contrary, if no mismatch found then the icon will remain disabled.
Fig: Demographic Updates Icon shown enabled when one or more fields have a mismatch
Clicking on the icon invokes a pop up displaying comparison of information.
Copyright 2012, Bizmatics, Inc. 4010 Moorpark Avenue, Suite 222, San Jose, CA 95117
User Quick Guide Insurance Eligibility Demographic Updates
Fig: Patient Fields on Demographic Updates pop-up
There are two tabs that are shown in the ‘Demographic Updates’ pop-up:
a. ‘Patient’
b. ‘Subscriber’
Patient Tab: Currently, there are 32 fields supported at max to be displayed on this pop-up.
When the pop-up is invoked by default the first tab ‘Patient’ will show selected and its details
will be displayed. Currently, there are 19 fields supported under ‘Patient’ tab including 5 fields
for Address. On screen only 14 fields can be seen as Address is shown in single row. If any
Copyright 2012, Bizmatics, Inc. 4010 Moorpark Avenue, Suite 222, San Jose, CA 95117
User Quick Guide Insurance Eligibility Demographic Updates
mismatch is found between data from Eligibility and from PrognoCIS, the check box present for
the row will get enabled.
There will not be any automatic updates in patient demographic information. Instead, it will be
an explicit user action. User will take explicit decision whether to update the data from
Eligibility if different into Patient Register and/or Pat-Insurance screen of PrognoCIS by explicitly
checking the mismatched fields checkboxes.
A ‘select all’ check box is present next to the column ‘Update In PrognoCIS’. User can check this
check box to select all the check boxes which are enabled easily. User can also check the
required check boxes manually where they want certain Demographics to be updated in
PrognoCIS. This ‘Select All’ checkbox will be enabled only when atleast one field on that page is
editable.
Copyright 2012, Bizmatics, Inc. 4010 Moorpark Avenue, Suite 222, San Jose, CA 95117
User Quick Guide Insurance Eligibility Demographic Updates
Fig: Patient Fields on Demographic Updates pop-up showing Select All checkbox enabled.
Subscriber Tab: The second tab is ‘Subscriber’. This tab currently supports 13 fields including 5
fields for Address but visible fields are only 9 because Address of Subscriber is shown in a single
row. Unfortunately very few fields are actually received while fetching Eligibility. The details
present under the Subscriber tab are coupled to the ‘Relation’ field in the patient tab. If the
check box ‘Relation’ is checked on the ‘Patient’ tab then following three fields in the
‘Subscriber’ tab i.e. ‘Subscriber First Name’, ‘Subscriber Last Name’ and ‘Subscriber DOB’ gets
automatically checked if there is a mismatch and are disabled. All other fields with Mismatch on
the Subscriber tab also show the checkbox checked but those checkboxes are enabled in case
the user wants to skip them from updates.
Copyright 2012, Bizmatics, Inc. 4010 Moorpark Avenue, Suite 222, San Jose, CA 95117
User Quick Guide Insurance Eligibility Demographic Updates
Fig: Subscriber Fields Enabled with Last and First Name checked and disabled.)
The Subscriber Tab will be shown Disabled in following situations:
1. When PrognoCIS Subscriber Relation and Eligibility Subscriber Relation both are ‘Self’. 2. When PrognoCIS Subscriber Relation is other than Self but Eligibility Subscriber is ‘Self’.
Fig: Subscriber Fields on Demographic Updates pop-up showing disabled
What this means is that when Eligibility info has Relation as Self, then Subscriber Tab will be
shown disabled. For changing Subscriber to Self, user will have to manually change the field
‘Relation’ from Patient Insurance Screen. Only then will the reference of Subscriber be removed
from program, else not.
Copyright 2012, Bizmatics, Inc. 4010 Moorpark Avenue, Suite 222, San Jose, CA 95117
User Quick Guide Insurance Eligibility Demographic Updates
List of Fields Supported for the Comparison including Patient and Subscriber tabs: The
number for each field is considered in the Comparison field.
1. Patient Last Name
2. Patient First Name
3. Policy Num/Subscriber ID
4. Pat DOB
5. Pat Gender
6. Pat SSN
7. Subscriber Relation
8. Pat Add Line1
9. Pat Add Line2
10. Pat City
11. Pat State Code
12. Pat Zip
13. Pat Res Tel
14. Pat Fax
15. Pat Email
16. Plan ID
17. Group No
18. Plan Start Date
19. Plan Expiry Date
20. Subscriber First Name
21. Subscriber Last Name
22. Subscriber DOB
23. Subscriber Gender
24. Subscriber SSN
25. Subscriber Address Line1
26. Subscriber Address Line2
27. Subscriber Address City
28. Subscriber Address State
29. Subscriber Address Zip
30. Subscriber Address TEL
31. Subscriber Address Fax
32. Subscriber Address Email
Copyright 2012, Bizmatics, Inc. 4010 Moorpark Avenue, Suite 222, San Jose, CA 95117
User Quick Guide Insurance Eligibility Demographic Updates
In the above mentioned fields, if any deviation is found in PrognoCIS info from fetched eligibility
response, then the patient will qualify for Demographics Updates.
Mapping for Subscriber Relation field:
A hardcoded Mapping Table is defined in PrognoCIS for mapping appropriate Subscriber
Relations from Eligibility with Relation defined in PrognoCIS. For Example - When Eligibility
value for Relation is sent as ‘Child’, the program interprets as ‘Parent’ and then compares it
with relation in PrognoCIS.
Eligibility Data Received Mapped Eligibility Data for
Comparison
Spouse Spouse
Self Self
Child Parent
Employee Employer
Unknown Other
Organ Donor Other
Cadaver Donor Other
Life Partner Life Partner
Other Relationship Other
For ex: If Relation comes from Eligibility as ‘Child’ and PrognoCIS has Relation set as ‘Parent’
then it will be considered as match, else a mismatch.
I.e Eligibility info sends Patient’s relation to Subscriber whereas PrognoCIS stores Subscriber’s
relation to Patient. That’s why conversion is needed.
Copyright 2012, Bizmatics, Inc. 4010 Moorpark Avenue, Suite 222, San Jose, CA 95117
User Quick Guide Insurance Eligibility Demographic Updates
Button ‘update’
Initially the button ‘update’ remains disabled but after checking any ‘Update In PrognoCIS’
check box, the button gets enabled. Clicking on the ‘update’ button initiates some validations
after which appropriate messages are displayed and check boxes get checked, unchecked or
disabled.
If any of the Subscriber details check box is checked but field ‘Relation’ on ‘Patient’ tab is
unchecked, then a validation message is displayed saying, ‘Please select Subscriber Relation
from Patient Tab.’
Note: This validation should take place only if ‘Relation’ check box is enabled for update.
Copyright 2012, Bizmatics, Inc. 4010 Moorpark Avenue, Suite 222, San Jose, CA 95117
User Quick Guide Insurance Eligibility Demographic Updates
Fig: Validation on checking Subscriber details checkbox when ‘Relation’ checkbox on ‘Patient’
tab is unchecked.
When none of the checkboxes on the ‘Patient’ tab are checked and users click the button
‘update’, a validation message saying ‘Please select atleast one Field to update’ is displayed.
Fig: Validation on the button ‘update’ when no checkbox checked.
The updates are available till the next ‘Eligibility’ is fetched for the same patient or until
Updates are done in PrognoCIS. Latest Eligibility of a patient will be considered for
Demographics comparison and updates. If the new Eligibility fetched does not have the updates
like last Eligibility mismatch or any other mismatch, then Demographic Updates icon will
become disabled.
Copyright 2012, Bizmatics, Inc. 4010 Moorpark Avenue, Suite 222, San Jose, CA 95117
User Quick Guide Insurance Eligibility Demographic Updates
Button ‘cancel’
If any check box is checked then clicking on the button ‘cancel’ will invoke a validation message saying
‘Are you sure you want to exit without updating changes in PrognoCIS?’ On clicking the ‘ok’ button the
pop-up get closed and parent screen is shown. On clicking the ‘cancel’ button, the validation message
pop-up gets closed and user remains on the same screen.
Fig: Validation on Button ‘cancel’
Button ‘ignore’
The button ‘ignore’ is used when user is sure he wants to ignore the fields even if there is mismatch
because they are ok with the data in PrognoCIS. On clicking the button ‘ignore’ a validation message
appears saying ‘By clicking button 'ignore' the Demographics Updates icon will be disabled till Eligibility
is fetched again and mismatch is found. Are you sure you want to proceed?’
Copyright 2012, Bizmatics, Inc. 4010 Moorpark Avenue, Suite 222, San Jose, CA 95117
User Quick Guide Insurance Eligibility Demographic Updates
Further, on clicking the ‘ok’ button to proceed, the validation pop up and Demographic Updates pop up
will get closed and the Demographics Updates icon will become disabled. Else, on clicking the button
‘cancel’ the validation pop up will get closed and user will remain on the same screen.
Fig: Validation on Button ‘ignore’
History Log and Audit Trail:
All the users actions related to Insurance Eligibility Demographic Updates will be logged in to
the audit trail under the ‘Menu’ Option – ‘Patient Insurance’. For both Patient and Patient
Insurance screen fields, the Menu option used to save in Audit Trail is the same. In addition, the
button ‘History’ on the ‘Patient Registration’ and ‘Patient Insurance’ screen also displays the
updates done through Insurance Eligibility Demographic Updates.
Copyright 2012, Bizmatics, Inc. 4010 Moorpark Avenue, Suite 222, San Jose, CA 95117
User Quick Guide Insurance Eligibility Demographic Updates
Fig: Patient Registration History
Fig: Patient Insurance History on click of button ‘history’.
Copyright 2012, Bizmatics, Inc. 4010 Moorpark Avenue, Suite 222, San Jose, CA 95117
User Quick Guide Insurance Eligibility Demographic Updates
Fig: Audit Trail Report
Tabular Report
A new tabular report named ‘Patient Eligibility Demographic Mismatch List’ Code TELIG 304
has been introduced along with this feature. The report gives a consolidated list of all current
patients who are flagged to have some mismatch in Patient and Subscriber Demographics in
PrognoCIS while comparing with Insurance Eligibility Demographic information fetched in
selected date range. By running this report user will also be able to access Insurance Eligibility
Details and Insurance Eligibility Demographic Updates. It will allow working on all patients with
mismatches from a single list.
Last Eligibility fetched Date is considered here. 1st Hyperlink for each patient is 'Insurance
Eligibility Details' which when clicked will open the Eligibility Details pop-up which will show
latest Eligibility Details fetched. The second hyperlink is 'Insurance Eligibility Demo Updates'.
By clicking this link, the Demographics Updates pop-up will open where the list of Patient and
Subscriber fields from PrognoCIS and Eligibility are shown for comparison. The users will be able
to update one or more mismatched fields by selecting the appropriate fields and clicking button
update. The update button will be disabled if a user doesn’t have appropriate user role
assigned. The patient goes away from the report if all mismatched fields are updated or ignore
button is clicked to ignore the mismatches.
Fig: Patient Eligibility Demographic Mismatch List
Same two columns 'Insurance Eligibility Details' and 'Insurance Eligibility Demo Updates' are
also added in tabular report ‘Eligibility Report for patients on schedule’ Code TELIG 301.
Copyright 2012, Bizmatics, Inc. 4010 Moorpark Avenue, Suite 222, San Jose, CA 95117
User Quick Guide Insurance Eligibility Demographic Updates
Fig: Eligibility Report for patients on schedule
Upcoming Enhancement: Efforts are being made to make the Insurance Eligibility Demographic Updates Feature more effective. During Patient Registration, if users are let to add basic minimum information required for fetching eligibility like Insurance and Subscriber ID, we can trigger automatic Eligibility fetching action and also do automatic Demographic fields comparison and update the blank fields. This way, users will not be required to add fields like Patient Address, SSN, Subscriber Details, Plan Details manually. Defining Patients will become very easy and quick.
Document Details
Created by: Meghna Chakravorty
Created date: March 14, 2016
Verified By: Malvika Tarnekar
Last updated: May 13th, 2016
Version Introduced In: V2B2.1 (Patch)
Document Version: DemographicUpdates_2016_V3B2.1