Admin Report Screen





 

Report Name

Function

Required Parameters

Optional Parameters
Print Employee EOBs This prints off an Employee Explanation of Benefits statement according to the parameters specified by the user.
  • Claim Type
  • Claim No OR
  • Check No OR
  • Print all PROC Claims OR
  • Effective Date Range
  • Effective Date AND End Date
  • Group Number
  • Suppress Check
  • Dollar Amount (functions as Threshold)
  • Force Old Address
  • Force Check Reprint
  • Date End (functions as ProcDate)
    		•
    Print Provider Statements This prints off an Provider Statement according to the parameters specified by the user.
  • Claim Type
  • Claim No OR
  • Check No OR
  • Print all PROC Claims OR
  • Effective Date Range
  • Effective Date AND End Date
  • Group Number
  • Suppress Check
  • Dollar Amount (functions as Threshold)
  • Force Old Address
  • Force Check Reprint
  • Date End (functions as ProcDate)
    		•
    Print STD Checks This prints off an std check for the individual(s) specified by the parameters.
  • Effective Date
    		•
  • Group Number
    		•
    Print Pend Letters This will print a letter for each claim marked pend (max of 8 potential letters) which are in the group specified by the user.
  • Group Number
    		•
  • Claim Number
    		•
    Claims to Print List This will print of a report of all remaining claims to be printed. If Effective Date Range is used, the earliest date of service for the claim must fall within that range for the claim to appear in the report.
  • Claim Type
  • Group Number
    		•
  • Effective Date
  • End Date
  • Dollar Amount
    		•
    Print Flex Checks This prints an employee flex check and statement, for the specified group, that apply within the specified date range.
  • Group Number
  • Effective Date
  • End Date
    		•  None


     

    Extract Name

    Function

    Required Parameters

    Optional Parameters
    NMHCS Elig

    summary of column titles     		Generates a tab de-limited table in a file of user specified filename. It prints one row for each Employee and Spouse and Dependent who has medical coverage.
  • Group or Unit Number
  • Effective Date
    		•  None
    Claims Extract

    summary of column titles     		Extracts claims into user specified file containing all claims of specified claim type, with data entry date between Date Begin and Date End parameters. If r is checked, after creating the file, the program will create a printer friendly report containing claims summary totals. If Effective Date range is specified, it will be applied to earliest DOS.
  • Group or Location or Unit
  • Claim Status
  • Date Begin
  • Date End
  • R Checkbox(next to Claims Extract)
  • Effective Date
  • End Date
    • Vendor Extract

    summary of column titles     		Extracts data into user specified file containing coverage information each employee, spouse and dependent. One individual per row, in the tab-delimited table.
  • Group Number
    		• None
    Accum Extract

    summary of column titles     		Extracts data into tab-delimited table, in a user specified file. In each row there will be a unique Individual, Benefit Count, Year, Amount. Dependents are included.
  • Group, Location or Unit
    		• None
    RX Extract

    summary of column titles     		Extracts data into tab-delimited table, in a user specified file. In each row contains one unit of the specified group.
  • Group Number
    		• None
    Census Extract

    summary of column titles     		Extracts the census data into tab-delimited table, in a user specified file. If r is checked, after creating the file, the program will create a printer friendly report containing the census extract data. If a group location or unit is not specified, an extract will be performed on all groups.
  • Effective Date
  • Group, Location or Unit Number
  • R Checkbox(next to Census Extract)
  • FV Checkbox(next to Census Extract)
  • Do Cobra on Census
  • Network Summary
  • Do Terms on Census
  • Do Deps on Census
    		•
    1099 Extract

    summary of column titles     		This generates a 1099 Extract file containing provider information, and if G is checked, a printer friendly 1099 graphic will be produced. If NG is checked the graphic will not appear, but the 1099 information will print 2 per page.
  • Effective Date
  • End Date
  • Group Number
    		•
  • NG Checkbox(next to 1099 Extract)
  • G Checkbox(next to 1099 Extract)
    • Event Extract

    summary of column titles     		Scans for telephone and event information within user specified time period and extracts it to a file.
  • Effective Date
  • End Date
    		•
  • Unit, Location, or Group Number
    		•


     

    Button Name

    Function
    Backup/Restore Opens up a window to specify parameters for Backuping and Restoring data.
    BCodes/PlanAccs Opens a window to edit Benefit Line Codes, Benefit Line Code Groups, and Plan Accumulators.
    Edit Misc Tables Opens a window to edit MCC Codes/External Unit IDs, Check and ID Card Graphics and Correspondence Messages.
    Special Functions Opens a window to execute certain actions, involving option moves, accumulator regeneration, and web access pins.


     

    Report Name

    Function

    Required Parameters
    Delete Claim Clicking this button will delete the specified claim.
  • Claim Number
    		•
    Post Refund This creates a new claim containing the same data as the claim to be refunded, except with negative charges up to the dollar amount of the refund specified. This will also decrement the accumulators by the appropriate amount and will also credit next years accumulators as well, if carryover is applicable. Only dollar accumulators are decemented, since partial refunds are allowed.
  • Claim Number
  • Dollar Amount
    		•
    Adjust Claim This creates a new claim containing the same data as the claim to be refunded, except with negative charges. This will also decrement the accumulators by the appropriate amount and will also credit next years accumulators as well, if carryover is applicable.
  • Claim Number
    		•
    Void Check This function changes the status of the check associated with the specified claim to void. The checks would then appear in the Check Register as voided checks.
  • Claim Number OR
  • Group Number AND Check Number
    • Change SSN Will go into the database and swap the new SSN for the old SSN in the following tables: claims, empacc, contrib, corspond, emppay, depend, empplan, event, unithistory, addrhistory, eligible, elignotes, ancillaryelig, internet, session, checks, flexcards, flexclaims, flexpayments, flexplan, mbiupdates, stdchecks, and stdclaims.
  • Old SSN
  • New SSN
    		•
    Processor Prod The Processor Productivity Report reports the number of claims processed per operator per group in the specified date range.
  • Effective Date
  • End Date


    •  

    Button Name

    Function
    Import Claims Imports a properly file from FutureVision, a claims OCR company, containing MED, DEN or UB claims.
    CCN This imports all original and update repricing files delivered by CCN. If the TPA has repricing option 1 selected, CCN tables will be used for repricing claims. To use this feature to import multiple files, use Ctrl-Click selection in the file dialog box.
    MBI Access The MBI Access screen is where the TPA controls import and export text file communication with MBI Flex services. This screen also provides exception handling capability.
    ADP This imports ADP U&C national repricing files.
    PMCS Access The PMCS Access screen is where the TPA controls import and export text file communication with PMCS Out-of-Network claims services.


     

    Parameter Name

    Definition

    Used with Buttons/Reports
    Claim Type This parameter is used to determine which time of Claims are to be printed. Options include: ALL, DEN, MED and VIS.
  • Print Employee EOBs
  • Print Provider Statements
  • Claims to Print List
    		•
    Dollar Amount This is a dollar amount to associate with the given report. In printing Claims to Print List, Employee and Provider EOBs this functions as a threshold. In these three reports if no Dollar Amount is entered, it will default to 1000000.
  • Print Employee EOBs
  • Print Provider Statement
  • Claims to Print List
  • Post Refund
    		•
    Group Number The Group is the highest level of the four level eligiblity hierarchy.
  • Print Employee EOBs
  • Provider Provider Statement
  • Print STD Checks
  • Print Pend Letters
  • Print Flex Checks
  • Claims to be Printed List
  • NMHCS Elig
  • Claims Extract
  • Vendor Extract
  • Accum Extract
  • RX Extract
  • Census Extract
  • 1099 Extract
  • Event Extract
  • Void Check
    		•
    Location The Location is the second highest level of the four level eligiblity hierarchy.
  • Claims Extract
  • Accum Extract
  • Census Extract
  • Event Extract
    		•
    Unit Number
    		 The Unit is the third highest level of the four level eligiblity hierarchy.
  • NMHCS Elig
  • Claims Extract
  • Accum Extract
  • Census Extract
  • Event Extract
    		•
    Claim Status This is one of the four states the claim may be in at any given time. The four states are: DATA, PEND, PROC, or DONE.
  • Claims Extract
    		•
    Date Begin Used in a secondary date range, where reports/extracts need two date ranges. In Claims Extract a claim's data entry date needs to fall within the date range specified using this parameter to be included in the report.
  • Claims Extract
    		•
    Date End Used in a secondary date range, where reports/extracts need two date ranges. In Claims Extract a claim's data entry date needs to fall within the date range specified using this parameter to be included in the report. For employee and provider EOBs, this parameter is actually the Proc Date. If Proc Date is not specified it defaults to 1/20/2045.
  • Claims Extract
  • Print Employee EOBs
  • Print Provider Statement
    		•
    Claims Ext (R) If this option is selected, after extracting the claims, the program will generate a Claims Extract Summary Report.
  • Claims Extract
    		•
    Census Ext (R) If this option is selected, after extracting the claims, the program will generate a Census Extract Summary Report.
  • Census Extract
    		•
    1099 Ext NG If this option is selected, after the 1099 data is extracted, a non-graphical 1099 report will be generated, 2 per page.
  • 1099 Extract
    		•
    1099 Ext G If this option is selected, after the 1099 data is extracted, a graphical 1099 report will be generated, 1 per page.
  • 1099 Extract
    		•
    Claim No This is a reference to the Claim Number given to each claim when entered.
  • Print Employee EOBs
  • Print Provider Statements
  • Print Pend Letters
  • Delete Claim
  • Post Refund
  • Adjust Claim
  • Void Check
    		•
    Check No The unique identification number of an individual check.
  • Print Employee EOBs
  • Print Provider Statements
  • Void Check
    		•
    Effective Date This is the starting date of the primary date range used in reports and extracts.
  • Print Employee EOBs
  • Print Provider Statements
  • Print Flex Checks
  • Claims to be Printed List
  • NMHCS Elig
  • Claims Extract
  • Census Extract
  • 1099 Extract
  • Event Extract
  • Processor Prod
    		•
    End Date This is the ending date of the primary date range used in reports and extracts.
  • Print Employee EOBs
  • Print Provider Statements
  • Print Flex Checks
  • Claims to Print List
  • Claims Extract
  • 1099 Extract
  • Event Extract
  • Processor Prod
    		•
    Print all PROC Claims If this option is selected all PROC claims will be printed.
  • Print Employee EOBs
  • Print Provider Statements
    		•
    Suppress Check If this option is selected, when an Employee or Provider EOB Statement is to be printed, the associated check will be suppressed.
  • Print Employee EOBs
  • Print Provider Statements
    		•
    Force Check Reprint This will reprint a check associated with an Employee or Provider EOB Statement even if it has already been printed once.
  • Print Employee EOBs
  • Print Provider Statements
    		•
    Force Old Address This will use the employee's old address in the EOB statement and Pend letters.
  • Print Employee EOBs
  • Print Pend Letters
    		•
    Do Cobra on Census Selecting this option includes COBRA people in the census extract.
  • Census Extract
    		•
    Network summary Selecting this option groups employees by their associated network in the census extract.
  • Census Extract
    		•
    Do Terms on Census Selecting this option includes terminated people in the census extract.
  • Census Extract
    		•
    Do Deps on Census Selecting this option includes dependents in the census extract.
  • Census Extract
    		•
    SSN Old This is the current SSN of an employee currently existing in the database. The Employee is the lowest level of the four level eligiblity hierarchy.
  • Change SSN
    		•
    SSN New When changing an SSN, this is the new SSN of the employee. When changing SSNs, if the new SSN already references someone else, and error will occur.
  • Change SSN
    		•


      The Done button closes the Admin Report Screen, returning you to the main control area.