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    BCBSM Nasco 3 Party (Non-NASCO) Subsidiary/Other LOB/BCBSA Organizational Unit Solution Option

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    Roby Raj
    This document discusses options to enhance the error resolution process for ASC claims loading. It describes two options: 1. Utilize a new billing configuration extract file to bill vendor claims (covering drugs, dental, vision, and Medicare Advantage medical) to ASC groups instead of local rating tables. 2. Leverage the existing ASC claims loader and error resolution process, and make targeted enhancements to address specific issues. The document provides a high-level overview of the impacted systems and organizations for each option, and indicates that option 1 has an estimated duration of 6 months to 1 year and cost of $100,000 to $500,000.

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    BCBSM Nasco 3 Party (Non-NASCO) Subsidiary/Other LOB/BCBSA Organizational Unit Solution Option

    Uploaded by

    Roby Raj
    53 views3 pages
    This document discusses options to enhance the error resolution process for ASC claims loading. It describes two options: 1. Utilize a new billing configuration extract file to bill vendor claims (covering drugs, dental, vision, and Medicare Advantage medical) to ASC groups instead of local rating tables. 2. Leverage the existing ASC claims loader and error resolution process, and make targeted enhancements to address specific issues. The document provides a high-level overview of the impacted systems and organizations for each option, and indicates that option 1 has an estimated duration of 6 months to 1 year and cost of $100,000 to $500,000.

    Original Description:

    C Arch

    Original Title

    17184 CADD

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    This document discusses options to enhance the error resolution process for ASC claims loading. It describes two options: 1. Utilize a new billing configuration extract file to bill vendor claims (covering drugs, dental, vision, and Medicare Advantage medical) to ASC groups instead of local rating tables. 2. Leverage the existing ASC claims loader and error resolution process, and make targeted enhancements to address specific issues. The document provides a high-level overview of the impacted systems and organizations for each option, and indicates that option 1 has an estimated duration of 6 months to 1 year and cost of $100,000 to $500,000.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    53 views3 pages

    BCBSM Nasco 3 Party (Non-NASCO) Subsidiary/Other LOB/BCBSA Organizational Unit Solution Option

    Uploaded by

    Roby Raj
    This document discusses options to enhance the error resolution process for ASC claims loading. It describes two options: 1. Utilize a new billing configuration extract file to bill vendor claims (covering drugs, dental, vision, and Medicare Advantage medical) to ASC groups instead of local rating tables. 2. Leverage the existing ASC claims loader and error resolution process, and make targeted enhancements to address specific issues. The document provides a high-level overview of the impacted systems and organizations for each option, and indicates that option 1 has an estimated duration of 6 months to 1 year and cost of $100,000 to $500,000.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    of 3

    Key

    17184 - ASC Claims Loader - Error Resolution Enhancements

    BCBSM

    Enterprise Resource Planning


    Vendored Claims
    443

    Dental Claims Processing

    325 6

    NASCO

    Medicare Advantage

    Underwriting and Rating


    SQL

    120

    Rating System
    SQL

    603 5

    621 5

    NASCO - NPS - Claims

    Heritage Vision
    SQL
    DB2 Rating Table

    SQL

    704 7

    VSP - Vision Service Plan


    Reports

    ASC Claims

    NDM

    Claims

    SQL
    510 5

    SQL

    786 0

    MetaVance - MembersEdge Membership and Billing

    MEDCO / ESI - Pharmacy


    Claims

    774 9

    DNoA - Claims Interface

    Enterprise Architecture Services - Document: Current Filename: 17184 - ASC Claims Loader Error Resolution Enhancements - Candidate Architecture - Wegienek 20160324.vsdx Updated: March 29, 2016

    Blue

    BCBSM

    Red

    NASCO

    Purple

    3rd Party (Non-NASCO)

    Green

    Subsidiary/Other LOB/BCBSA

    White/Blue

    Organizational Unit

    White/Black

    Solution Option

    Key

    17184 - ASC Claims Loader - Error Resolution Enhancements

    ASO Claims/Capitation
    Pass Thru Configuration
    Extract File

    NDM

    Blue

    BCBSM

    Red

    NASCO

    Purple

    3rd Party (Non-NASCO)

    Green

    Subsidiary/Other LOB/BCBSA

    White/Blue

    Organizational Unit

    White/Black

    Solution Option

    BCBSM
    Enterprise Resource
    Planning
    Vendored Claims
    443

    Dental Claims Processing

    325 6

    Medicare Advantage

    NASCO

    SQL

    SQL

    2
    B

    603 5

    621 5

    NASCO - NPS - Claims

    Heritage Vision
    SQL

    DB2 ASO Claims/


    Capitation P ass Th ru
    Configuration Extract File

    SQL

    704 7

    VSP - Vision Service Plan


    Reports

    ASC Claims

    NDM

    ASO Claims/Capitation
    Pass Thru Configuration
    Extract File

    Claims

    SQL
    510 5

    786 0

    SQL

    MetaVance - MembersEdge Membership and Billing


    A

    MEDCO / ESI - Pharmacy


    Claims

    774 9

    DNoA - Claims Interface

    1. Utilize new MTV billing configuration


    extract file (to be delivered under
    CFS026) to bill vendor
    claims (covering lines of business drugs,
    dental, vision, and medical under
    Medicare Advantage) to ASC groups
    instead of Local Rating Tables.

    Rough Order of Magnitude


    TIER
    DURATION
    ROM RANGE

    0 - Insignificant

    ESTIMATION CONFIDENCE
    Socialization
    Status

    Enterprise Architecture Services - Document: Option 1 Filename: 17184 - ASC Claims Loader Error Resolution Enhancements - Candidate Architecture - Wegienek 20160324.vsdx Updated: March 29, 2016

    6 months - 1 year
    100-500k
    Medium

    Peer
    review

    3/24/2016

    Business

    Govern ance

    3/29/2016

    review

    review

    Key

    Enterprise Architecture Services - Document: KEY Filename: 17184 - ASC Claims Loader Error Resolution Enhancements - Candidate Architecture - Wegienek 20160324.vsdx Updated: March 29, 2016

    Blue

    BCBSM

    Red

    NASCO

    Purple

    3rd Party (Non-NASCO)

    Green

    Subsidiary/Other LOB/BCBSA

    White/Blue

    Organizational Unit

    White/Black

    Solution Option

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