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Travelers Admin Settings 8.31.07

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Title page


Travelers Implementation Administration Reference Guide

==

IEP (Import Export Program) Settings:

  • Import/export tab—set up queues—reference standard IEP reference guide
File:Travelers Admin Settings 8 31 07 02.jpg
  • Validation Tab:
  • Import Defaults/Rules:
File:Travelers Admin Settings 8 31 07 01.jpg

Company office--blank

  • Coverage Type--blank
  • Provider Specialty—blank
  • Use Data Importer—unchecked
  • Index Claim # Only—unchecked
  • One Claimant per Claim—checked
  • Always index claimant on Last/First---*need to check with Travelers….if send clmt suffix, do not check
  • Specialty Cross Walk---unchecked
  • Add New Providers---unchecked
  • Use Custom Provider Matching—unchecked
  • Permit Line Allowed Amount Greater Than Charged Amount---unchecked
  • Pass all endnotes---*need to check with Travelers….if unchecked, passed what's on EOB, if checked, will have everything including original endnotes, etc
  • No Claim match on DOL---unchecked
  • No Claim match on Client Claim Rep id on update---unchecked
  • Bypass Provider Specialty/State validation---unchecked
  • Do NOT Add Adjuster when not found---checked
  • Export Rules:
  • Generate XML Export—checked
  • Always--(radio button selected)
  • Request Bill (RB) Only---(radio button grayed out)
  • Send Bill Delay Status---checked
  • Manual Change Notification:
  • Always--(radio button selected)
  • Submit Bill (SB) Only---(radio button grayed out)
  • Submit bill on PPOM returns—unchecked
  • Manual New Assigned User (MNA) –checked
  • Manual New Reason—checked
  • Manual Update Bill (MUB)—checked
  • Exported Messages:
  • Full XML Export--(radio button selected)
  • Abbreviated xml export---(radio button grayed out)
  • Export Long Descriptions—checked
  • Bodily Injury Tab:
  • Use First _____ of Claim # on Export

PPO/IEP:

  • Connection Tab:
  • 35—Select Add
  • 40---Company Name: Travelers, then Select OK
File:Travelers Admin Settings 8 31 07 12.png
File:Travelers Admin Settings 8 31 07 13.png
  • Connection Properties
  • 42-45: All fields TBD by Mmed
  • Select the networks this company uses:
  • 46-Select Corvel
File:Travelers Admin Settings 8 31 07 14.png
  • Import Properties Tab:
  • File Locations
  • 50-Names Directories TBD by Mmed
  • 51-Delete File After Processing—unchecked
  • 52-Move File After Processing--checked
 
  • 53-Move File To: TBD by Mmed
  • 54-Rejects Folder: TBD by Mmed
  • File Type: 55-XML
  • 56-Retain Decision Point Allowed amount if lower—unchecked
  • 57-Stop PPO Rejections--unchecked
File:Travelers Admin Settings 8 31 07 07.jpg
  • Export Properties Tab:
  • File Locations:
  • 59-Export Path TBD by Mmed
  • 60-Combine File—unchecked
  • 61-Export Files Individually—checked
  • 62-Filename—leave blank
  • 63-File Type: Defaults to XML
  • 64-Append Date-Time Stamp to Filename--checked
File:Travelers Admin Settings 8 31 07 08.jpg
  • Run Times Tab:
  • 65-Run Import:
  • 66-Run On Interval selected, 67-Start 12:00am, 68-End 12:00am
  • 69-Check Interval 1 minutes
  • 70-Run Once deselected
  • 71-Run at—leave blank
  • 72-Run Export:
  • 73-Run On Interval selected, 74-Start 12:00am, 75-End 12:00am
  • 76-Check Interval 1 minutes
  • 77-Run Once deselected
  • 78-Run at—leave blank
File:Travelers Admin Settings 8 31 07 09.jpg
  • Identifying Info Tab:
  • 79-Payor Name—Travelers
  • 80 & 81—TBD by Mmed
File:Travelers Admin Settings 8 31 07 10.jpg
  • Monitoring Tab:
  • 82-Enable Heartbeat –checked
  • 83-Write to Event Log every 1 minutes
  • 84-Email recipient when reject occurs
  • 85-Need email address from Travelers
  • 86-Once an hour—unchecked
  • 87-Once a day at 12:00am--checked
File:Travelers Admin Settings 8 31 07 11.jpg

Decision Point:

  • Administrator Profiles:
  • Analyst Headers/Footers:
  • Create address under each State/Coverage profile. Office address created for each profile.
File:Travelers Admin Settings 8 31 07 15.png
  • Expert Headers/Footers:
  • Create expert header and footer under each State/Coverage profile. "For Internal Use Only" header and footer created for each profile.
File:Travelers Admin Settings 8 31 07 16.png
  • Bill Line Display:
  • 5 & 6-Alert When Days Pending > --Set at Profile Level per State and Coverage
  • 401—Bill Line Display—Bill #, Date Received, Bill Status Reason, Bill Status, DOS Range, Amount Charged, Amount Allowed, & Check Total
File:Travelers Admin Settings 8 31 07 03.jpg
  • Analyst Edits:
  • Select appropriate analyst edit settings under each State/Coverage profile. All profiles the same with all edits selected except, PA Chiropractic Limitations. All SOJ/ZOS settings same as screen shot below.
File:Travelers Admin Settings 8 31 07 17.png
  • Diagnosis Edits:
  • Select appropriate diagnosis edit settings under each State/Coverage profile. All settings the same for all profiles as seen in this screen shot.
File:Travelers Admin Settings 8 31 07 18.png
  • Limit/Duration Settings:
  • Select appropriate limit/duration settings under each State/Coverage profile. All settings the same for all profiles as seen in this screen shot.
File:Travelers Admin Settings 8 31 07 19.png
  • Analyst Defaults:
  • Select appropriate analyst default settings under each State/Coverage profile. All settings the same for all profiles as seen in this screen shot.
File:Travelers Admin Settings 8 31 07 20.png
  • Policy Defaults:
  • Policy Limit, Co-Payment, Co-Payment Maximum, & Deductible left blank.
  • Limit Warnings Enables—checked
  • Only Include Committed Bills in Policy Limits—unchecked
  • Warn user when ___ % of limit used---leave blank
  • 1-Enable Bill Release—checked
  • 2- Enforce Policy Limits on Bill Release screen—unchecked
  • 3- Maximum # of payments per bill—checked
  • 4- Enter 3 in box
  • 322-Allow Submit from Find Bill screen--unchecked
File:Travelers Admin Settings 8 31 07 04.jpg
  • Fee Schedules:
  • Select appropriate fee schedule settings under each State/Coverage profile. All profiles reflect screen shot except, KY, MD and FL in which Ingenix is turned off.
File:Travelers Admin Settings 8 31 07 21.png
  • Provider Networks:
  • Select Corvel and enter in contract dates under appropriate State/Coverage profile
  • Only when Bill is not pended should be checked for both Auto Send and Auto Resend (only one option is selectable)
  • Bypass--checked
File:Travelers Admin Settings 8 31 07 22.png
  • Special Edits:
  • Select appropriate special edit settings under each State/Coverage profile

Emergency Room Service Edit and Duplicate Bill Checking the same for all profiles.

Inclusive Edits: PA—Primary--NCCI, Secondary--Analyst. OR—Primary—Analyst, Secondary—None. All other profiles, Primary –Analyst, Secondary--NCCI.

Mutually Exclusive and Comprehensive/Component Edits: PA and All Other set to deny. OR set to ignore.

File:Travelers Admin Settings 8 31 07 23.png
  • Sentry Rules:
  • Complete list of Sentry Rules to be provided once they have been finalized. Current rules will need to be updated with Pend and Lock Criteria for MRT Routing.
  • Logon (DLL) & Security Administrator:
  • 8- Default Adjuster field on Find Bill screen--check
File:Travelers Admin Settings 8 31 07 05.jpg
  • Set up rights groups with appropriate functions and reports access
File:Travelers Admin Settings 8 31 07 24.png
  • FL CPI Values:
  • Need to update with 2007 values
File:Travelers Admin Settings 8 31 07 25.png
  • Provider Matching Profile:
  • Provider Match Weighting should be set at 100% for TIN
File:Travelers Admin Settings 8 31 07 26.png
  • Autopay:
  • Enable AutoPay—checked
  • Lock Committed Bills—checked, with account locked to some designated user (should be an Admin user—Travelers to identify who)
  • Transaction Type:
  • Approved for Payment
  • Reverse Decision to Commit: Allow?
  • Reconsider: Allow
  • Set Bill Status Reason to: Travelers Value
  • Update Bill Description: No
  • Reissue Payment
  • Reverse Decision to Commit: Allow?
  • Reconsider: Allow?
  • Set Bill Status Reason to: Travelers Value
  • Update Bill Description: No?
  • Reject Payment
  • Reverse Decision to Commit: Automatically perform--check
  • Reconsider: Don't Allow
  • Set Bill Status Reason to: Travelers Value
  • Update Bill Description: No (Travelers will feed the value to use in the return xml)
  • Mitchell Error
  • Reverse Decision to Commit: Allow
  • Reconsider: Allow
  • Set Bill Status Reason to: Travelers Value
  • Update Bill Description: "Error occurred in processing payment – call Mitchell Technical Support at 1-800-424-1132, option 2."
File:Travelers Admin Settings 8 31 07 27.png
  • Enhancement #372: Editable & Configurable Bill Status Reasons:
  • Need to define list for NY and non-NY to display and customize any additional from the existing list
File:Travelers Admin Settings 8 31 07 28.png
File:Travelers Admin Settings 8 31 07 29.png
File:Travelers Admin Settings 8 31 07 30.png
  • CTG Administration:
  • Need Serial # to turn on CTG
  • 20- Specialty List should match screen shot

313-Auto-apply IME records to the NY Bill Release

File:Travelers Admin Settings 8 31 07 06.jpg

screen--unchecked


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