Benefit Enrollment and Maintenance (834)
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Admission (Outpatient)
- Benefit Enrollment and Maintenance (834)
- Cross Episode Financial Eligibility
- Guarantors/Payors
- Pre-Fill Financial Eligibility Data (834) Setup
- Registry Settings (PM)
- Update Client Data
- User Definition
Scenario 1: Benefit Enrollment and Maintenance (834) - Load/ Compile/ Post File
Specific Setup:
- Registry Settings:
- 'Enable 834 Transaction Set' = Y.
- 'Pre-Fill Financial Data (834/271)' = Y.
- 'Update Demographic Data When Posting Eligibility File' = Y.
- Tester has access to the 'Benefit Enrollment and Maintenance (834)', 'Pre-Fill Financial Eligibility Data (834/271) Setup', 'Guarantors/Payors', 'Update Client Data' and 'Cross Episode Financial Eligibility'' forms.
- Guarantors/Payors:
- Select a guarantor to use for 270 / 271 / 834 activity. Note the 'Financial Class' and 'Default Guarantor Plan'.
- 270 / 271 / 834 section:
- Insurer Identifier Code Qualifier (1000B-N1-03) = Code Assigned By Organization That Is Destination Of Transaction Set.
- Insurer Identifier Code (1000B-N1-04) = desired value, noting the value.
- Pre-Fill Financial Eligibility Data (834/271) Setup:
- 'Guarantor = above guarantor.
- Benefit Plan = above 'Default Guarantor Plan'.
- Insert Guarantor Before or After Financial Classes = desired value.
- Financial Class = above 'Financial Class'.
- Client:
- 'Client 1' is enrolled with no demographic data, no cross episode financial eligibility data, and no 'Benefit Enrollment and Maintenance (834)' submission.
- 'Client 2' is enrolled with no demographic data, no cross episode financial eligibility data, and no 'Benefit Enrollment and Maintenance (834)' submission.
- Benefit Enrollment and Maintenance (834)
- A file exists for 'Client 1' only, that contains the above guarantor, the 'Insurer Identifier Code (1000B-N1-04)' value, and demographic data. 'File 1'.
- A file exists for 'Client 1' and 'Client 2', that contains the above guarantor, the 'Insurer Identifier Code (1000B-N1-04)' value, and demographic data. 'File 2'. Update at least one field of demographic data for 'Client 1', noting the value.
Steps
- Open 'Benefit Enrollment and Maintenance (834)'.
- Load, compile, and post 'File 1'.
- Open 'Update Client Data' for 'Client 1'.
- Validate that the demographic data displays correctly.
- Close the form.
- Open 'Cross Episode Financial Eligibility' for 'Client 1'.
- Validate that the guarantor information displays correctly.
- Close the form.
- Open 'Benefit Enrollment and Maintenance (834)'.
- Load, compile, and post 'File 2'.
- Open 'Update Client Data' for 'Client 1'.
- Validate that the demographic data that was edited displays correctly.
- Close the form.
- Open 'Cross Episode Financial Eligibility' for 'Client 1'.
- Validate that the guarantor information did not change.
- Close the form.
- Open 'Update Client Data' for 'Client 2'.
- Validate that the demographic data displays correctly.
- Close the form.
- Open 'Cross Episode Financial Eligibility' for 'Client 2'.
- Validate that the guarantor information displays correctly.
- Close the form.
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Topics
• Benefit Enrollment and Maintenance (834)
• Cross Episode Financial Eligibility
• Update Client Data
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