Updating Payors

Shama was saying a screen was missing and requiring her to go back and add necessary info - for example the missing info can include the subscriber details when the relationship is anything other than “self” and would include the subscriber name and DOB when the relationship is spouse or child.

The objective here is to prompt all within one screen during the insurance change process for the user to gather all of their needed details from the patient for the insurance subscriber.

The current process for updating these details is to make the insurance change and then circle back to the details being the payor and input the subscriber name and DOB if the subscriber is someone other than the patient themself.

There are really 2 avenues for improvement here that may help. With the first having a simplified workflow for the teams to follow, the SBP coverage correction tool option helps to enforce that the coverage correction process must be followed by users upon saving a change to the payors. This also provides the benefit of an updated workflow that does not have the user have to later go back and add the details for the parent or spouse if the policy is from a different member of the family. The second area of consideration is the ledger verifier that can help to surface when there are potential issues and help to resolve them early. The ledger verifier can be set to run automated solvers when there is a proposed solution from Raintree. This can also be run as a scheduled report that can help to highlight if and when there are common mistakes that can be used for internal training.

Dependency for the proposed solution to use SBP workflow is a new enhancement that is behind a feature flag in latest service packs that the database would need to be on recent Raintree production service pack.

Not applicable