Travelers Admin Settings 8.31.07

Title page

Travelers Implementation Administration Reference Guide

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IEP (Import Export Program) Settings:


 * Import/export tab—set up queues—reference standard IEP reference guide




 * Validation Tab:


 * Import Defaults/Rules:



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






 * Connection Properties


 * Select the networks this company uses:
 * 46-Select Corvel




 * Import Properties Tab:


 * File Locations
 * 50-Names Directories TBD by Mmed
 * 51-Delete File After Processing—unchecked


 * 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


 * Export Properties Tab:


 * File Locations:


 * 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


 * 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




 * Identifying Info Tab:


 * 79-Payor Name—Travelers
 * 80 & 81—TBD by Mmed




 * 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



Decision Point:


 * Administrator Profiles :


 * Analyst Headers/Footers:


 * Create address under each State/Coverage profile. Office address created for each profile.




 * Expert Headers/Footers:


 * Create expert header and footer under each State/Coverage profile. "For Internal Use Only" header and footer created for each profile.




 * 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


 * 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.




 * 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.




 * 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.




 * 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.




 * 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


 * 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.




 * 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




 * Special Edits:

Emergency Room Service Edit and Duplicate Bill Checking the same for all profiles.
 * Select appropriate special edit settings under each State/Coverage profile

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.




 * 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
 * 8- Default Adjuster field on Find Bill screen--check




 * Set up rights groups with appropriate functions and reports access




 * FL CPI Values:


 * Need to update with 2007 values




 * Provider Matching Profile:


 * Provider Match Weighting should be set at 100% for TIN




 * 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."




 * 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
 * Need to define list for NY and non-NY to display and customize any additional from the existing list







313-Auto-apply IME records to the NY Bill Release
 * CTG Administration:
 * Need Serial # to turn on CTG
 * 20- Specialty List should match screen shot
 * 20- Specialty List should match screen shot

screen--unchecked