The Medical Plan application group contains
the applications that are used to construct plans to administer Medical
benefits to groups. Medical Plans are the benefit offerings that the group has purchased.
The plan is the marketing name for a particular set of benefits. The product is
the actual combination of components, rules and regulations that make up the
set of benefits. Each plan is linked to a product category (Medical, Medical,
Life, Vision, etc.) and a product. The following applications are part of this
application group:
1.
Administrative Information
2.
Administrative Rules, Medical
3.
Alternate Funding Rules
4.
Area & Industry Rate Factors
5.
Automatic Action Criteria
6.
Benefit Summary
7.
Billing Component
8.
Claim Interest Rates
9.
Claim/UM Matching Parameters
10.
Class/Plan Definition
11.
Clinical Editing Admin Rules
12.
COB Rules
13.
Component Prefix Descriptions
14.
Conversion Factor Definition, Medical
15.
Covering Provider Set
16.
Deductible Rules
17.
Duplicate Claim Rules, Medical
18.
Duplicate UM Rules
19.
EOB Information
20.
Group Administration Rules
21.
HCFA AAPCC Rate Table
22.
HCFA Rate Factors
23.
In Area Zip Codes
24.
Limit Rules
25.
Network Set
26.
Other Party Liability
27.
Plan Descriptions
28.
Premium Rate Table
29.
Processing Control Agent
30.
Product
31.
R&C/Schedule, Medical
32.
RBRVS Zip Code Area
33.
Service Code Conversion
34.
Service Conversion Description
35.
Service Definition
36.
Service ID Descriptions
37.
Service Payment
38.
Service Pricing
39.
Service Related Parameters
40.
Service Rule Definition
41.
Service/Procedure Conversion
42.
Service/Revenue Code Conversion
43.
Supplemental Procedure Conversion
44.
Supplemental Revenue Code Conversion
45.
Trend Rate Factors
46.
UM Service Group
47.
Unit Value Pricing Definition, Medical
48.
User Warning Messages
49.
Volume Calculation
50.
Volume Reduction Calculation
51.
Warning Messages
52.
Zip Code Area Definition
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