Friday, January 27, 2017

Back End Validation of Pre-existing conditions in Facets

As per  Affordable Care Act (ACA) popularly known as Obamacare, no NGF health plan can apply pre-existing conditions from 2014. This is one of the popular and major pillars of ACA. President Donald Trump and Republicans want to repeal and replace ACA but they all like the pre-existing conditions related provision of the ACA. So, we do hope , if Obamacare is repealed and replaced, still the pre-existing condition policy of the ACA  will will be incorporated in  the Replacement Act in some form. So, developers, configuration analysts, quality assurance analysts and testers has a great role to implement this provision of the law.

Facets application is a great tool to handle pre-existing condition policy. In my previous post, I have narrated how to validate whether the health plan of a group has excluded pre-existing condition or not. It was Facets front end validation. Now let us discuss how to perform  Facets back end validation. In order to perform this validation, you need the product id of the particular health plan and access to the database .

Step 1: Open Facets Medical Plan application group and scroll down to Product application.
Step 2: Now press Ctrl+O on the keyboard and enter product Id in edit box and click OK. you will find the different information of the products on the right hand site of the window.
Step 3: Double click on "Components" section and Facets will display you all the product component prefixes of the product. Note 4 digit (alphanumeric) Administrative Information prefix id . Suppose it is A001

Step 4: Now open your database and open the  Administrative Information table of the database.
Step 5: Now run a query using Administrative Information prefix id.


Now check the pre-existing months column of the query result. You will see here 0 months if there is no pre-existing condition in the particular health plan.

4 comments:

  1. As per ACA, Insurance companies can't deny coverage or charge more for people with preexisting conditions. Insurance companies can no longer deny any insured person for any reason other than fraud. This is the beauty of the Obamacare. The benefits, rights, and protections offered to those with preexisting conditions only apply to plans that have to comply with the Affordable Care ACT(ACA)

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