Contents

• Title and Copyright Information
• Preface

1 What's New in This Release

• What's New in Siebel Healthcare Guide, Siebel CRM 20.7 Update
• What’s New in Siebel Healthcare Guide, Siebel CRM 20.1 Update
• What’s New in Siebel Healthcare Guide, Siebel CRM 19.1 Update

2 Overview of Siebel Healthcare

• Overview of Siebel Healthcare
• About Siebel Healthcare
• Siebel Healthcare Functionality
  • List of Reports

3 Getting Started with Siebel Healthcare

• Getting Started with Siebel Healthcare
• About Applications Administration Tasks
• Renaming Siebel Account Objects
• Configuring Lists of Values
• Configuring Summary Views
  • Editing a Summary View Layout
• Adding Products and Product Lines
• About Command Center
  • Command Center Interface Types
• Command Center Configuration and Administration
• Process of Configuring the Command Center Action Form
  • Defining the Command Center Business Object
  • Defining the Command Center Actions
  • Selecting the Command Center Responsibilities
  • Example of Configuring the Command Center Action Applet
  • Creating Global Commands for the Command Line Applet

4 Managing Companies

• Managing Companies
• About Managing Companies
• About Company Hierarchies
• Scenario for Managing Company Information
  • Sales Representative Tracks Company Information
• Process of Managing Companies
  • Administrator Procedures
  • End-User Procedures
• Setting Up Values for Companies
  • Adding Industries
  • Adding Territories
• Deleting Company Information
• Managing Competitor Information
  • Removing Records from the Competitors List
• Verifying Coverage Team Members
  • Searching for a Company without Coverage Team Members
  • Adding and Deleting Members of the Coverage Team for a Company
  • Changing the Primary Coverage Team Member for a Company
• Managing the Custom-Defined Relationship Types LOV
• Generating Company Hierarchies for Data Aggregation
  • Default Company Hierarchies
  • Dynamic Company Hierarchies
    • Associating Dynamic Hierarchies with an Organization
• Adding Companies and Investors (End User)
• Updating Company Profiles (End User)
• Viewing Company Hierarchies in Roll-Up Views (End User)
  • Viewing the Aggregated Coverage Team for a Company
  • Viewing the Aggregated Opportunities for a Company
  • Viewing an Aggregated List of Contacts for a Company
• Creating Company Assessments (End User)
• Adding Company Applications (End User)
• Adding Company Service Requests (End User)
• Managing Company Coverage Teams (End User)
• Viewing Company Summaries (End User)
• Viewing Company Relationship Hierarchies (End User)
  • Creating a Custom-Defined Relationship
• Displaying Lists of Investor Transactions or Holdings (End User)
  • Displaying a List of Holdings by Investor

5 Managing Contacts

• Managing Contacts
• About Managing Contacts
• Scenario for Adding a New Contact
  • Sales Representative Adds a New Contact
• Process of Managing Contacts (End User)
• Updating or Reviewing a Contact’s Holdings
• Updating or Reviewing a Contact’s Investment Profile
• Managing Contact Information (End User)
  • Adding Contacts
    • Associating a Contact with a Company
  • Creating Categories for Contact Information
  • Creating Notes About Contacts
  • Managing Contact Referral Information
    • Entering a Referral Received from a Contact
    • Creating a Referral to a Contact
• Creating Customer Assessments (End User)
• Setting the Customer Value Icon (End User)
• Viewing a Contact Summary (End User)
• Viewing Contact Relationship Hierarchies (End User)
  • Defining a Relationship Between Contacts
• Managing Mortgages (End User)
  • Performing Mortgage Needs Analyses
  • Making Mortgage Product Recommendations
  • Performing Mortgage Prequalifications
  • Using the Mortgage Calculator

6 Managing Households

• Managing Households
• About Managing Households
• Scenario for Managing Households
• Process of Managing Households
• Adding Households
• Setting the Household Privacy Option
• Associating Contacts with Households
• Viewing Household Summaries
• Using the Household Relationship Hierarchy

7 Managing Call Reports

• Managing Call Reports
• About Managing Call Reports
• Scenario for Managing Call Reports
• Process of Managing Call Reports
  • Administrator Procedures
  • End-User Procedures
• Viewing Call Report Charts
• Activating the New Call Report Workflow
• Managing Call Report Templates
• Adding Call Reports (End User)
• Creating Call Report Distribution Lists (End User)
• Associating Action Items, Notes, and Attachments with Call Reports (End User)
• Setting the Call Report Privacy Flag (End User)
• Emailing and Printing Call Reports (End User)
  • Emailing or Printing a Call Report

8 Facilities

• Facilities
• About Facilities
• Scenario for Adding a New Healthcare Facility
• Administrator Procedures for Facilities
• Adding Facilities to the Facility Locator
• End-User Procedures for Facilities
• Adding Facilities
• Associating Providers, Facilities, and Contacts with a Facility
• Adding Facility Contracts
• Adding Facility Payments
• Adding Facility Claims

9 Individual Health Policies

• Individual Health Policies
• About Individual Health Policies
• Scenario for Health Insurance Quote and Application
• Administering Individual Health Policies
• Adding Insurance Products and Product Lines
  • Specifying Product Line Type
• Adding Insurance Rate Bands
• End-User Procedures for Individual Health Policies
• Providing Individual Health Policy Quotes
• Accepting Individual Health Policy Applications
  • Performing a Health Risk Assessment
  • Converting a Quote to an Active Policy
  • Associating Policy Coverages with an Applicant
• Adding Service Requests to Individual Health Policies
• Setting Up Pay Plans for Individual Health Policies

10 Managing Group Policies

• Managing Group Policies
• About Group Policies
  • Common Policy Views
• Scenario for Group Policies
• Process of Managing Group Policies
  • Administrator Procedures
  • End-User Procedures
• Adding Group Insurance Products and Product Lines
• Adding Group Insurance Rate Bands
• Defining Activity Plan Templates for Group Policies
  • Creating Activities for the Template
• Defining Proposal Templates for Group Policies
• Adding Group Policy Records
• Importing Census Information
  • Importing Segmented Census Data
• Adding Census Information in the Group Policies Screen
  • Associating a Census with a Policy
• Adding Employee Classes for Group Policies
• Designing Plans for Group Policies
• How Enrollment Waiting Periods Affect the Start of Coverage
• Reconfiguring Customizable Products in Plan Design
• Generating Proposals for Group Policies
• Managing Underwriting Information
  • Viewing Historical Underwriting Information
• Adding Eligible Members to Group Policies
• Enrolling Members in Group Policies
• Adding Beneficiaries to Group Policies
• Setting Up Payment Plans for Group Policies

11 Members

• Members
• About Members for Siebel Healthcare
• Scenario for Handling Insurance Agent and Member Inquiries
• Administrator Procedures for Members
• Adding Health Programs
• Configuring the Command Center for Common Member Services
• End-User Procedures for Members
• Editing the Layout of the Members Summary View
• Enrolling Members in Health Programs
• Example of Using the Command Center for Common Member Services
  • ID Card Requests
    • Placing a New ID Card Order
  • PCP Requests
    • Changing the PCP
  • Claims Inquiries
• Changing the Primary Network or IPA for Members
• Adding Additional Benefits Coverage for Members
• Setting the Member HIPAA Privacy Option

12 Managing Partners and Agencies

• Managing Partners and Agencies
• About Partners and Agencies
• Scenario for Working with Partners and Agencies (Users)
  • Employee Adds a New Agency
  • Company Signs a New Agent
• Process of Managing Partners and Agencies (Users)
• Adding New Partners
• Adding Agents
• Adding Information Associated with an Agent

13 Referrals and Authorization

• Referrals and Authorization
• About Referrals and Authorization
• Scenario for Creating and Authorizing a Referral
• Administrator Procedures for Referrals and Authorizations
  • Creating Activities for the Template
• End-User Procedures for Referrals and Authorizations
• Creating Referrals or Authorizations
• Associating Actions and Providers to Referral or Authorization Requests
• Recording Approval Decisions for Referrals or Authorizations

14 Providers

• Providers
• About Providers
• Scenario for Adding and Managing a New Provider
• End-User Procedures for Providers
• Adding Providers
• Adding Addresses for the Provider Locator
• Associating Facilities with Providers
• Associating Specialties with Providers
• Adding Profile Information
• Adding Provider Contracts
• Viewing Provider Payments and Adding Payments Manually
  • Adding Payments Manually
• Adding Provider Claims
• Viewing and Printing a Provider Report

15 Managing Billing Accounts

• Managing Billing Accounts
• About Billing Accounts
• Scenario for Billing Accounts
• Process of Managing Billing Accounts
  • End-User Procedures
• Creating Billing Account Records
• Associating Billing Accounts with Other Records
  • Associating a Billing Account with a Contract or a Company
  • Adding a Service Request to a Billing Account

16 Siebel Integration Messages

• Siebel Integration Messages
• About the Siebel Financial Services Business Platform
• Siebel Healthcare Integration Messages