Product Service Definition

This page enables maintaining product service definitions across products. Often the same update to a product service definition needs to be applied to more than one product. This page enables such updates by allowing the user to search on and view the product service definitions of multiple products.

The page is divided into two areas:

  • An area to provide search dimensions used to limit the number of displayed product service definitions.

  • A product service definitions area used to configure the product service definitions contained in the products.

The system can contain a very large number of product service definitions. Provide enough filter criteria to limit the number of queried product service definitions to a maintainable set. A large result set may affect page performance.
Product Service Definition
Figure 1. Filtering Product Service Definitions across Products

Product Service Definition Filters

The page holds four filter options:

  • Product

  • Service Option

  • Service

  • Service Definition

The final filter is the "AND" result of all four filters. The Product Service Definitions section only display those rows that comply with all four filters.

The filters work in combination with the quick and advanced search on the product service defintions. Each filter must have an option selected before adding extra conditions in the quick or advanced search.

Selecting an option refreshes the displayed results on the next filters automatically. This helps create logical combinations. For example, when selecting the Select All option in the service options filter, the services and service definitions filters also display all the options, including the Select All option.

Product

This filter limits the resulting product service definitions to those associated with the product(s) returned by the selected product pre-filter.

Filter the list of products by selecting a pre filter from the pre-filter list. See Search Object - List View for steps to configure a prefilterList.

Example

  1. Add a prefilterList to the product service definition’s floorplan that has two pre-filters: "Approved Products" and "Not-approved Products".

    Pre filter list in the floorplan 
    {
    "resource": "product",
    "floorplan_search_listview": {
    ...
        "preFilter":"",
        "preFilterList":[{
           "descr": "Approved Products",
           "query": "product.status.eq("Approved")"
         },
         {
           "descr": "Not-approved Products",
           "query": "product.status.neq("Approved")"
         },
        ],
        "quickSearch": {
            ...
        }
        ...
    }
}

  2. Filter the product service definitions with the search filters service option as BBPRV, service as Fetal Ultrasound, and service definitions as Facility, Coverage.
    Do not filter the products, that is, keep the product filter to None. In this example the page displays the following results:

    Table 1. Product Service Definitions Without Pre-Filter Selection
    Product Status Service Option Service Service Definition Type

    PR001

    Test

    BBPRV

    Fetal Ultrasound

    Facility

    Coverage

    PR002

    Edit

    BBPRV

    Fetal Ultrasound

    Facility

    Coverage

    PR003

    Approved

    BBPRV

    Fetal Ultrasound

    Facility

    Coverage

    PR004

    Approved

    BBPRV

    Fetal Ultrasound

    Facility

    Coverage

  3. Keep the search filters as specified above and select the "Approved Products" pre-filter. In this example the page now displays the following results.

    Table 2. Product Service Definitions With "Approved" Pre-Filter Selection
    Product Status Service Option Service Service Definition Type

    PR003

    Approved

    BBPRV

    Fetal Ultrasound

    Facility

    Coverage

    PR004

    Approved

    BBPRV

    Fetal Ultrasound

    Facility

    Coverage

  4. Keep the search filters as specified above and select the "Not-approved Products" pre-filter. In this example the page now displays the following results.

    Table 3. Product Service Definitions With "Approved" Pre-Filter Selection
    Product Status Service Option Service Service Definition Type

    PR001

    Test

    BBPRV

    Fetal Ultrasound

    Facility

    Coverage

    PR002

    Edit

    BBPRV

    Fetal Ultrasound

    Facility

    Coverage

Service options

This filter limits the results to product service definitions for a selected service option or to one of the Select All options. Selecting a service option from the service options filter limits the returned result in the services filter to services that reference the selected service option.

Services

This filter limits the results to product service definitions for a selected service. The Select All option includes all services displayed in the filter. For a selected service, the filter limits the returned results to all service definitions referencing a service definition for a selected service.

Service definitions

This filter limits the results to all product service definitions defined for the selected service definition. The Select All option encompasses all service definitions displayed in the filter. If a service definition is selected, then the filter limits the returned results to all product service definitions that reference that service definition.

Product Service Definitions

This section largely resembles the product service definition section of Setup Product page but with the following differences.

  • The service definition field is view only on this page.

  • There is no option to create individual product service definitions on this page. Product service definitions can only be added by selecting Add Service Definition to Product from the advanced editing feature.

  • Additional columns and filtering

  • Advanced Editing Features

Additional Columns

  • The service definition field is view only on this page.

The Mark? field.

This field replaces the standard select row checkbox. It serves the same function with one difference, the value in the Mark? field can be stored. This allows the user to create a custom set of product service definitions.

The New? field.

Product service definitions that are created in this page using the the copy selected rows feature have this field checked. The user can manually check or un-check the New? field. The value in the New? field can be stored.

The Product and Product Status

These fields display the product and product status the product service definition is part of.

Mark and New Toggles

The product service definitions created from this page have the Mark? field checked by default. The copied records have the Mark? and New? fields checked.

With the Mark? toggle switched on (show all marked) the page displays all product service definitions with the Marked? indicator as true. With the New toggle switched on (show all new) the page displays all product service definitions with the New? indicator as true. With the Mark? and New? toggles both switched on (show all marked and new) the page displays all product service definitions with the Marked? and New? indicators as true.

Advanced Editing Features

The following advanced editing functions described in Setup Product are also available in this page, with the difference that the functionality now applies across products.

Click the More button to display the available features.

Add Service Definitions to Product

Product service definitions cannot be created with the "+" icon, this is only possible with the advanced editing feature "Add Service Definitions to Product". This feature works in a different way than the Setup Product page. First, this feature is only available when a service definition is selected in the "Service Definitions" filter and a product filter is selected that contains at least 1 product. Second, it will add the selected service definition to all the products in the product filter.

The "Add Service Definitions to Product" feature will not immediately create product service definitions, it displays a detail dialog that allows the user to fully configure all the attributes first. The following fields can be entered:

  • Regime (mandatory)

  • Auth. (Authorization) Missing? If the service definition is of type coverage this indicator is mandatory (unchecked by default)

  • Network Status (mandatory). Are the product provider groups in or out of scope (or either)?

  • Specific Networks. Consisting of two parts. A list of provider groups (including assignment labels) that are connected specifically to the product service definition and the scope of these groups (are they in of out of scope for the product service definition). Configured with the "Set Specific Networks" link which displays the "Specific Networks" dialog.

  • Multiple parameter columns for the situations where it is possible to select a parameter alias for a cover withhold category or limit. Examples covering these situations are explained in Product Configuration Examples

    • When a limit has the indication "Display in UI" and the limit is selected as an adjudication limit for the product service definition

    • When a cover withhold category is indicated as such, by setting its type and a regime is selected containing the cover withhold category as a parameter

  • Adjudication Stop Limits. A list of the stop limits that apply to the product service definition. Configured with the "Set Limits" link, this displays the "Edit Accumulation Options" dialog.

  • Adjudication Continue Limits. A list of the continue limits that apply to the product service definition. Configured with the "Set Limits" link, this displays the "Edit Accumulation Options" dialog.

  • Gender

  • Age From

  • Age To

  • Empl. (Employer) Usage. Is the specified county region (or group) in or out of scope.

  • Employer Country Region

  • Employer Country Region Group

  • Pers. (Person) Usage. Is the specified county region (or group) in or out of scope.

  • Person Country Region

  • Person Country Region Group

  • Prov. (Provider) Usage. Is the specified county region (or group) in or out of scope.

  • Provider Country Region

  • Provider Country Region Group

  • Condition

  • Priority

  • Start Date (mandatory)

  • End Date

Any dynamic fields defined for the product service definition appear in the page.

Add Accumulation Options

An accumulation option is a combination of a cover withhold category, a limit and a reached action. For example: the cover withhold category "Deductible" counts towards the limit "In-Network Insurable Entity Deductible" and stops counting when the limit is reached.

This action enables defining the limits to which a product service definition counts.

Add Accumulation Options to Service Definitions
Figure 2. Add Accumulation Options to Service Definitions

The detail dialog displays all the accumulation options based on the selected cover withhold rule that is part of those accumulation options.

Cost Sharing

This feature enables users to add parameter value to a single parameter alias across multiple products. Selecting a parameter and entering the value for that parameter will add it to each product connected to the list of selected product service definitions.

This feature is available only if at least one of the selected product service definitions is configured to allow parameters. It is not possible to update existing parameter values with this feature.

To add a parameter value, do not use the product service definition table. It is a part of the advanced editing options from the More menu.

To add a Parameter Value, follow below steps:

  1. Navigate to the product service definition across the product page.

  2. Select required Product Service Definitions.

  3. From the More dropdown menu, select Cost Sharing.

  4. In the Cost Sharing drawer, select required Parameters Aliases. After selecting Parameters Aliases, a list of products will be displayed as illustrated below:

  5. Select preferred product from this list, and then update the parameter value, start date, and end date as needed.

costshare drawer

The parameter section includes the following fields:

Field Description

Parameter Aliases (Required)

  • Displays a distinct list of all the Parameter Aliases that have a parameter alias usage for one of the selected product service definitions.

  • Parameters Aliases of type Amount are disabled if the products selected from the product list have different currencies.

Type (Read-only)

  • Derived depending on the type of the Cover Withhold Category or Limit that is referenced by the selected parameter alias.

  • For a Parameter Alias with a foreign key to a cover withhold category, use the type of the Cover Withhold Category.

    • If the type is Amount, display "Amount"

    • If the type Percentage, display "Percentage"

  • For a Parameter Alias that has a Parameter Alias Limit, use the Type of the Limit, use the type of the Limit.

    • If the type is Amount, display "Amount"

    • If the type is Number, Show "Number"

    • If the type is Days, Show "Service Days"

  • For a Parameter Alias with a foreign key to a cover withhold category as well as a Parameter Alias Limit

    • If the type is Amount, display "Amount"

Parameter Value (Required)

  • If a parameter alias has no values as details, then a value can be specified. However, If a parameter alias contains at least one value as detail (for type Amount, this means at least one value that matches the product currency), it indicates that this value applies to all products (e.g. a state mandate) and cannot be overwritten here. In such cases, the fields on the form are filled with the value and time validity as specified in the parameter alias value.

  • If multiple parameter alias values exist as details, display the one with the highest start date.

  • Conditions

    • Parameter Alias of Type Amount:

      • For a parameter alias, have at least one parameter value that matches with the selected product currency. This means that the value is meant for all products and cannot be overwritten here. If multiple parameter alias values exist as details, display the one with the highest start date.

    • Parameter Alias of Type Number, Percentage, and Service Days:

      • If the parameter alias has one or multiple parameter alias values as details, display the one with the highest start date.

Start Date (Required)

  • Specifies when the parameter value takes effect.

End Date

  • It indicates when the value of the parameter will expire.

Product List (Required)

  • Displays a list of products linked to the selected product service definition and out of those products which are applicable based on selected parameter aliases.

Cost Share (Overview Section)

On click of overview, the details of the parameter value for the applicable products selected for the parameter aliases are displayed. The overview section allows users to update parameter values for multiple products. Here, users can also assign different parameter values to different products with the same currencies. The following illustrations display the Overview functionality.

overview

Business Rule: Automatically updates the status of the selected product to Edit if the underlying parameter values are updated.

Consider the following example scenario:

Six product service definitions are configured and three of them are selected. Each of them refers to a coverage regime and a parameter alias.

Table 4. Cost Sharing
Marked Prod Service Def No Product Service Definition Coverage Regime Parameter Aliases

Y

1

HMO

Physical Therapy

Copay

Office Visit Copay

Y

2

PPO

Physical Therapy

Coinsurance

Standard Coinsurance

Y

3

PPO

Alternative Therapy

Copay

Office Visit Copay

N

4

HMO

PCP Visit

Copay

Office Visit Copay

N

5

POS

Physical Therapy

Copay

Office Visit Copay

N

6

HMO

Alternative Therapy

Copay

High Copay

These parameter aliases have the following parameter values defined on product level.

Table 5. Parameter Values
Product Parameter Alias Value Start Date End Date

HMO

Office Visit Copay

$10

1 Jan 2014

HMO

High Copay

$40

1 Jan 2014

PPO

Office Visit Copay

$100

1 Jan 2015

PPO

Standard Coins

15%

1 Jan 2015

POS

Office Visit Copay

$40

1 Jan 2014

After marking three of the six product service definitions and accessing the "Cost Sharing" feature, the drop-down box shows the list of parameter aliases connected to the marked product service definitions: "Office Visit Copay" and "Standard Coinsurance". The drop-down box will not show the parameter alias "High Copay" because its product service definition it is not part of the selection.

If the user selects the parameter alias "Office Visit Copay" AND no parameter alias values that match the product currency (for example, state mandate values) are defined for this alias it becomes possible to enter the value and time validity fields. If the user enters the following values: Value "$50", Start Date "1 Jul 2014", End Date "empty" and presses the OK button, the list of parameter values will look like this.

Table 6. Alias
Product Parameter Alias Value Start Date End Date

HMO

Office Visit Copay

$10

1 Jan 2014

30 Jun 2014

HMO

Office Visit Copay

$50

1 Jul 2014

HMO

High Copay

$40

1 Jan 2014

PPO

Office Visit Copay

$100

1 Jan 2015

PPO

Office Visit Copay

$50

1 Jul 2014

PPO

Standard Coins

15%

1 Jan 2015

POS

Office Visit Copay

$40

1 Jan 2014

So what happened for the different products and parameter aliases?

  • The "Office Visit Copay" for the HMO product is updated. The existing parameter with the value of $10 is end dated and a new parameter is added because there is a partial overlap with the start date of the new parameter value. All parameter values before 1 July 2014 are retained. Note that the new parameter value also applies to the "PCP Visit" service definition for the HMO product that was not in the set of marked product service definitions. This is because the parameter value is set at the product level and not for the individual product service definition.

  • The "Office Visit Copay" for the PPO product is updated. The existing parameter value is removed because the start date of 1 July 2014 functions acts as a resend from date replacing everything after that date.

  • The "Office Visit Copay" for the POS product did not change. The Product Service Definition is not part of of the marked set, so the referenced product is not updated.

Update Applicable Cost Share

This feature allow user to update the parameterized columns for multiple rows at once by selecting the column and then selecting a value.

  • Updating the parameterized columns requires at least one row (means one product service definitions) to be selected, in case no rows are selected, display the following error 'There are no rows selected. Select table rows with the selection checkbox before applying this action

  • Apply button on drawer only updates the values in the table, page level save is required to commit the changes.