Catastrophe Effective Configuration
The decision table AM_Catastrophe_Dates is used to check the effective dates for the catastrophe. This is different from the service dates as this controls the system processing dates for the claims that meet the catastrophe configuration. This will enable a client to support late billing and any other delays associated with claim submissions. This table also provides the name and description for the catastrophe to support logging and auditing. The other fields for diagnosis, provider and member provide a higher level of configuration in the catastrophe control, limiting the reporting to specific diagnoses, billing providers or members.
The existence of a True value in the Check Diagnosis, Check Billing Provider or Check Member columns will enable the SCE to check the associated decision table against the claim data. The decision tables controlling these configurations are:
AM_Catastrophe_DiagnosisCode – Validates the primary diagnosis on the claim for the catastrophe to see if the catastrophe is limited to this diagnosis code.
AM_Catastrophe_Provider – Validates the billing provider’s Tax ID on the claim for the catastrophe to see if the catastrophe is limited to this provider.
AM_Catastrophe_Member – Validates the patient contract ID or ID on the claim for the catastrophe to see if the catastrophe is limited to this member.
The tables controlling the catastrophe configuration can be easily updated or extended to support the processing requirements.
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