Creating an event group
Creating and Event group can be initiated by clicking the Add Event group button above the Event group list.
Step 1 – Create Event Group
To create an Event group, you need to enter a unique Event group name and other required fields. In this screen the user will be able to input a unique Event group name, description, status (inactive or active), effective and end date.
The table below describes the fields in the Basic information of the Event code creation process. Fields with an asterisk (*) are required.
| Basic info field | Description |
| Event group name* | Alpha Numeric field that contains the internal name used to identify the business event rule that was applied during claims execution. The name is unique. |
| Description | Description of the Event group. |
| Effective Date * | The date on which the defined Event group becomes active. This date refers to the date the claim is adjudicated or adjusted in SCE and must be today’s date, or a date in the future. |
| End Date* | The date on which the defined Event group becomes inactive. This date refers to the date the claim is adjudicated or adjusted in SCE and must be equal to or after the Effective date. |
Step 2 - Configure Event codes to an Event group
In this step (step 1) the user may associate one or multiple Event codes to the Event group. In so doing, this logic will enable that Event group to capture and include any claims with those configured Event codes, and ultimately reprocess those claims in a single action.
When configuring Event codes to an Event group, the user selects a module source to filter the display of event codes that are available to be added to the event group. The user then selects those Event codes that fall under the displayed Module source.
The table below describes the fields in the Add event code screen. Fields with an asterisk (*) are required.
| Add Event code field | Description |
| Module source | Module that sets the Event code. |
| Available event codes | All Event codes under the selected Module which are not grouped in other event group. |
| Selected event codes | Available Event codes, those are selected to narrow down the claims selection. |
Step 3 - Configure categories & properties to an Event group
The user must configure at least one category and property to an Event code that will be used to capture and ultimately reprocess claims.
- If the user has configured an Event code(s) to the Event group, the configuration of additional properties helps to further refine those claims containing the configured Event code(s) to be captured by the group.
- If the user has not configured an Event code(s) to the Event group, the configuration of properties will allow for the capture of a broader group of claims (those that do not contain an Event code).
In this step, the user first selects the category of properties to be configured in the Event group. Once the category is selected, the user then narrows down the criteria that will be used to capture and group claims with similar attributes.
The table below describes the categories and properties that are available for configuration.
| Category | Properties |
| Membership | Member ID, Member last name, Member first name, Member Date of Birth, Policy ID |
| Subscriber | Subscriber ID, Subscriber last name, Subscriber first name, Subscriber Date of Birth, Calendar year, Policy ID |
| Billing Provider | Billing provider name, Tax ID, Contract effective date, Contract end date |
| Benefit | Plan ID, Policy effective date, Policy end date, Service code (Revenue or Procedure code), Place of service, Diagnosis code, Bill type, Gender |
Step 4 - Configure threshold values
SCE provides the flexibility to limit the volume of claims that can be resolved using the Event group functionality. (Providing this restriction will stop potential system issues from grouped claims.) When the number of claims captured by an Event group exceeds the configured threshold, SCE automatically engages the Mass reprocessing feature for the entire set of claims associated to the Event group. However, the user can configure a role(s) that can override that threshold limit.
In addition, the user can configure a reporting threshold that when exceeded automatically creates a report that is sent to a specified work queue for review. The report contains a list of those claims that were captured in the Event group (see below).
The table below describes the fields in the Threshold screen.
| Threshold value | Description |
| Resubmission Threshold Limit | The maximum number of claims that the examiner can reprocess as a group before mass reprocess is automatically engaged. |
| Threshold Override Roles | The role that allows for overriding the Resubmission threshold limit. Multiple roles may be selected. |
| Reporting threshold number | The maximum number of claims that can be included in an Event group. When the number of claims in the group exceeds this threshold, SCE automatically generates a report that is sent to a workbasket for review. |
| Reporting Workbasket | The workbasket configured by the user to which the threshold report is routed. |
Step 5 – Review and Submit
In this step a note is required to keep the record of any changes for approval purposes. The table below describes the fields in Event group creation workflow. Fields with an asterisk (*) are required.
| History | Description |
| Operator ID | The role/user ID who is creating or updating the Event group. |
| Operator name | Who is creating or updating the Event group. |
| Created date | Day the Event group is created or updated. |
Once you verify all the event code group information, click Review and Submit. The Review screen appears in read only mode.
- Review the information and click Submit to send for approval.
- Click OK in the confirmation dialog box in the BA portal.
This Event group is sent to the system manager and will be available in the Event groups list once it is approved
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