Creating an event group
Creating an event group can be initiated by clicking the Add event group button on the event group list screen.
This will present the user with the screen and process to create a new event group. There are two steps to the process. The first is the population of all the appropriate fields for the event group and the second is to review the fields and submit the group for approval.
The event group screen is configured into 4 areas.
- Event group information - the key event group information, including the unique name, description, and effective and end dates.
- Threshold configurations – configurations for event group reporting and examiner overrides.
- Event code information – configurations to add similar event codes to the group configurations.
- Categories and properties – configurations to detail the specific claim attributes needed for event grouping.
Once the group is configured, the settings can be reviewed and then submitted for approval. Once approved, the event group will be available in the list.Event group information
The key event group information, including the unique name, description, and effective and end dates. The name and effective and end dates must be entered.Threshold configurations
Threshold configurations for reporting and overrides. The threshold configurations detail the maximum number of claims an examiner can resolve when grouped and if it is greater, the role required to override that capability. If the number of claims is greater than the threshold, a mass reprocess task will be automatically created to manage the reprocessing. The threshold reporting defines the minimum number of grouped claims that will cause an event group report to be generated. This report may indicate that a system, data, or configuration issue is impacting claim processing. The report, shown below, will contain a list of all the claims that have been grouped together along with other key data and will be available in the configured work queue for review. This is an optional configuration.Event codes
Event code configurations to add multiple related event codes to be considered as part of the group. Note that each event code can only be associated to one event group. This is an optional configuration. Selecting + Add event code will present the UX to define the event codes to be considered in the event group configuration.Categories and properties
Categories and properties to define the specific field data relationships that will cause claims to be grouped. This section is required for the group and defines the attributes that link claims together for event grouping. For example, matching provider IDs or member IDs. At least one property must be defined. Selecting + Add properties will present the UX to define the attributes needed to group the claims. Categories are used to help define like properties. Properties can be removed from the configuration by selecting the trashcan icon.
Managing categories and properties Additional categories and properties can be added to the event group configuration by updating the EG_CategoryCriteriaSelection decision table. This table defines the list of fields that are available when attributes across claims are evaluated for the purposes of grouping the claims.
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