2014

ClaimsStatusReportBatchJob

OPERATIONALDOCUMENTATION
KULLYHARDINGTECHNICALDESCRIPTIONWRITINGSAMPLE

TABLEOFCONTENTS
CLAIMSSTATUSREPORTJOB(CSR)........................................................................................2
PAYMENTINTERFACES................................................................................................................................2
DEPENDENCIESANDLIMITATIONS..............................................................................................................2
Not Covered Claim Discount Stored Procedure (NC/SP) .......................................................................................... 2
Table Access ................................................................................................................................................................. 2

JOBSCHEDULE.............................................................................................................................................2
Production ..................................................................................................................................................................... 2
UAT Test......................................................................................................................................................................... 2
Adhoc Requests ............................................................................................................................................................ 3

JOBFAILURES..............................................................................................................................................3
Production Control ....................................................................................................................................................... 3
Claim Examiners/Central Support ............................................................................................................................... 3

CSRHIGHLEVELSERVERANDDATABASESTRUCTURE..............................................................................4

CLAIMSSTATUSREPORTJOB(CSR)
TheNotCoveredClaimDiscountStoredProcedure(NC/SP)isapostclaimspaymentbatchjobmadeupof
complexcodethatpullsdisallowdollardatafromtheBatchPrinttables,performscalculations,andthen
makesliabilitydecisionsforthedisallowdollarsforeachclaim.TheClaimsStatusReportJob(CSR)isthepre
paymentequivalenttotheNotCoveredClaimDiscountStoredProcedure(NC/SP).CSRperformsthesame
calculationsbutpullsthedatafrompreclaimspaymenttables.Uponjobcompletion,tablesarewrittento
theKCWKdatabaseforPRODand/orUATTest.ThesetablesarethenusedbytheClaimsDepartmentsto
identifyclaimsthatpotentiallyneedreviewforprocessingand/orconfigurationerrorspriortobeingreleased
forpayment.

TheCSRjobwascreatedinconjunctionwithCentralSupportBusinessAnalystsandISDeveloperstoincrease
theefficiencyandaccuracyoftheoutput.

PAYMENTINTERFACES
AllofthePaymentInterfacesrelyontheNotCoveredClaimDiscountStoredProcedure(NC/SP)to
accuratelyreconcilepostpaymentclaimsdata.CurrentlythePaymentInterfacesare1)ClaimsPayment
Extract(CPE),2)DataandDollars(DND),3)AllPayerClaimsDatabase(APCD),3)ExplanationofBenefits
(EOB),and4)CHIP837OB.ContactCentralSupportwithanyquestionsregardinganyofthesePayment
Interfaces.

DEPENDENCIESANDLIMITATIONS
NotCoveredClaimDiscountStoredProcedure(NC/SP)
IfanychangesaremadetothelogicofthepostpaymentNotCoveredClaimDiscountStored
Procedure(NC/SP),thesamechangesmustbemadetothisproduct.
TableAccess
TheCSRjobisnotabletorunifUsersarelockedinanyofthetables.AnyUsersaccessingthetablesin
theKCWKdatabase(s)mustpayattentiontothejobscheduleandexitoutofthetablesinatimely
manner.ItisrecommendedthatUsersmakecopiesofthetablesifthereisaneedtoworkinthemfor
anextendedperiodoftime.

JOBSCHEDULE
TheCSRjobrunsautomaticallythroughProductionControl(PCO)asfollows:
Production
Monday,Wednesday,andFridayat8am
TuesdayandThursdayat8am,12pm,3pm,and6pm
UATTest
Adhocuponrequest.

WhenthejobcompletesanotificationemailisautogeneratedandsenttoCentralSupportandClaims
Examiners.Thenotificationemailinformstherecipientswhetherthejobhassuccessfullycompleted.If
thejobissuccessful,therecipientsareabletoproceedrunningtheirreports.
2

AdhocRequests
ProductionorUATTest
SendanemailtoPCOBatchandrequesttheCLAIMSTSRPT(Production)orUAT_CLAIMSTSRPT(UAT
Test)job.Specifytheenvironmentfortherequest.Allnecessaryapprovalsfromtheenvironment
datastewardarerequired.
OtherParameters
TheCSRjobparameterscanbechangedtolookforaspecificclaimID,claimsstatus,paiddate
range,ordateofservicerange.TheserequestsaresenttoCSAnalystviaemail.AllCentralSupport
BusinessAnalystshavebeengrantedrightstoexecutethisstoredprocedureinProductionandUAT
Test.

JOBFAILURES
ProductionControl
ThelogsfortheClaimsStatusReportarelocatedinthefollowingdirectories:
Production
\\KCappprod01\PROD\App\CSRPT\Log
UATTest
\\KCappuat01\UAT\App\CSRPT\Log

Theapplicationreturnsanonzeroreturncodeifthereareanyerrorsduringthejob,andPCOwill
getanotificationfromControlM.Inthecaseofanerror,bothCentralSupportAnalystsandIS
Developmentshouldbenotifiedviaemail.
ClaimExaminers/CentralSupport
FollowthesestepsuponreceivingafailureemailfromControlMfortheCSRjob.
1) EmailCentralSupportimmediatelytonotifythemofthefailure.MarktheemailwithHigh
Importance.
2) ACentralSupportBusinessAnalystwillreviewthelogstodeterminethereasonforthefailure.
Dependingonthereasonforthefailure,oneoftwothingscanbedone:
a. EmailPCOBatchtorequestinformationregardingthefailure.Requestanadhocjobbe
runimmediatelyifpossible.
b. ExecutetheCSRStoredProceduremanually.Beforedoingthis,makesurePCOisnot
alreadyrerunningthejob.Oncethejobiscomplete,notifytheClaimsExaminers
immediatelylettingthemknowtheycannowrunthereports.
c. Ifitisdeterminedthatrerunningthejobwillnotwork,immediatelyinformtheClaims
Examinerstobeginrunningthebackupreports.

CSRHIGHLEVELSERVERANDDATABASESTRUCTURE
ProductionServers

RelatedUATServers

PROD

PROD

UATTEST

UAT

KCDB

KCWK

KCWK

AlljobsandstoredproceduresexistinthisenvironmentEXCEPTforCSR

AlljobsandstoredproceduresexistinthisenvironmentEXCEPTforCSR

PRODRep

UATTESTRep

ReplicatedEnvironmentofPROD

ReplicatedEnvironmentofUATTEST

PROD

KCDB

KCWK

CSRStoredProcedure

Notalltablesarereplicated
OnlySELECTstoredproceduresallowedinthisenvironment,withthe
exceptionoftheCSRstoredprocedure
CSRstoredprocedurerunsinKCDBandwritestoKCWK

UAT

KCDB

KCWK

CSRStoredProcedure

Notalltablesarereplicated
OnlySELECTstoredproceduresallowedinthisenvironment,withthe
exceptionoftheCSRstoredprocedure
CSRstoredprocedurerunsinKCDBandwritestoKCWK

KCDB