Procella HelpdeskRules Dashboard provides an efficient view and navigation to view all the rules in a table view. The rules are displayed in the order of Benefit Hierarchy. Within a benefit hierarchy, the rules are displayed based on Rule type. Within a Rule type, the rules are displayed based on priority.
The rules dashboard has a long horizontal scroll which helps the user to view all the details of the Rule. The rules dashboard can be accessed from the Plan list screen. Click on the ellipsis icon and select Rules Dashboard option.
In the Rules Dashboard,
- Plan name is displayed at the top left.
- Users can view all the rules in a plan for a chosen effective date. Rules can be filtered by name, rule status, benefit assignment group status, benefit hierarchy level.
- Following are the columns displayed in the Rules Dashboard
| Column Name | Description | Other Info |
| Benefit Hierarchy | Shows the rule hierarchy level | |
| Rule Type | Shows the rule type Coverage Rule/Adjudication Rule/Clinical Rule | When the user clicks on the rule type, the user can view the benefit assignment group screen that display all the similar rules of the benefit hierarchy |
| Priority | Priority of the rule within Rule type | |
| Rule Name | Name of the rule | Rule Name in the filter can be used to search by name. Partial searching can be done. |
| Rule Status | Rule Status It can be Active or Draft or Inactive. | The data is shown based on the Rule status selected in the filter. By default, Active is selected in the Rule status filter. |
| BAG Status | Benefit Assignment Group (BAG) status | The benefit Assignment group is like a container that holds rules. BAG also status, the status could be Active or Draft or Inactive. The data is shown based on the BAG status selected in the filter. |
| Prov. /Prescr. | Shows the total Provider or Prescriber count. | When user click on the count, it opens a pop-up screen that displays Provider / Prescriber data. This pop-up has a free search option to search for any provider or prescriber. Click on the provider name/provider group name to navigate to the view/edit screen to view more details. |
| Criteria | If a rule has Criteria in it, this column will show the criteria name | When the user clicks on the criteria name, the criteria view/edit screen opens in a new tab. |
| Other Info | This column display additional info of a Rule. For eg., This column displays Covered Drug Status code if it’s a benefit coverage rule Formulary type if it’s a Formulary rule Similarly Drug Tier, Prior Authorization type, Rebates Price code For provider default rule, the provider type is displayed in this column | |
| Eff. Start | Effective start date of the rule | |
| Eff. End | Effective end date of the rule | |
| Edits Count | This column displayed the number of edits available in that rule. | |
| Copay/Coins. | | Financial Edits are displayed. Users can click on the edit name to view the details.
|
| Deductible | | |
| Dispensing Fee | | |
| Incentive Fees | | |
| Ingredient Cost | | |
| Member OOP Max | | |
| Other Services Fee | | |
| Plan Amount Stop Loss | | |
| POS Rebate | | |
| Program Admin Fee | | |
| Age Limit | | Claim limit edit categories are displayed next. Users can click on the edit name to view the details. |
| Claim Min/Max | | |
| DAW | | |
| Day Supply Limit | | |
| Filling Limitation | | |
| Override | | |
| Package Size | | |
| Quantity Limit | | |
| Quantity Per Day | | |
| Refill Limit | | |
| Day Supply Max | | The benefit Maximums category are displayed next. Users can click on the edit name to view the details. |
| Fills Max | | |
| Plan Pay Max | | |
| Quantity Max | | |
| Units Max | | |
| Refill Too Soon | | Clinical rule categories are displayed next. Users can click on the edit name to view the details. |
| Safety Edits | | |
| Step Therapy | | |
| BCA | Benefit Coverage Alternatives | If it’s a clinical rule, then the Benefit coverage alternative added to the rule will be displayed. Users can click on the BCA name to navigate to the view/edit screen of BCA. |