August 19th, 2025 [Planned]

Enhancements

Claim Processing Improvements

• TE validation is the process which includes general data, drug and provider validation. Currently, this process adds over 200ms to the overall claim processing time. To improve performance, we've implemented drug data caching, reducing the processing time by approximately 70-100ms.

Search Improvements

• Added the ability to search for Provider groups by provider group ID in the following screens. This enhancement helps users accurately identify the correct provider group, especifically when group names are similar
  • Provider Network (Create/edit screen)  : Right side panel for dragging and dropping provider groups.
  • Plan/ Manage rules - Provider Exception & Provider Complex rules : Right side panel for dragging and dropping provider groups.

Fixes

• Aurora MySQL minor version upgrade
• Bug fixes in Customer Services / Pricing claim history module

June 11th, 2025 

Enhancements

Basis of Cost Load / Medispan weekly drug file Load

• Issue / Gap: Custom Pricing (Basis of Cost Pricing) load always expands the data to NDC11 when storing the pricing information. As a result, newly introduced NDCs did not use custom pricing immediately and defaulted to AWP pricing until the next custom pricing data was loaded.
• Fix: The Basis of Cost load process has been enhanced to store GPI11 data. This allows newly introduced NDCs (via the Medispan weekly drug file load) to automatically inherit custom pricing based on their GPI

New Data Management jobs to download and load NADAC (Government Pricing)

• NADAC File Download job - This job downloads the latest drug pricing data from https://data.medicaid.gov/ ("As of Date" filter will be applied to ensure we down the recent data )
• NADAC pricing load job  - This job handles the load process of both weekly price updates and also full historical load (E.g complete pricing file for the year 2024)

Refer this article for more details about the NADAC pricing integration in the platform

Bug Fixes

• Customer Services / Claim History /  Financial
  The percentage sales tax rate of the plan was previously rounded. This has been fixed to show the exact value.

• Benefit Manager / Provider Network Management:
  

  The right sidebar was displaying deleted Edits. This has been fixed to show ONLY the active edits

Feb 20th, 2025

Feature

• Plan Rules Export - Ability to download Benefit Plan overview in Excel format from Benefit Manager -> Plan screens. Ability to schedule jobs to export Benefit Plan overview for one or more plans. Refer this document for more details
• Customer Services -> Pricing Claim History - Ability to test pricing from the platform. Refer this document for more details

Bug Fix

• Basis of Cost job load failed as the unit price had more characters than the allowed limit. This issue has been fixed. Here after the job will not fail, instead the record will be errored out and will be available in the output error file for user review.

Jan 21st, 2025 

Feature

• Rules Dashboard - Benefit Plan Overview screen for the users to view all the rules for a particular service date in a single screen. The rules are displayed based on benefit hierarchy levels and priority of rules within each rule type. Refer this article for more details

Enhancements

Pricing API Enhancement (Pricing API)

• To provide a quick pricing response when a pricing request hits the system, we have improved few logics to improvement the performance. Duplicate check validation is skipped and data persistence has been reduced. 
• Users should refer to the (new screen) Customer Services -> Pricing Claim history screen to view all the pricing requests received in the system.

Note: These changes are for Pricing requests received through API. Not for standard claims received through Relay Health and claims received through API.

Bug Fixes

• Transaction code and Version number has been fixed and will be displayed for all claims in Claim History Summary screen
• Product Service ID was not displayed in Claim History / Claim / Drug section. This has been fixed now.
• Require Group ID flag control is displayed in PBM configuration screen for user clarity.

Simple Provider Load  

• Provider group membership was not updated when the effective date of provider group was later than Provider's effective date. This validation has been relaxed now. 
• Provider hours for Saturday have been fixed.
• The logic has been enhanced to capture all the errors and warnings when processing each record. The output file (error file) has been enhanced to capture all errors and warnings of each record so that user is aware when a given data is not updated.

Dec 10th,2024

Enhancements

• Program Administration Fee (PAF) - Minimum Admin Fee has been added for Method type Variable. When the calculated PAF is less than the minimum admin fee, then NO PAF will be applied to the claim
• 568-J7 Payer ID Qualifier and 569-J8 Payer ID field has been added to the Claim Response. Payer ID Qualifier will be 03 which is BIN. BIN will be sent in the payer field

Fixes

• Basis of Cost Load - Validation has been handled. An error file is generated with all the records that are not loaded due to any validation issues.
• Claim History Search - BIN and PCN for Test claims has been fixed
• Indexes have been added in the test_claim_history_* tables. Going forward, all the pricing claims will be processed as test claims. This will improve the performance in the claim history search and also show only standard transactions.

Standard - This will list only standard claims

Test-Claims - This will list the pricing claims and also any test claims processed by PBM users.

• Aurora MySQL version update

Oct 22nd,2024

Enhancements

• Route claims to specific group based on BIN/PCN - A new configuration is introduced in PBM configuration where the user can set a specific adjudication group for the BIN/PCN combinations. Refer to this documentation for more details.
• Claim History search
  • Search performance has been improved
  • BIN and PCN search options have been added 
  • Reject Reason is added to the Claim history list screen for quick reference

Fixes

• Validations have been handled in Ingredient Edit to avoid calculating 0$ ingredient fee due to incorrect setup
• Special characters in the Group name were causing errors in the Group Plan association screen. This issue has been fixed now.
• Group Configuration - Response Group ID is fixed to send either Adjudicated Group ID or submitted Group ID based on the selected configuration
• Rules Cache refresh Issue - The PBM Brand class rules cache was not getting refreshed when we added/edited rules in it. This has been fixed now.

Sep 24th,2024

Feature

• Simplified Provider Load - A simplified pharmacy load batch option that can establish provider group membership as well. Refer this page for more details

Enhancements

• Pricing API - Enhanced to accept BIN, PCN, and Group ID in the request.

Aug 8th,2024

Feature

• New API 
  • New API to submit claims. This API requires providing 128-byte API access key in the header for authorization. This API accepts the content type "application/EDI-NCPDP"
• Claim Performance Improvement
  • The claim Switch consumed approximately 60-100ms before sending the claim response out, now this has been reduced to 1-3ms
• Report
  • Therapeutic Report has been added to Data Management. This report provides a review of Drugs with therapeutic class. This report gives you an insight into the program's performance by therapeutic class to see where high costs are being incurred. Refer to this page for more details

Enhancements

• Switch validation properties have been moved to the database. Previously it was available in the Properties file, so whenever we had to make an update, we had to go into maintenance mode and restart the switch to make it effective. With this enhancement, we don't have to put the system in maintenance mode. The update can be made through API (by the Procella support team). The data cache will get refreshed every 30 minutes, so any changes made in the switch validation properties will be effective within 30 minutes.
• Claim Submission Tool - The Test Claim radio button can be selected to submit the claims as a test claim. Previously, we had to choose the Standard claim option and enter an appropriate value in the 'software vendor certification ID' to process the claim as a Test claim. With this enhancement, the software vendor certification ID will be automatically populated when the Test Claim option is selected. Refer to this page for more details
• 484-JE Percentage Sales Tax Basis - Allowing claims with blank JE value to pass through when 483-HE Percentage Sales Tax Rate Submitted and 482-GE Percentage Sales Tax amount submitted are zero. This fix is made to avoid rejects that are happening in production.

June 19th, 2024 

Feature

• Group PTA Enhancement - 
  • The PTA logic has been modified in the group module to maintain non-overlapping effective dates. This is performed so that the old record does not become effective automatically when the user inactivates the latest version.
  • Ability to inactivate old historical record
  • Ability to change the effective end date of the old historical record
  • Ability to view the active version by selecting an effective date in the group history screen. For more information, please refer to Group Update flows section in  this article
• Report
  • Operational Report has been added to Data Management. This report gives a group-level summary of transactions for a selected period range. It also provides information like the daily variance of transactions, average # transactions per day, etc. Refer to this article for more details on the report

Enhancements

Performance Improvements

• Criteria Cache - It was observed that sometimes during the claim processing, more millisecond is spent when evaluating complex criteria. Complex criteria are criteria with more number of expressions. This has been handled by caching the criteria data. (Changes will be deployed but will not be enabled for Procella PROD)

Provider Manager Module

• A Search button has been introduced in the Provider and Provider group screen so that the search is not automatically initiated before the user provides all search parameters.
• Ability to search by Store Number option has been added
• Search performance has been improved in the provider module

Fixes

• Ingredient Cost Evaluation - Ingredient cost evaluation logic has been fixed to use the submitted Usual and customary value as the claim's ingredient cost if the system is unable to calculate the ingredient. (This happens when the unit price of the drug is 0$ , or the unit price of the drug does not exist for the selected basis of cost)

May 26th, 2024

• Enabling Provider Network cache to improve the claim processing performance

May 7th, 2024

Fix

• Ingredient cost Edit has been fixed to continue iterating through the rate rules until it finds a non-zero unit cost for the drug. This fix is done to avoid calculating 0$ ingredient cost when the rate rule cost option is 'First Found' / 'Lowest Rate Rule'

May 1st, 2024

Upgrade

• Procella DB (db.r5.8*large) and Transaction Engine (8 CPU and 16GB RAM) specs was upgraded

Apr 23rd, 2024

TE Performance Improvements

• Provider Network data are cached just like Plan rules. This cache is refreshed every time, when a group/plan record or a provider network or provider group is updated.  (Feature deployed but currently disabled in Procella PROD)
• Finding the B1 claim for reversal request takes longer time if we have more than 100K claims with the same service date. This query has been optimized.
• The query that checks for Duplicate claims takes longer if we have more than 100K claims with the same service date. This query has been optimized.
• Any Pricing API request will be processed as Test Claims instead of Standard Claims. This change is done to reduce the amount of data added to claims history tables.
• Plan rules cache enabled.

Feature

• Ability to perform bulk claim testing using the Data Management module. User has to be provide the claim data in an input file, the batch process will adjudicate the claims and provide a test report, and claim data file for review. Refer to this documentation for more details - Test Claims - Batch
• A new batch job has been implemented to schedule the download of DUR incremental file.

Fixes

• Medicaid Paid Amount (113-N3) is not used in B Transactions. When a request contains this field, the B2 claims are rejected. This was due to the data persistence issue. This has been fixed to ignore the N3 field.
• Other amount claimed loop - When a request contains these fields, the claim reversal is rejected with a Host Processing error due to a number format issue. This has been fixed now, the number formatting is handled.
• 462-EV Prior Authorization ID causing Number format issue exception is handled in TE when an invalid data is submitted

Feb21th, 2024 

• MySQL 8.0 Upgrade

Jan 18th, 2024 

Enhancements

• Whenever a claim validation fails at main switch, the claim gets rejected (without getting routed to the respective client). Because of this, clients are unable to access their rejected claim data. So, the claim flow has been fixed to perform proxy routing before validation at the main switch. So now the claim is first routed to the appropriate client's switch. The validation happens at client's switch, incase of NCPDP errors - the claim data can be accessed from client's claim_audit table.

Fixes

• Drug Unit Price Fix - In Medispan drug data, few high-priced drugs have unit price extended value. Unit price value was 0$ for such cases. This would calculate the drug price as 0$. Fix has been made to use unit price extended value when available.
• Pricing API and API claims would be responded with 'Scheduled Downtime' when the switch is in Maintenance mode during system upgrades.
• Provider Network Batch Load Fixes
  • Update flow has been fixed to update the baseline edits
  • Provider Network batch error file consolidates and list all the errors in the Provider network record (Previously only the first found error was shown in the error file)
• Reject Code '69 - Date of Service After Coverage Terminated' and '41-Submit Bill to Other Processor or Primary Payer' are added to the pharmacy response when a run-out claim is received after the allowed run-out processing period
• Provider Invoice: The network fees total was incorrectly displayed in the invoice PDF. This has been fixed now
• Customer Services / Member / Member Accumulation - Medical accumulator total is now displayed based on the latest date of service and created date. (Previously it was just fetched based on the DOS/run date)
• Group Plan Association - Member Out of Pocket on/off logic is fixed to include/exclude the amounts in total OOP.
• Switch Claim Validation has been fixed to accept the padded zero value (Field that has been fixed 463-EW Intermediary Authorization Type ID)

Jan 8th,2024

Features

• API Claim : Ability to receive and process claims through Web-Api

Dec 7th,2023 

Enhancements

• Run-Out Claim Configuration - This configuration has been included in the Group to turn on run-out claim processing and also an option to select an end date after which the run-out claims will not be allowed.
• Provider Network Batch Load - Ability to load provider network through batch process. This helps the users to easily create and update provider networks. Refer to these documents for more details - Provider Network Batch Load Layout, Provider Network Batch Load

Fixes

• Provider Network Panel - A Fix has been made to fetch the future effective provider networks to associate with the Network Panel
• Group Plan Association - A Fix has been made to fetch the future effective provider network panels to associate with the Group Plan.
• Safety Edits / MME  -
  • Fix has been made to handle reject messages when calculated MME is not available.
  • Fixed the input to handle the scenario when member's history has multiple claims for the same drug
• Host processing error reject caused by data parsing of these 334-1C & 477-BE fields has been fixed

Nov 21st,2023 

Enhancements

• Customer Services / Claim History Search
  • Ability to filter Net Paid claims (Paid claims that are not reversed)
• Customer Services / Member / Accumulations - Member Accumulation search has been enhanced to 
  
  • Filter by Accumulator Type - Pharmacy & Medical accumulators
  • Filter by Accumulator Level - Default (added to Member's accums bucket) and Non-Default (Exception/complex rules - Deductible/OOP not added to Member's accum bucket)
  • Family accumulations displayed along with individual accumulation
• Drug Look Tool - New drugs/ drugs in the report have some lag in appearing in the Procella system. This has been fixed.
• Morphine Equivalence Daily Dose Screening has been enhanced with the ability to define the max limit in the Safety Edits.
• Client Services / Group Plan Association 
  • New toggles have been introduced so that PBM can control how Individual and Family accumulation needs to be done. (No difference in how the accumulations are calculated). The options are added in case the accumulations need to be handled differently)

Fixes

• Criteria Manager - Unable to view criteria history screen if the criteria name contains special characters (esp like /,\,% etc). This bug has been fixed now.
• Hierarchy Group - Ability to add new user (user is pending status/ not activated) to the hierarchy group
• Value 00 in the 384-4X field was failing validation at Claim Switch rejecting the claim with 'M/I Patient Residence'. This has been fixed to accept the value of 00
• Inactive Edits were appearing in Prior Auth screen. This has been fixed to show ONLY active edits.

Nov 2nd,2023 

• Group_ID_Submitted data fix- All the claim extracts (All versions of format DCE_V0X.X) have been fixed to populate pharmacy submitted external group id in the 'Group_ID_Submitted' column.

Oct 20th,2023 

Enhancement

• Access Management / Hierarchy Group 
  
  • Access Management / Users - The user edit screen displays the Hiearchy group(s) that the user belongs to. It also displays all the Groups that the user has access to.
  • Member module and Claim history module data are restricted based on the groups for the logged in user based on Hierarchy Group. For more details refer to this documentation
  • Note: We have created a default Hierarchy Group (Name: DEFAULT SHG, which has access to all groups). All the existing users are added to this Hierarchy Group. The existing users will have the same access as they do today. After this deployment, Please follow this documentation to create new Hierarchy Groups if you would like to limit data to the Users. For any new users created after this deployment, you will have to specifically add them to the Hierarchy group to view data in Claim history and Member modules.
• Member Authorization 
  • Drug name has been added in the Member authorization list screen and details screen when you are using Drug Level and Drug Value to add Member Authorization
• Claim Extract / Format (Procella ALG 2.0 and Procella CAS 1.0 format) - Added the Patient pay dollar amounts in the "Copay amount" field. Also fixed the populated patient pay amount for reversal claims.
• Claim History/ Claim Adjudication date/time: Seconds have been added to the adjudication time in the claim history list screen and summary screen.

Fixes

• Refill Too Soon - A claim with the same date of service as the history, got paid when the day supply was One. This has been fixed by considering the prescription used as 0 days/ 0% when the date of service of the current claim and history claim is the same.
• Active MQ Issue - For commercial claims, We had an issue where the claim was processed in the system but the pharmacy did not receive any response because of the connectivity issue. This created a problem for pharmacies to reprocess the claims as it would be rejected as 'Duplicate of Paid'. 
  • Solution - We revert the data stored in the Procella system when there is an issue with connectivity. The data are reverted ONLY when a response is not sent to the Pharmacy. This allows the pharmacy to reprocess the claim and also the accumulator to the TPAs is not affected.
• Access Management / Users: User deactivation can be scheduled to a specific date and time. The termination date/time will be displayed in the 'Edit User' screen. For more info, refer to this document

Claim Adjudication - Accumulation Fixes

• Member Deductible was applied even though Family Deductible was met. This was an issue in the code where the comparison of the remaining deductible to zero was not working. [Impact: Deductible Accumulation Method - Member or Family. Affects the scenario, where the Family Deductible is met but the Individual deductible is not met]
• Member Accumulation Fix for Family Coverage.
  • To match how accumulations are done by Medical TPA, we have included termed members accumulations for all benefit tiers (Emp+spouse, Emp+1Dep, Emp+Dependents, Family). 
  • Having a configuration to manage if termed member's accums to be included in 'Employee Only' coverage will provided in a future release.

• Accumulation fix to restrict accumulators being shared across families when the member moves from one family to another family.

Prior Release

Family 1	Scenario	Family 2	Accumulators
Cardholder X, Spouse Y, Dependent Z	Entire Family moves to COBRA coverage	Cardholder X, Spouse Y, Dependent Z	Accums carried over for all members
Cardholder X, Spouse Y, Dependent Z	Cardholder moves to COBRA coverage	Cardholder X	Member X Accums are carried over
Cardholder X, Spouse Y, Dependent Z	Spouse from family 1 becomes an Employee	Cardholder Y	Member Y Accums are carried over
Cardholder X, Spouse Y, Dependent Z	Spouse becomes an Employee and the dependent moves under spouse coverage (or) Spouse & dependent moves to Cobra coverage	Cardholder Y, Dependent Z	Member Y and Z Accums are carried over
Cardholder X, Spouse Y, Dependent Z	The dependent becomes an Employee (or) The dependent moves to Cobra coverage	Cardholder Z	Member Z Accums are carried over

After Release

Family 1	Scenario	Family 2	Accumulators
Cardholder X, Spouse Y, Dependent Z	Entire Family moves to COBRA coverage	Cardholder X, Spouse Y, Dependent Z	Accums carried over for all members
Cardholder X, Spouse Y, Dependent Z	Cardholder moves to COBRA coverage	Cardholder X	Member X accums are carried over
Cardholder X, Spouse Y, Dependent Z	Spouse from family 1 becomes an Employee	Cardholder Y	Member Y accum starts fresh when Y becomes a cardholder
Cardholder X, Spouse Y, Dependent Z	Spouse becomes an Employee and the dependent moves under spouse coverage (or) Spouse & dependent moves to Cobra coverage	Cardholder Y, Dependent Z	Member Y, Z accum starts fresh
Cardholder X, Spouse Y, Dependent Z	The dependent becomes an Employee (or) The dependent moves to Cobra coverage	Cardholder Z	Member Z accums starts fresh as Z moves to a different family and becomes a cardholder

Sep 21st, 2023 

Features

• Access Management / Hierarchy Group feature has been added in Access Management. This Hierarchy Group module helps to restrict the data access for users based on the Sponsor/Carrier/Account/Group. (For eg., User X logins as 'customer service representative' role can be restricted to viewing members/claims data of only Group A. User Y with the same role can be restricted to viewing member/claims data of only Group B)

Note: There are a few functionalities still under development related to the Hierarchy Group. We recommend not to use this feature until we complete pending functionalities and share detailed documentation on how to use/set up the Hierarchy Group.

Bug Fix

• Criteria / Claim Domain - Logic for U&C, Gross Amount Due, and SBM ingredient cost attributes has been coded and is available to use.
• The scroll issue in the Criteria edit (text editor) has been fixed
• Access Management / Roles - The 'PBM Admin' role of each PBMs has been fixed.

Issue : 'PBM Admin'  is a system-defined role. This role can be assigned to users who are PBM Administrators. Any user who is assigned the 'PBM Admin' role will have access to all the modules in the platform. The issue was this role was not automatically updated with the privilege of accessing new modules, so users had to create new roles for the new modules introduced and assign them to users for full access. This has been fixed now, using the 'PBM Admin' role will have access to all modules and will automatically add if any new modules are introduced in the future.

• Negative Net Amount Due - There was an issue with 'Amount to Cost Sharing' which was causing a negative net amount due in the claims. This issue was happening when the member met the deductible and then had a few claims processed. Later some of the past claims were reversed which reduces accumulated deductible.
• 835 Fix - DTM02 segment fixed to populate the Date of Service of the claim instead of the Claim adjudication date
• Member Accumulation fix -  When a family has a termed dependent, the termed member's accumulation amount was not included when calculating the total family accumulation dollar. Now it has been fixed to include termed members in the family within the benefit year.
• DAW Penalty Fix - The exclude from accumulation logic has been fixed. The penalty can be excluded/included from a member's accumulation based on the setup.

Aug 17th, 2023

Features

• Benefit Coverage Alternatives - Ability to include drug-specific messages in the pharmacy response based on the claim status. Create a BCA record and use the BCA to set it up in the Clinical rules in the plan.
• Rules Audit - We have added different flags to show criteria matched and rules applied

This change was specifically made to clearly view rules applied during claim adjudication. For eg., The criteria could have matched because of the 'Exclude' condition but this means the criteria matched and because of Exclude the rule was not applied.

• Duplicate Provider Network functionality has been implemented

• Medispan Drug Update - The process to download the weekly drug update file automatically has been implemented. Once the setup up is done, the file would be automatically downloaded and get staged to load in the system.
• Material UI upgrade -  v1.2.1 to v4.11.3

Bug Fix

• Member Authorization - was showing an error in the screen when the authorization is created with a future start date. This bug has been fixed.
• Medispan Weekly Drug update - The job was not automatically triggered per schedule. This was being triggered manually. This issue has been fixed

Transaction Engine Fixes

• DAW - 'Price as Generic' processing method has been fixed now. Previously it was still pricing the claim as Brand even though the DAW is set up to calculate as Generic

Jul 20th, 2023 

Bug Fixes

• Refill Too Soon - There was an issue in the logic to pick the matching claims from Member's history. This has been fixed.
• Drug Update - Few errors were observed in the weekly drug update. To resolve the validation issue - Updated data set for Storage Condition Code

Jun 21st, 2023 

Features

• Data Management - Ability to choose required timezone in the Job configuration. This will extract data's based on the selected timezone.
• Covered Drug Status Code is captured for each claim. It is available to use from claim_history_drug table / covered_drug_status_code field
• Administration/Data Management - Basis of Cost load batch load process is enabled. Load job can be scheduled and multiple file load is supported
• Super Admin/ Data Management - Drug Pricing Load has been included
• Ability to view Edits from Authorization screen (Previously only Inline edits were viewable, now we can view any edits that is added in override section in Prior Authorization)
• Claim History Load - Few fields are relaxed/ made non- mandatory in the Procella Claim Layout
• Ability to configure Data Client Input Folder path in the Job configuration (Moved from Data Client Connection setup as we may need to setup dedicated folders based on group)
• 53 - NON-MATCHED PERSON CODE reject code is added in the pharmacy response if the member identification fails because of incorrect person code submitted
• Reconciliation Report - Ability to extract member accumulations for the benefit year till date
• Super Admin / Drug Management - Ability to add new NDC and its equivalent Medispan NDC into the system (Currently Instance level Drug Maintenance)
• Drug Data Load - Drug issue - gap in effective dates. Few Claims getting rejected with 54 - Non matched product service ID
• Ability to create edits (Quantity Limit and Quantity Per day) from Member Authorization screen
• Applied Filter is added in Rules Audit screen to filter and view ONLY the rules applied during adjudication
• Ability  to include Claim Mix Max limits in the Prior Auth API
• Ability to provide Provider Limitation / Provider Exclusion in the Prior Auth PA
• Ability to provide Day supply min/max limits in the Prior Auth API

Bug Fixes

• Ability to add a single day coverage for family members under all scenario's
• Network Based claim extraction - Auto Scheduling is fixed
• Claim Submission Tool - Number Of Refills Authorized (415-DF) was not accepting 0. Unable to submit claim with NO Refills authorized
• UI -Radio button in claim history as 'test' instead of ' Claim-test'
• UI - Claim history screen - Test claim Radio button issue
• Claim history load - Dates are loaded in varchar field instead of date type field .
• Claim History Batch Load issue -Other Amount (claimed/paid) amount is not stored in procella
• DM (UI)- Registration code is not visible in claims extracts
• UI - DM - Flex/location Config Screen - External Plan ID Should be shown instead of internal ID
• Claim History - Drug Name search functionality fix based on Drug name shown in list screen ( DRUG LABEL NAME WITHOUT STRENGTH)
• BE/UI - Plan - Manage Rules - rules priority Issue
• BE - Rules audit for test claim - load more is not working
• claim history response pricing - total amount paid is not populated when loading history claims
• BE - while migrating member inside same family ,coverage end dates are set lesser than start dates
• UI - Removed $ placeholder in benefit amount in Max Accumulation edit
• BE - TE_Processing_time Format fix for test claims in all environments.
• PA API - change preferred drug status and formulary status fix.
• PA API - TE - NO RESPONSE FROM TE CONTACT SUPPORT reject code fix.
• Unable to Add Benefit Coverage for dependent
• Claim History Batch load - Claim history summary should store group id and plan id.
• UI-Login screen- Show password option needs to be shown
• Member Accumulation screen - "CREATED AT" needs to be added with correct time zone inside the accordion.
• Refill Too Soon - Enhance to look for matching claim history with past Date of Service
• BE/UI - Rules Audit & network rules Audit Screen - Add filter to view ONLY the applied rules for particular claim.
• UI - Claim history listscreen - set start and end date with 15 min gaps for Adj date & Time.
• UI - Claim submission tool list screen - set start and end date with 15mins gaps for DATE MODIFIED START field.
• Wire up Additional Message section for Test Claims
• Drug Management- Item status code validation to be handled.
• Unable to add Group in the Load jobs because of Effective future start date of the group.
• Member Authorization : Change the Character limit in Prescriber info field to 5000 characters
• Add an Info in the Claim History / Accumulator to clarify the Benefit Year to Date Accumulation

Transaction Engine Fixes

• Step Therapy Issue - If Member has drug (driving ST) in history,then it should skip ST
• COB OCC8 - copay/coinsurance amounts are not adjusted as per claim cost
• Member Authorization - By Pass PA option was getting applied irrespective of the status/conditions of the Authorization itself.
• Compound Claims - Compound coverage (Bypass - Covered Drugs) was causing an error during Ingredient cost calculation