Procella Helpdesk- This page explains different jobs and its purposes. The jobs are available in the Data Management module.
- Data Management is the user interface for the PBM to manage different loads and extracts. Data management allows both automated (scheduled) and manual (adhoc) loads and extracts process.
- Data Management exist in Administration and also in Super Admin module.
- Administration / Data Management : The data's specific to the PBM will be managed here. For eg., Eligibility load, claims extract, MAC pricing loads.
- Super Admin / Data Management : The data's that are common to all the PBMs within an instance is managed here. For eg., Drug Updates , DUR Drug Data Update etc
| Job Name | Job Criteria | Job Format | Description |
|---|---|---|---|
| Claim | Extraction | DCE_V03.1, DCE_V04.3, Procella HE 201907, Procella HP 5.1, Procella LK 201501, Procella CAS 1.0, Procella FCH 202210, Procella ALG 2.0, DCE_V04.6, DCE_V05.0 | Claim job with this configuration is used to extract claims from the system in different formats as mentioned. Each format has different extraction layouts. |
| Claim | Process | Test claims | Claim job with this configuration is used to process claims for testing purposes by clients. Currently, we support only test claims to process through this job. This job has a feature of uploading the input file, which contains basic claim details. Users can download the output file (CLAIM_REPORT, TEST_REPORT) once the claims are processed. |
| Prescriber | Load | Job with this configuration is used to load prescriber information into the system. | |
| Criteria | Load | This job configuration is used to load criteria information into the system. | |
| Eligibility | Load | 834 File, Standard, Ameriben COBRA, First choice health file, Coastal Administrative, Allegiance 834 File | This job is used to load member information into the system. Different types of input file formats are supported. |
| Eligibility | Extraction | This job extracts Members and their eligibility information from the system into a file. | |
| Accumulator | Load | Select Health, First choice health, Coastal administrative, Allegiance | Job with this configuration is used to load accumulator amounts into the system based on the accumulator job format. |
| Accumulator | Extraction | Select Health, First choice health | Job with this configuration is used to extract accumulator amounts from the system into a file based on the accumulator job format. |
| Medical Eligibility | Load | The job with this configuration loads the Medical Cardholder ID and Medical Person Code into the system. | |
| Claim History | Load | Job with this configuration is used to load historical claims into the system. | |
| Prior Authorization | Load | Job with this configuration is used to load prior authorization details into the system. | |
| Prior Authorization | Extraction | Expiry, Active | Expiry - For a selected period range, this job extracts all the Member authorizations that are expiring within that period. Active -For a selected period range, this job extracts all the Member authorizations that are active in the selected period. |
| SFTP File Downloading | Other | Sometimes there may be a need to pull a file from an external server. This job is used for downloading the file from an external server into our internal S3 bucket for further actions. | |
| Network Based Claims | Extraction | This job is configured to extract claims based on the provider networks. It retrieves claims associated with the provider networks specified within the job settings. | |
| Reconciliation Report | Extraction | Select Health | The Reconciliation Report job generates a comprehensive report containing membership level accumulation details: Membership level Pharmacy Deductible total, Membership level Pharmacy Member OOP total, Membership level Medical Deductible total, and Membership level Medical Member OOP total. Currently extract is supported for a specific period within a benefit period. |
| Provider | Load | This job is configured to load provider data into the system. | |
| BasisOfCost | Load | This job is configured to load custom drug pricing into the system (MAC Pricing Loads). | |
| Provider Network | Load | "Provider Network" job is used to create/update network in the system. This job helps in updating providers and provider group within a network. |