Prescription Carve-out requirements - BPMS-I-16 AB-172 EA-249 AB-194

[g4gaurang]

We would like to get a level of effort and timeline assessment on the Prescription Carve-out requirements for SBCs. We have shared these requirements with you in the past. You can also find them below: (click link)

https://drive.google.com/file/d/0B_7OzEEzvKXzUEFTb3IxdnZxcGM/view?usp=sharing https://drive.google.com/file/d/0B_7OzEEzvKXzZ244WDZ2bXNNZXc/view?usp=sharing

Requirement for Prescription CarveOuts.docx |

RxCarveOutExampleTiebackToRequirements.doc |

Let us know if you have questions.

@markderg @jddecoste

[michparrish]

@g4gaurang the docs are not loading for me. I've tried the hyperlinks above and tried to open in Chrome directly - can you please forward them via email? Thank you

[g4gaurang]

@g4gaurang the docs are not loading for me. I've tried the hyperlinks above and tried to open in Chrome directly - can you please forward them via email? Thank you

The links should work now. Seems like there was a temporary issue accessing the google cloud.

[michparrish]

https://drive.google.com/open?id=0BwDpjEumPUB7MkE3aEtoMUpvcUU

let me know if this doesn't work - this is the first time I've used the google drive...

[g4gaurang]

https://drive.google.com/open?id=0BwDpjEumPUB7MkE3aEtoMUpvcUU

let me know if this doesn't work - this is the first time I've used the google drive...

@michparrish, you will need to provide permissions for access to your documents on google drive. An alternate to this is if you put it on the Highroads system and copy the direct hyperlink to it, that will work as well. Here is the format you can follow -

just replace the text in the parenthesis and leave the parenthesis as is.

So just for example- Document Name

[michparrish]

I can't copy the Send Link that I have to the document since you all use SSO (different URL).

Sorry for the confusion here - where in Google Drive do I update permissions? It's not obvious.

[g4gaurang]

You can also use Pclient5 to host the document and share the link -

Here is how to do it on google drive -

[michparrish]

Thank you!

https://drive.google.com/file/d/0BwDpjEumPUB7MkE3aEtoMUpvcUU/view?usp=sharing

this work?

[g4gaurang]

Thank you!

https://drive.google.com/file/d/0BwDpjEumPUB7MkE3aEtoMUpvcUU/view?usp=sharing

this work?

Yes, It did work. I was able to access and download it and I noticed this document is not for the prescription drug carve-out requirement for which this request is opened. It may belong to #251 instead. Also, I see that you have used an enhancement template to capture information - It may work for the HR team but BCBSMA has so far not agreed to contribute to and use it as a basis of agreement and approval. Also, I noticed that on #251, you have noted 72 hours but have quoted 75 hours on the attachment.

@jddecoste @kselvo01

[michparrish]

oh dear, my bad. it does belong to 251 - I'll move it. My apologies!

[g4gaurang]

@michparrish @markderg Do you have LOE and timing on this requirement ?

[michparrish]

Hi Gaurang, In the meeting last week, we stated that we would present the options along with risk and LOE to your team by 10/2. Mark has set up a meeting for 2:00 on Friday, 10/2.

[michparrish]

Added enhancement request # to name as needed to submit enhancement request to assess LOE for last requirement of new mapping from doc gen to 'SBCs (Word-Carve Out) Final' folder. This will be reviewed in the upcoming sprint which starts on 9/30.

[michparrish]

correction to the sprint start date - 10/7

[michparrish]

updated requirements document that was reviewed on 10/2: https://drive.google.com/file/d/0BwDpjEumPUB7eWE5a1dpMEtYYmc/view?usp=sharing

[michparrish]

AB-172 will be included in next build, we are pending a deployment schedule to pclient5 for testing - this is for the ability for us to map to a new set of Carve-out-specific templates. I will update the item when this is deployed and tested with success BPMS-I-16 - pending LOE for the Doc Gen page updates to allow users to select Carve Out denotations so the generated document routes correctly to the SBC-Carve Out folder in plan masters

[michparrish]

AB-172 was moved to Prod 11/27. No testing required as this was an internal bug to allow us to properly map templates by more attributes. Still pending BPMS-16. Meeting scheduled for week of 12/7 with Development to assess request.

[TimHeasley]

Total hours for the HighRoads product & services team is 60 hours.

[g4gaurang]

We approve the 60 hour estimate. Please provide a definitive sprint release estimate.

[michparrish]

Submitted acceptance to Dev - will report back when timeline for work is provided to Services team.

[TimHeasley]

Completed in Dev and ready for testing by QA team. We will work with QA testing to try and secure a Production date by end of January.

[TimHeasley]

Other 2 enhancements have taken priority to complete this week. Carve out enhancement will be completed in February.

[TimHeasley]

BCBSMA team has approved request to refresh PCLIENT5. HighRoads team plans on having enhancement ready for BCBSMA team to test on March 2nd.

[willdwyer]

Hi Tim,

Just assigning a deadline label of March 2nd to this item, so HighRoads is aware this must be ready for test by then.

[willdwyer]

Hi,

Just following up on this, as March 2nd is 2 days away. Is HighRoads close to completing this?

[TimHeasley]

Will, We are currently in the process of updating the templates and workbooks. Our goal is still for you to be able to test on March 2nd. Thanks, Tim

[TimHeasley]

Hi Will, He have completed our internal testing and the enhancement is now ready for you to test in PClient5. Please reference the requirements document above for the enhancement updates. Let me know if you have any questions. Thanks, Tim

[willdwyer]

Hi Tim,

I have tested this enhancement, per the requirements listed, and half of them have been filled, while the other half have not been fulfilled. Our requirements in the document were as follows (below).

3, 5, 6, 8 and 9 have been fulfilled.

However, 1, 2, 4 and 7 have not been met, per the testing.

1. The system should remove the BCBSMA Logo from page 1 of the output SBC document
2. The system should remove copyright/registered wording and licensee language on the both the first and last page footers of the SBC document.
3. The system should remove the QR code from footer of the first page of the SBC document
4. The system should remove the BCBSMA hyperlink under the If you need drugs to treat your illness or condition Common Medical Event and leave it as www.____.com
5. The system should indicate “Not covered” as cost share across all tiers/cost columns across Generic drugs, Preferred, Non-preferred and Specialty drugs services under the If you need drugs to treat your illness or condition Common Medical Event. In addition, the system should also indicate “--- none ---” across the Limitations and Exceptions for those services
6. The system should move “Prescription drugs” to the Services Your Plan Does NOT Cover box in the appropriate order.
7. The system should modify the Minimum Value Standard language to indicate “Does not meet” "8. The system should pass the values “Not covered” as benefit input for i. Generic Drugs - Mail Order, Preferred Brand Drugs – Retail and Preferred Brand Drugs - Mail Order services on the Type II Diabetes coverage example calculator. ii. Generic Drugs - Retail Cost Sharing on the Maternity Calculator"
8. The system should generate Word versions of the Carve-out SBC and store the output document in the SBCs (Word – Carve Out) Final folder for that account in the content library

I generated a carve-out document, and the SBC still had the: (1) BCBSMA logo on page 1, (2) copyright/registered wording and licensee language on both the first and last page footers; (4) BCBSMA hyperlink in the Rx drug Common Medical Event section and (7) Minimum Value Standard language said "Does Meet" instead of "Does Not Meet" (as it should), along with the Does Meet disclosure instead of the Does Not Meet disclosure. I have also attached this sample SBC.

Please make these adjustments, and we will retest. sbc_preview-15.pdf

[TimHeasley]

Hi Will, I just went into the plan you used "3539157" in PClient5. On the Plan Details Tab, Rx Carve Out was No. Please change this to Yes and you will see the updates for 1, 2, 4 and 7. Thanks, Tim

[willdwyer]

Tim,

So, I re-generated with checking Yes on the Plan Details Tab, and see that requirements 1, 2 and 4 have all been met. However, requirement 7 has still not completely been fulfilled (see attached).

On this SBC, the Minimum Value Standard language has been changed to "Does Not Meet", which is correct, but the disclosure does not match the language. The disclosure at the end is MCC-Does Meet disclosure. This would have to be changed in the enhancement. sbc_preview-21.pdf

Also, it is not very convenient/practical for the user to have to click 2 options for Carve-Outs (both in the Plan Details and Misc Fields tab. Can they consolidate this into one? The user would never click just one, and leave out the other. It would always be both yes, or both no.

[TimHeasley]

Will, Thank you for testing. I will look into these items and let you know the outcome. Tim

[willdwyer]

Hi Tim,

Do you have an estimate as to when requirement 7 will be fulfilled completely, so we can retest?

[sayotte7701]

Hi Will,

I'm going to look at this now. thanks

[willdwyer]

Hi Steve,

Do you have an update on this? We want to retest this ASAP.

Thanks,

[TimHeasley]

Will, I am currently working on updating the disclosures so that they appear correctly in PClient5. As soon as it is ready for retest I will let you know. Thanks, Tim

[willdwyer]

Hi Tim, do you have an ETA on when the disclosures will be updated?

[michparrish]

Hi Will, One of the requirements for this item, noted at the bottom of the requirements document attached to this item, was that when Carve Out = Yes, the option for Disclosures is greyed out as there should not be Disclosures generated with a Carve out plan. This code does work. Therefore, if you were getting a disclosure, then you were running this on a Carve Out = No plan and when this happens, you are using the original templates, which pull the 'does not meet' from the plan design. So you would have to change the value in the Configurator > Misc Fields tab to 'does not meet' in order to get the right Disclosure. Please retest to confirm that Disclosures are not available for Carve Out = Yes plans and that things are working as normal for Carve Out = No plans. Thank you.

[willdwyer]

Hi Michelle,

Just to follow up on the call - I just generated a Carve-Out plan, and the areas highlighted in red (BCBSMA logo, registered wording) should be removed for ALL Carve-Out plans (whether it is a Word, PDF, Draft, Final, etc.)

Please make sure this is completely globally with the enhancement

[michparrish]

Per conversations with Will today and Friday, 3/18, a new enhancement request has been opened for Dev, EA-249.

This item was opened due to the original requirements instructing PDF to not be available when generating Final Carve Out documents, only Word. Will has confirmed that Final Carve Out docs can be in both Word and PDF and should be routed as such: If it is a Carve Out = Yes, Final, PDF, map to: 1-SBCs (PDF) – Final If it is a Carve Out = Yes, Final, Word, map to: 2-SBCs (Word – Carve Out) – Final If it is a Carve Out = Yes, Draft, PDF or Word, map to: 2-SBCs (PDF and Word) – Draft (added in just for consistency)

Since the code from the original requirements is completed and tested successfully, we will still push this code into Prod with the other code that is coupled with it, but BCBS will not utilize this functionality until the updated PDF code is in place. Associated items with code pushed to Prod: 260, 293, 335, 336

@willdwyer please add your confirmation for us to move forward with the code as is. We will continue to post updates to this item as we move the updated code through the process.

Thanks!

[willdwyer]

You have my confirmation. Please proceed.

[willdwyer]

Please provide an ETA of when this will be uploaded today.

[michparrish]

Hi Will, The full code push won't be finished today. Now that you've finished your testing and approval for all of the code updates, we need to go back to the process and have IT push the code to a QA env for a final 'sanity check' and then we'll have a go/no go meeting. We'll likely push that night. It's just a scheduled thing that we need to set up now. I'll let you know when we schedule the push to Prod. We're hoping by end of this week but we need to ensure we have the availability of everyone in play. Thanks!

[michparrish]

just a note that the updated template mapping is updated in pclient5 for your review as well. Understood that we will NOT be pushing this configuration into Prod, but it's there for you to test.

[willdwyer]

Michelle,

As I mentioned, we need enhancements #260 #293 and #335 pushed to production ASAP. New hires have already been trained on these, and they must start the process in production soon. Please treat this as an urgent matter.

[michparrish]

email exchange between Michelle and Will - just documenting:

The requirements below look correct. The Rx Carve Out region on the Generator screen is used to determine if a Word document is mapped as 2-SBCs (Word – Carve Out) - Final or 2-SBCs (Word) - Final.

In an ideal world, we would like the Carve Out option to be isolated to 1 sole button. We currently have 3 different options to select a Carve Out (Plan Details, Misc Fields and Generator screen), which may cause issues if not all buttons are selected by a user in a carve out plan.

Just a thought – You had mentioned that the Carve Out button on the Plan Details tab was to determine attributes, while the Carve Out button on the Misc Fields tab was to determine logic. Can there be a relationship/correlation between the Carve Out attribute and designation of subfolder for plan(s) being generated? For example, if Carve Out Yes on plan details tab is selected, it would function the same as the Rx Carve Out plan button on the generator? Please let me know.

––––––––––––––––––––––––––––––––––––––––––– William Dwyer Business Analyst Compliance & Benefit Communications Blue Cross Blue Shield of Massachusetts One Enterprise Drive, Quincy, MA 02171-2126

617.246.3827

From: Michelle Parrish mparrish@highroads.com Date: Thursday, March 24, 2016 at 3:14 PM To: bcbsma William.Dwyer@bcbsma.com Cc: Tim Heasley theasley@highroads.com, Steven Ayotte sayotte@highroads.com, Mark Der Garabedian mdergarabedian@highroads.com Subject: Rx Carve Out Requirements

Hi Will,

I’m working with Dev right now and I wanted to just confirm the requirements again:

Rx Carve Out: Yes/No on the document generation screen was implemented to incur the proper mapping of the document generated when it was a Final Word doc, which would map the document to the “2-SBCs (Word – Carve Out) – Final” folder.

Therefore: Rx Carve Out: Yes/No field will be disabled when user selects Draft – all draft documents, Carve Out or not, will continue to map to the same folder - 2-SBCs (PDF and Word) – Draft’ Rx Carve Out: Yes/No will be enabled on Final for both Word and PDF Final Word documents route to ‘2-SBCs (Word – Carve Out) – Final’ Final PDF documents route to ‘1-SBCs (PDF) – Final’ Additionally: Rx Carve Out: Yes/No field will be disabled when Disclosures = Yes Disclosures field will be disabled when Rx Carve Out = Yes

Thank you so much for re-confirming. This was stated a little differently than how I presented it, but it meets the exact same end result.

[TimHeasley]

Code has been moved to Production, taking into consideration previous information.

"Since the code from the original requirements is completed and tested successfully, we will still push this code into Prod with the other code that is coupled with it, but BCBS will not utilize this functionality until the updated PDF code is in place."

[TimHeasley]

Additional enhancement request has been sent to development team and is being worked on.

[michparrish]

EA-249 has been released to pclient5 for testing. This is specifically for the 'Rx Carve Out: Yes/No' radio button on the Doc Gen screen of the Configurator. Requirement - when Rx Carve Out = Yes, and document is a Final Word document with no Disclosures, the document should map to the 2-SBCs (Word - Carve Out) - Final. Original requirements rolled back/removed - PDFs are now allowed when creating a Carve Out doc, Disclosures are now allowed when creating a Carve Out doc.

Testing results are as follows: Draft + No Carveout + No Disclosures + Word = 2-SBCs (PDF and Word) - Draft Draft + No Carveout + No Disclosures + PDF = 2-SBCs (PDF and Word) - Draft Final + No Carveout + No Disclosures + Word = 1-SBCs (Word) - Final Final + No Carveout + No Disclosures + PDF = Marketing Vendor Production

Draft + Yes Carveout + No Disclosures + Word = 2-SBCs (PDF and Word) - Draft Draft + Yes Carveout + No Disclosures + PDF = 2-SBCs (PDF and Word) - Draft Final + Yes Carveout + No Disclosures + Word = 2-SBCs (Word - Carve Out) - Final Final + Yes Carveout + No Disclosures + PDF = Marketing Vendor Production

Draft + Yes Carveout + Yes Disclosures + Word = n/a Draft + Yes Carveout + Yes Disclosures + PDF = 2-SBCs (PDF and Word) – Draft Final + Yes Carveout + Yes Disclosures + Word = n/a Final + Yes Carveout + Yes Disclosures + PDF = 1-SBCs (PDF) - Final

Draft + No Carveout + Yes Disclosures + Word = n/a Draft + No Carveout + Yes Disclosures + PDF = 2-SBCs (PDF and Word) - Draft Final + No Carveout + Yes Disclosures + Word = n/a Final + No Carveout + Yes Disclosures + PDF = 1-SBCs (PDF) - Final

All other functionality originally put into place re: the Carve Out button has been removed such as graying out Disclosures button and not allowing PDF as an option when Carve Out = Yes.

Please test at your convenience. Thank you!

[willdwyer]

Hi Michelle,

A couple things...

First off, we've encountered a defect while testing. See below screenshot and attached PDF. The calculations for the diabetes calculator on this plan are incorrect. This is for plan 3565160_Lisa Test_HMO_Blue_NE_Options_Ded_III_v.5_1234TEST.

3565160_Lisa Test_HMO_Blue_NE_Options_Ded_III_v.5_1234TEST.pdf

[michparrish]

Hi Will, Please open a new defect for that. That is not related to the code push. Thanks!

[willdwyer]

Michelle,

Also, after conferring internally, we would like to move this Rx Carve Out Plan radio button on the configurator so that it is below the Output option (Word or PDF). Since this option is SOLELY used to determine whether or not a Word document should be mapped as 1-SBCs-Final (Word) or 2-SBCs Word – Carve Out) - Final, it should be contingent on whether or not a BE selects a Word or PDF option.
Also, if a user does NOT select a Word Output option, the Rx Carve Out Plan radio button should be grayed out.

Please make this adjustment in PCLIENT5.