Reporting and print screens

Report windows (clmrpt)

Most report windows follow the same pattern: a criteria panel (group picker w_group_select or w_group_response_selection, date range, status/message-type dropdowns sourced from claim_status_order / global_messages), a retrieve, and print/save options. Business purposes below are grounded in the window/DataWindow comments and retrieval SQL.

Accumulator reports

Window	Title / purpose	Key DataWindows
w_clmrpt_accum_rpt	Member Accumulator Listing — accumulators for a group's members; variants for medical/dental deductible layout, JHP layout, external save format; includes pending (non-paid) claims that have affected accumulators	d_clmrpt_accum_rpt, _med_den_deduct, _jhp, _external*, d_clmrpt_accum_pending
w_clmrpt_member_accum_search	Member accumulator search — enter member criteria, list the claims for the member or whole family and how each affected accumulators	d_clmrpt_search_member, d_clmrpt_member_accum_search_results, d_member_count
w_rpt_group_selected_accums	Accumulators By Member for selected accumulators/reason codes	d_rpt_group_accums_bymember, d_group_accums_memselect, dddw_reason_accum_picklist
w_rpt_member_accum_rulemax	Member Accumulators By Benefit Rule (accumulated vs rule maxima)	d_rpt_member_accum_byrule
(datastores)	Lifetime amounts per member; accumulator credits	d_clmrpt_lifetime_rpt, d_clmrpt_credits_rpt, d_clmrpt_period_find

Claims listings & workload

Window	Purpose
w_rpt_group_claim_bendefs	Detailed Claims Listing By Benefit Definition (per group, selectable definitions)
w_rpt_group_claim_benrules	Detailed Claims Listing by Benefit Rule Type
w_clmrpt_status_count (Status Count)	Number of claims in each pipeline status
w_clm_message_status_summary	Open-message / status summary for a group
w_clmrpt_open_messages	All claims with open messages (filter by message type)
w_clmrpt_claims_older_than_90_days	Claims older than 90 days for a group or a parent group and its children
w_clm_claimed_amt_morethan	Claims whose claimed amount exceeds an entered threshold
w_claimrpt_large_claim_report	Large-claim report
w_clmrpt_no_sub_or_pat	Claims with no subscriber and/or patient assigned
w_no_group_id_fix (Claims with NO Group ID assigned)	Find/fix claims missing a group id (by claim-id prefix)
w_nobs_group_rpt	NOBS group report

Outbound / financial follow-up

Window	Purpose
w_clmrpt_outbound_aging_tv (Claims - Outbound Aging)	Tree view of aging for claims sent to partners/networks
w_clmrpt_outbound_edi_older_than_10_days	Claims in outbound_edi_transactions not returned within 10 days
w_clmrpt_outstanding_adjustments	Claims with outstanding external adjustments (ext_adjust)
w_clmrpt_outstanding_refunds	Outstanding refunds for a group or all groups
w_cigna_p4p (Cigna Pay for Performance Reporting)	Cigna P4P extract for configured report groups (cigna_report_groups, d_clmrpt_cigna_p4p_out)
w_ppaca_letters (PPACA Letters)	PPACA letter generation (also listed under Letters)

Pickers: w_group_select ("allows the user to select a group"), w_bank_acct_select ("select a bank account for a group"), plus the shared clmutils response-selection windows.

Print library (clmprint)

• Claim reprints: a print DataWindow set per claim form — d_claim_print_hcfa1500(_comp), d_claim_print_ub92_* (approx. 20 section layouts), d_claim_print_generic_medical, d_claim_print_generic_reprice_*, d_claim_print_sfpi_dental, vision exam/lens, HCR, dependent, WDI, SSO (a/b/c + diag), ineligible, drug — rendered through clmprint/n_claim_print (with clmprint/w_viewclaim as the on-screen viewer).
• EOB print: clmprint/w_claim_print_eob — builds the EOB for one claim via n_check_copy and prints it on demand.
• Check/payment views: d_check_payments, d_check_payments_backed_out, d_checkrun_claim_lines — claim-line payment detail used for check-copy reproduction (shared with the Funding domain via base/n_check_copy ancestry).
• Letter print objects (claims library): n_claim_print_letters / n_reportobject_claims_letters render queued claim letters for the Print Queue Manager.

Claims output practice — EOB / RA / registers (User Guide ch. 14)

The check-run outputs themselves are produced by the Funding domain, but the guide's Claims Output chapter defines the document set and the rules the EOB/print objects in this module serve:

• Document set per check run: EOB (member is payee; explains benefits paid/denied), RA (vendor is payee; one RA aggregates all payments for a group's members to that provider for the run), EOB Copy ("Employee Copy" — compiles the run's vendor payments on the member's behalf; produced for every vendor payment, never carries a check), and optional Employer Copy (copy of the EOB bundled to the group; printing can be enabled/disabled; addressed with the employee's address). RA Copies were deliberately not produced.
• Checks vs worksheets: any EOB/RA either has a check printed on the top portion (check stock) or is a worksheet — a zero payment or a payment the group disburses itself — on plain 8½x11 paper. Six coverage-based formats existed on the legacy system (medical, dental, vision, flex, WDI, Medicare supplemental); medical/dental/vision/medicare-supplemental may combine, flex and WDI stay separate, and WDI produces no RAs.
• Format/verbiage sources: contact table (names), pricing data (allowed reasons; whole-claim Detail Y/N switch controls whether detail lines print), plan design (bottom-of-form verbiage), and benefit-rule reason codes whose explanations print on EOBs/RAs to justify retained amounts. The allowed reason is a free-form/table-driven field examiners control precisely to steer EOB wording (a UCR-wording dispute is the documented motivation). Dependent-care balance lines are suppressed when group_enroll_opts has enroll_opt_cd = 'SuppDepC'.
• Suppression rules: no EOB/RA for claims that are responses to repricing requests; rejected duplicate lines print only when the original line was paid more than 21 days ago (CLM-70); rejected claims still reach Funding and appear on the register as zero-dollar lines with an EOB/RA; interim claims print "Interim claim received, waiting for final bill".
• Provider RA control: provider maintenance carries an RA format flag (Standard / EDI / None); non-participating providers always receive RAs.
• QMCSO: with the switch set and an alternate address on file, payments go to the dependent's alternate address in the dependent's name, and EOBs are generated for both subscriber and dependent.
• Archive & reprint: registers, EOBs and RAs are archived non-editable (print image as BLOB), searchable by register date (= run/check date), check number or worksheet number; reprints are requested per check run or per single benefit payment, by document type. This is the requirement the clmprint check-copy/EOB reprint objects and report_archive implement.
• Claims letters plumbing: every clmforms letter shares one SQL select taking the claim id; letters needing extra data use dummy columns (dummy_string_1..5, dummy_date_1/2, dummy_number_1/2 — the guide maps them per letter number, e.g. letter 16 overpayment amounts, letter 19 other-carrier benefits, letter 26 MRS admission data). Associated-letter handling: a response received closes all associated messages and archives the letter history row; no response sends the claim to corrections, rejects the lines and completes the association; un-checking an association deletes the row (User Guide ch. 14, programming notes 11/2003).

Guide-era reports not found in clmrpt

Chapter 10 lists Claims Entry production reports — Batch Control Sheet, Claims Entry Daily Report (by date entered, per user), Data Entry Error Detail, and Data Entry Monthly Average — that have no obvious counterpart among the recovered clmrpt windows; they may live in the background application or were retired. Flag for SME confirmation (User Guide ch. 10).

Report/letter data flow notes

• Letters print through the shared reprint/archive subsystem: issued letters live in claim_letters_hist (+ claim_letters_data blobs), print state (prt_flg) is managed in the Print Queue Manager, and archived items go to report_archive via n_cst_reprint_print_reports.of_ArchiveItem('CLMLETTERS', key) (claims/w_claims_letters, clmshare/n_cst_return_claim_to_corrections).
• Accumulator reports read the same member_accums rows the adjudication engine maintains; the "pending claims" variant explicitly includes claims not yet PAID whose rules have already accumulated — an important reconciliation behavior to preserve.