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 throughclmprint/n_claim_print(withclmprint/w_viewclaimas the on-screen viewer). - EOB print:
clmprint/w_claim_print_eob— builds the EOB for one claim vian_check_copyand 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 viabase/n_check_copyancestry). - Letter print objects (
claimslibrary):n_claim_print_letters/n_reportobject_claims_lettersrender queued claim letters for the Print Queue Manager.
Report/letter data flow notes
- Letters print through the shared reprint/archive subsystem: issued letters live in
claim_letters_hist(+claim_letters_datablobs), print state (prt_flg) is managed in the Print Queue Manager, and archived items go toreport_archivevian_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_accumsrows the adjudication engine maintains; the "pending claims" variant explicitly includes claims not yetPAIDwhose rules have already accumulated — an important reconciliation behavior to preserve.