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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

WindowTitle / purposeKey DataWindows
w_clmrpt_accum_rptMember 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 accumulatorsd_clmrpt_accum_rpt, _med_den_deduct, _jhp, _external*, d_clmrpt_accum_pending
w_clmrpt_member_accum_searchMember accumulator search — enter member criteria, list the claims for the member or whole family and how each affected accumulatorsd_clmrpt_search_member, d_clmrpt_member_accum_search_results, d_member_count
w_rpt_group_selected_accumsAccumulators By Member for selected accumulators/reason codesd_rpt_group_accums_bymember, d_group_accums_memselect, dddw_reason_accum_picklist
w_rpt_member_accum_rulemaxMember Accumulators By Benefit Rule (accumulated vs rule maxima)d_rpt_member_accum_byrule
(datastores)Lifetime amounts per member; accumulator creditsd_clmrpt_lifetime_rpt, d_clmrpt_credits_rpt, d_clmrpt_period_find

Claims listings & workload

WindowPurpose
w_rpt_group_claim_bendefsDetailed Claims Listing By Benefit Definition (per group, selectable definitions)
w_rpt_group_claim_benrulesDetailed Claims Listing by Benefit Rule Type
w_clmrpt_status_count (Status Count)Number of claims in each pipeline status
w_clm_message_status_summaryOpen-message / status summary for a group
w_clmrpt_open_messagesAll claims with open messages (filter by message type)
w_clmrpt_claims_older_than_90_daysClaims older than 90 days for a group or a parent group and its children
w_clm_claimed_amt_morethanClaims whose claimed amount exceeds an entered threshold
w_claimrpt_large_claim_reportLarge-claim report
w_clmrpt_no_sub_or_patClaims 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_rptNOBS group report

Outbound / financial follow-up

WindowPurpose
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_daysClaims in outbound_edi_transactions not returned within 10 days
w_clmrpt_outstanding_adjustmentsClaims with outstanding external adjustments (ext_adjust)
w_clmrpt_outstanding_refundsOutstanding 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.

  • 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.

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.