COB & Pre-Existing Conditions — Screen Catalog

The domain libraries contain five windows (two in cob, three in preex). Because the actual COB editor windows live in the enroll library, they are listed here as well for completeness; they are counted under Enrollment in the inventory.

cob library

COB Select (cob/w_cob_select)

• Type / launch: MDI sheet, menu m_cob. Opened from the Claims menu item "Coordination of Benefits" (homersys/m_sys_frame, m_coordinationofbenefits::clicked) and from the Create/Edit COB button on UM and case-management screens, which pass a member id (um_cm/w_um_case_management cb_cob::clicked).
• Content: member search panel (u_member_search) above a sortable grid of the subscriber's whole family and their COB records (cob/d_cob_header: name, carrier, plan type, effective/expiration dates, status, status reason, policy no, coverage type). Members with no COB show a ** NO COB ** placeholder row produced by the outer join.
• Behavior:
  • Retrieval is by subscriber system key from the member search (dw_selection::pfc_retrieve).
  • When a member id is passed in, the list is filtered to that member (pfc_postopen).
  • Double-click on ** NO COB ** adds a record; on a real row opens the editor (dw_selection::doubleclicked).
  • Editing uses the PFC edit service registered to open w_enrollment_cob_maint, passing member keys, effective date, carrier and coverage type (dw_selection::constructor).
  • Placeholder rows are discarded before update so they never reach the database (pfc_preupdate); save commits or rolls back with an error message (pfc_save).
  • Menu New is enabled only after a successful member search; Open only when rows exist (uo_membersearch::ue_search, dw_selection::pfc_retrieve).

COB Edit (cob/w_cob_maintenance) — legacy, unused

• Export comment: "Unused - w_enrollment_cob_maintenance is actual window".
• MDI sheet titled "COB Edit" with menu m_cob_maint; header DataWindow cob/d_cob_detail plus three address panes (cob/d_cob_address) for plan, employer and other-subscriber addresses.
• Retains the full save flow: address standardization through the mailers service (wf_stand_addr), update of d_cob_detail, commit/rollback; its in-window business-rule validation (wf_validate_rules) is commented out in favor of a database trigger (comment dated 3/13/00).
• Displays member name, SSN (masked edit ###-##-####) and member id passed in from the caller (pfc_preopen).

Supporting drop-downs (cob library)

DataWindow	Code key	Used for
cob/dddw_cob_status_cd	COBSTATUS	COB status (order of benefits)
cob/dddw_cob_reason_cd	COBREASON	Status reason (e.g. Medicare, ESRD)
cob/dddw_cob_type_cd	COBTYPE	Plan type (e.g. Medicare, INTERNAL)
cob/dddw_typeoclaim	TYPEOCLAIM	Benefit coverage type

enroll library (COB editor windows, documented here for the domain)

Coordination of Benefits editor (enroll/w_enrollment_cob_maint)

• Type / launch: response-style window opened by the edit service from cob/w_cob_select, or directly with member keys passed as parameters (open event). Title shows the member's name.
• Content: single-record COB form (enroll/d_qe_cob_detail: carrier, effective/expiration dates, status, status reason, coverage type, plan type, policy no, phones, employer/school, other-insured name) with three embedded address panes (cob/d_cob_address) and per-section reset buttons (dw_coord::buttonclicked clears plan / employer / other-insured sections).
• Behavior: OK validates required fields and the duplicate/overlap rules (wf_validate, wf_checkforduplicates, of_comparedates; see COB-02..COB-06), standardizes changed addresses (wf_stand_addr, ue_validate events), then updates and commits (pfc_endtran); next/back/add buttons page through the member's COB records when opened via the edit service.
• As documented for users (User Guide ch. 1, "Coordination of Benefits (Modal) Window"): the window is reached from the Subscriber C.O.B. Information button on both the Eligibility tab and the Dependents tab of enrollment maintenance, from the C.O.B. buttons on the quick-enrollment Subscriber and Dependent tabs, and from the UM/case-management screens (COB-23). Because a member may hold several COB data sets, the window shows "record n of m" beside the Carrier Information area and is paged with < Back / Next >; Add New Row, Delete This Row, Cancel and OK (which asks whether to save) complete the button set. Fields are grouped as Carrier Information (carrier name, status, effective/expiration dates, status reason), Plan (plan type, policy number, carrier address, phone), Employer/School (name, address, phone) and Other Insured (first, middle, last name, home address, phone) — the other insured being "usually not a member of our system". Each address block carries a USA checkbox that, when cleared, replaces State and Zip with a free-form Postal Code line (COB-32). Date ranges may not overlap for a member within a single COB plan, and only one Primary, one Secondary and one Tertiary may exist per time frame while multiple Unknowns are allowed (COB-27).

Quick Enroll COB (enroll/w_quick_enroll_cob) — legacy

• Export comment marks it "** OLD **"; response window used during quick enrollment to capture a dependent's COB with default status Unknown (enroll/d_qe_cob_detail initial value).

preex library

Pre-Existing Conditions (preex/w_preex_maint)

• Type / launch: MDI sheet, menu m_preex_cond. Opened from the Claims menu item "Pre-Existing Conditions" (homersys/m_sys_frame, m_pre-existingconditions::clicked).
• Content:
  • Search fields: SSN, group id, last name, member id, group name; read-only name and hire date (cb_member_search, cb_clear).
  • HIPAA waiting-period pane (d_enroll_wait_pd, enroll library) with a Start Periods button (bolded when the member has more than one period, cb_all_wait_periods::ue_enable).
  • Eligibility-period list (preex/d_preex_eligibility_periods over member_eligibilities) with a pointer row-focus indicator.
  • Conditions grid (preex/d_preex_conditions): 3-character diagnosis code (required edit mask), read-only description from diagnosis_codes, Yes/No pre-existing radio buttons, end date.
• Behavior: search is security-scoped and counts matches first (preex/d_preex_count), lists candidates (preex/d_preex_member_select) and opens the member picker when more than one matches; selecting an eligibility period retrieves that period's conditions (dw_eligibility_periods::clicked); add-row stamps member keys, period effective date, user and timestamp (dw_preex_cond::pfc_addrow); save validates diagnosis code existence and the end-date rule, then commits and re-retrieves (pfc_preupdate, pfc_save); unsaved changes prompt before continuing (ue_check_save).

Select Member (preex/w_preex_member_select)

• Response window listing candidate members (shared datastore on preex/d_preex_member_select: name, member id, master group id, SSN, birth date, subscriber name). OK filters the shared datastore to the selected member; Cancel returns -1; double-click acts as OK.

View Waiting Periods (preex/w_preex_view_wait_period)

• Response window inherited from enroll/w_enroll_view_wait_period; forces the waiting-period DataWindow read-only on open, so pre-ex users can view but not edit HIPAA waiting-period start dates.
• The editable parent window is described for users as the Waiting Period Start Date Periods (Modal) Window, used "to track periods of medical coverage for members of our system"; members may have multiple HIPAA periods, which must cover time in SFPI/M3 plans and may also record time on prior plans not administered by SFPI/M3. Rows are added and deleted with right-mouse functionality; the three columns are Waiting Period Start Date (the subscriber's hire date), Effective Date (date the member elected Medical coverage) and Expiration Date (the member's termination date), and periods display in descending date order on the enrollment tabs (User Guide ch. 1). See PRE-12 for how start dates are derived for dependents.

Related screens in other modules

Screen	Library	COB/pre-ex role
Enrollment log	enrolaud/w_enrollment_log	COB tab shows insert + audit history per family (enrolaud/d_audit_trail_cob)
Case Management	um_cm/w_um_case_management	Create/Edit COB button opens w_cob_select; label from COB row count (wf_countcob)
Pre-Certification, Referral, Admission Notification, Authorization	um_ur/w_um_pre_certification, w_um_referral, w_um_admission_notification, w_um_authorization	Same Create/Edit COB button pattern (wf_countcob)
Claim entry tabs	clmentry/u_claims_tab_hcfa, u_claims_tab_ub92, u_claims_tab_sfpi_dental, u_claims_tab_drug	Capture claim_other_ins_infos per claim form (d_claim_other_ins_info_*)
Enrollment maintenance	enroll/w_enrollment_maintenance	Dependent COB tab present but its COB DataWindow calls are commented out in current source