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Screen catalog: plan design (benplans) and plan support (bensupport)

Plan-design screens share menus benplans/m_plan_design / m_plan_edit and common ancestors benplans/w_header_detail_maint (header/detail maintenance), benplans/w_maint_single (single-DataWindow maintenance), and benplans/w_response_selection (select-and-return response window).

benplans/w_benefit_plan_selection — Benefit Plan selection​

  • Purpose: list/search benefit plans (d_benefit_plan_select over benefit_plans: coverage type, plan code, description, filing/appeal limits, package logic, status, audit columns). Launches plan create/edit.

benplans/w_create_benefit_plan — Plan editor​

  • Purpose: create/edit one plan and its ordered package attachments.
  • Field groups: plan header (d_benefit_plan_edit / d_benefit_plan_maint): coverage type (dddw dddw_benefit_coverage_type_codes), plan code, description, status, package logic (PKGLOGIC codes; defaults to NORMAL), filing limit and appeal limit (length + PERIOD code). Package attachments grid (d_plan_packages over plan_pkgs): package (from d_benefit_packages picker), eff/exp dates, HCN, pricing plan, pricing logic (PRICELOGIC codes), UR firm, CM firm, search order.
  • Validations: search order renumbered from display order on save (wf_set_sequence); a live no-network default package required except ASMEDICAL drug plans (wf_check_default_pkg); no overlapping date ranges for the same HCN (wf_check_dates — "Effective Date must be BEFORE Expiration Date!"); missing-data check (wf_check_nulls); plan-code rename cascades to attachments (wf_rename_coverage_cd); plan code unique per coverage type (wf_check_cd_duplicates).
  • Actions: add/delete attachment rows, print plan (d_print_benefit_plan + nested package reports).

benplans/w_benefit_pkg_selection — Package selection​

  • Purpose: list benefit packages (d_benefit_pkg_selection) for edit/create.

benplans/w_benefit_pkg_maint — Package editor​

  • Purpose: maintain one package: header, rules, riders, and rule interactions.
  • Field groups: headers d_benefit_pkg_header1 / d_benefit_pkg_header2 (package code, description, default benefit definition, unassigned action + reason, pricing plan, second-opinion list, extraction / procedure flags); Summary tab (d_pkg_summary: per rule — type, code, dates, member scope decoded as Sub/Spouse/Deps combinations, PCP/Auth/Cert/Adm/Ref requirement string, accumulator, reason); rule attachment editor (d_pkg_rule_maint over pkg_rules with priority, member flags, managed-care indicators); rule picker (d_benefit_rule_picklist); riders (d_pkg_rider_maint, d_rider_rule); dependencies (d_pkg_rule_dep: accumulator + apply %), requirements (d_pkg_rule_req: accumulator min/max band), fulfillments (d_pkg_rule_ful: fulfilled rule).
  • Validations (pfc_validation): package code, default benefit definition, unassigned action ("ie. Hold, Exclude, Pay"), and unassigned reason are mandatory; unassigned-reason pick list filtered by the chosen action.
  • Opens: benplans/w_benefit_def_response (definition picker), bensupport/w_response_save_as_string (save-as prompt).

benplans/w_benefit_rule_select — Rule selection​

  • Purpose: search/list benefit rules (d_benefit_rule_list; rule-type filter dddw_rule_type adds an "<All>" row via UNION).

benplans/w_create_benefit_rule — Rule editor​

  • Purpose: create/edit one benefit rule with its detail, definitions, contingencies, tooth types, and package usage.
  • Field groups: master (d_ben_rules over benefit_rules): rule code (charset restricted, GRP-37), description, rule type (dddw_benrule), reason (dddw_reason_cd, filtered by rule type or ACCUM — ue_filter_reason_cds), accumulator (dddw_reason_accum), narrative (2000 chars), rule period (length + PLANPERIOD), age band (min/max, PERIOD codes), considered amount band and percentage, accident flag, weekdays (dddw_daysofweek), units between min and max, contingency period. Details tab (d_ben_rule_ded) relabeled per type — "Copay Details", "Deductible Details", "Coinsurance Details", "Out of Pocket Details", "100PCT Details", "Claimed Limits", "Paid Limits", disabled for EXCL/HOLD (wf_set_accum_type): Rule Applies (Retain / Pay at / Maximum of vs coverage-level schedule dddw_level_sched), per-individual / per-family maxima, members-to-meet, carryover (dddw_carryover_rule), per-day basis (PERDAY codes), per-unit flag, quantity basis + unit ratio. Definition list tab (d_rule_def_link + d_benefit_def_list with criteria search) — add/remove definitions the rule governs. Contingencies tab (d_rule_contingency + definition list; With / Without radio buttons drive contingency_ind, defaulting to With when contingencies exist — see GRP-39). Teeth tab (d_rule_tooth_types / d_tooth_types) for dental rules. Package usage (d_pkg_rules) shows/edits which packages carry the rule.
  • Validations / behaviors: per-type field nulling (wf_reset_rule_detail); DED forces retain_val = 100; COI/OOP store 100 − "pay at" (pfc_save); duplicate rule-code check (wf_dup_check); single-transaction save across five DataWindows (pfc_save); print rule report (d_print_rule + nested contingency/def/pkg reports).
  • Opens: bensupport/w_response_save_as_string.

benplans/w_benefit_def_selection / w_benefit_def_response — Definition pickers​

  • Purpose: search benefit definitions (d_benefit_def_selection / d_benefit_def_picklist); response variant returns the chosen definition.

benplans/w_benefit_def_maint — Benefit definition editor​

  • Purpose: maintain the service-classification criteria of one benefit definition.
  • Field groups: header (d_benefit_def_header1: code, description, short desc, inpatient/outpatient indicator); one tab per criterion — Procedures (3 code-type slots: type dddw + criterion multiline or pick list, plus reusable procedure groups via d_proc_cd_and_groups_list/_selected), Diagnoses (same pattern), Place of Service (d_pos_list), Specialty (d_specialty_list), Modifier (d_modifier_list), Revenue (d_revenue_list), Compound (child definitions, d_compound_ben_def). Each tab offers "Criterion" vs "Pick List" entry modes with add/remove (u_cb_add_remove).
  • Behaviors: criteria stored as SQL predicates; * converted to %, BETWEEN…AND protected during prefixing (wf_prepare_where_clause); IN-only criteria round-trip as pick lists (wf_ispicklist, wf_decode); usage report (d_benefit_def_usage) shows where a definition is used; summary/print DWs (d_benefit_def_summary, d_benefit_def_rpt1).
  • Opens: bensupport/w_response_save_as_string.

bensupport — plan support screens​

bensupport/w_codes_maint / w_code_selection — Code table maintenance​

  • Purpose: maintain rows of the generic codes table (d_codes_maint, d_code_key_maint, d_code_key_selection) — the source for BENRULE, PKGLOGIC, PERIOD, PLANPERIOD, PERDAY, PRICELOGIC, ENROLL, CONTACT, ROUNDTYP, VALSAVED, MBRCOVAPP, MBRCATAPP and similar code keys used across this domain.

bensupport/w_procedure_code_maint / w_diagnosis_code_maint / w_proc_code_display / w_diag_code_display​

  • Purpose: maintain and look up procedure and diagnosis codes (d_procedure_codes, d_diagnosis_codes, display windows resolve a typed code to its description).

bensupport/w_create_proc_group / w_proc_group_selection — Procedure groups​

  • Purpose: create/edit named procedure code groups (procedure_groups + procedure_code_groups; d_proc_groups, d_proc_cd_groups, d_proc_groups_edit) referenced by benefit-definition criteria (GRP-43).

bensupport/w_create_diag_group / w_diag_group_selection — Diagnosis groups​

  • Purpose: same pattern for diagnosis groups (diagnosis_groups, diagnosis_code_groups).

bensupport/w_create_second_opinion / w_second_opinion_selection — Second-opinion lists​

  • Purpose: maintain second-opinion procedure lists (d_second_opinion over second_opinion_lists: penalty %, penalty max, penalize-all flag; d_so_cd_groups for member codes). Attached to packages.

bensupport/w_create_tooth_group / w_plan_required_teeth / w_plan_required_surfaces​

  • Purpose: dental support — tooth-type groups (d_tooth_types, d_tooth_type_edit, d_tooth_numbers) and the procedure codes that require tooth (d_plan_required_teeth) or surface (d_plan_required_surfaces) identification.

bensupport/w_carryover_rule_maint — Carryover rules​

  • Purpose: maintain carryover rules (d_carryover_rules_maint): code, description, carryover percent, period length + type, and "Deductible Satisfied" flag (rule_fulfillment_flg).

bensupport/w_level_sched_maint / w_level_sched_selection — Coverage level schedules​

  • Purpose: maintain coverage-level schedules (d_level_scheds + d_level_scheds_items). Item formula per coverage level: Flat Amount + (Member Category × Multiplier), optionally Rounded (dddw_rounding_rules) and Step-Rated (dddw_step_rates_w_null) — the labels in d_level_scheds_items spell out the formula.

bensupport/w_step_rate_maint / w_step_rate_selection — Step-rate schedules​

  • Purpose: maintain step-rate schedules (d_step_rate_scheds) and their bands (d_step_rate_items: From / Thru / Rate).

bensupport/w_rounding_rule_maint — Rounding rules​

  • Purpose: maintain rounding rules (d_rounding_rule_maint): code, description, direction, significance.

bensupport/w_reason_code_maint — Reason codes​

  • Purpose: maintain reason codes (d_reason_code_maint over reason_codes): code, type, description, narrative, legend code, CAS code. Reason codes double as adjudication accumulators (type ACCUM) and per-rule-type denial/processing reasons (see rule editor filtering).

bensupport/w_plan_analysis_by_group — Plan analysis reports​

  • Purpose: report all rules (d_plan_rpt_group_rule_analysis) or accumulators (d_plan_rpt_group_acm_analysis) effective for a group, expanding the group subtree to leaf groups and joining group_coverages → plan_pkgs → pkg_rules → benefit_rules → reason_codes — the canonical adjudication join.
  • Opens: w_group_response_selection.

bensupport/w_plan_find_pkgs — Find packages​

  • Purpose: locate packages by contained rule/definition (d_find_packages).

bensupport/w_convert_plan — Convert Plans​

  • Purpose: reassign selected group coverages to a new plan code via stored procedure sfpidba.new_group_coverages, one commit per row, with status text ("=====COMPLETED====="). Uses d_group_coverages, d_group_coverage_selection, and a plan picker (d_benefit_coverage_cd style over benefit_plans).

bensupport/w_load_proc_diag_codes — Load Proc / Diag Codes​

  • Purpose: bulk-load procedure and diagnosis code files (d_load_procedure_codes, d_load_diagnosis_codes; helper u_load_procedure_codes).

bensupport/w_um_cm_serv_proc_cd_maint — UM/CM service procedure codes​

  • Purpose: maintain the procedure-code mapping used by UM/CM services (d_um_cm_serv_proc_cd_maint; dddws dddw_benefit_defs_cm_serv, dddw_proc_cd_cm_serv).

bensupport/w_wang_map — Legacy Wang rule mapping​

  • Purpose: maintain mappings from the predecessor (Wang) system's rules to HOMER rules (d_updt_wang_rule_map, d_updt_wang_group_rule_map, d_wang_group_list over wang_rule_map / wang_group_rule_map). Migration-relevance: historical cross-reference only.

bensupport/w_response_save_as_string — Save As prompt​

  • Purpose: ancestor response window prompting for a string value (used by plan / package / rule / definition "Save As" flows).