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Screen Catalog — provider library

Significant windows in the provider library. Every window that maintains segment-scoped data validates the user's client segment on open and shows it in the title ("... for Segment: name (code)") (provider/u_provider_sql.of_validate_client_segment).

w_provider_maintenance — "Provider Maintenance"​

Purpose: create and maintain providers with all identifiers, addresses, network panels and holds (provider/w_provider_maintenance, PBExportComments "Maintenance window for providers").

Search header: TIN (9-digit mask; EIN/SSN radio), Name (last/company vs Lookup-name radio, "Sounds Like" soundex checkbox), Provider Type, Specialty, City, State, status checkboxes Active/Inactive/Potential (default Active). At least one criterion and one status is required; >200 matches prompts before listing; multiple matches open w_provider_select_urcm; zero matches (Active included, provider-dept user) starts a new provider.

Tabs and field groups:

TabDataWindow(s)Fields
Providerd_providerStatus, Company Name, Provider Name (title/first/middle/last), Lookup Name, Birthdate, Educational Degree, Primary Specialty, Clearinghouse Number, UPIN, Medicare Number, Provider Type, Languages, After Hours contact info, System ID, Covering Provider (search button → w_provider_select_urcm), Default Vendor (search button → w_provider_vendor_select), General Comments
Provider (sub-lists)d_tin, d_medicaid, d_provider_npi, d_specialtyTINs (type EIN/SSN + number), Medicaid IDs (state + id), NPIs, Specialties
Addressesd_provider_address, d_provider_address_vendor, d_provider_contactsAddress (addr1/2, city, state, zip via pm_addresses, standardized flag), contact (name, phone, fax, email, position, comments via pm_contacts), and per-address dated vendor list with Add-Vendor search (name/TIN)
Panelsd_provider_hcn, d_provider_panelHCN search/add ("Add HCN" name search → w_provider_hcn_select), panel rows per HCN: panel, eff/exp dates, exp reason
Holdsd_provider_holdsStart date, hold reason (PRVDHOLD), end date, end-date type (PRVDHOLDDT)
Group Holdsd_provider_group_holdsGroup id, hold reason (PROVGRPHLD), start/end dates

Validations: see PRV-1..PRV-10 (index page). Save is a single transaction with address standardization and duplicate-address rejection (pfc_save).

Actions / windows opened: w_provider_select_urcm, w_provider_vendor_select, w_provider_hcn_select, w_provider_tin_enter and w_provider_tin_select (default vendor creation), notes service (n_notes). Menu m_provider_maintenance_menu adapts add/delete availability per tab and per mode (PROVIDER / UM / OTHER).

w_provider_vendor_maintenance — "Vendor Maintenance"​

Purpose: maintain payees (vendors) with addresses, contacts, holds, and status (provider/w_provider_vendor_maintenance).

Field groups: vendor header (d_provider_vendor: System ID, Name, Lookup Name, TIN + type EIN/SS#, Status, Payment Rule Claimed/Incurred/Received + rule date, Produce 1099? Y/N); addresses (d_provider_vendor_address, dated with exp reason VNDRADDRXR); contacts (d_provider_vendor_contact, contact type required); holds (d_provider_vendor_holds: start date, reason VNDRHOLD, end date + end-date type); status history (d_provider_vendor_status).

Validations: name, lookup name and TIN required; at least one address; address date rules; hold rules (see PRV-11/PRV-12).

w_provider_hcn_maintenance — "HCN Maintenance"​

Purpose: maintain Health Care Networks and their network-level withholds, contacts and pricing plans (provider/w_provider_hcn_maintenance).

Field groups: HCN tab (d_hcn): ID, Name, EOB Description (reason code), Eligibility File Format (census format), Code Review? Y/N, Type HMO / HMO-PPO / PPO, Automatic Contract Insertion Y/N, Automatic Provider Insertion Y/N, Reject Non-Reprice Sheets Y/N, Electronically Paid Y/N. Withholds tab (d_hcn_withhold): vendor (search → w_provider_vendor_select), withhold % (≤100), type Allowed/Paid, dated with exp reason. Contacts tab (d_hcn_contact + d_provider_contacts, standardized addresses with "update all HCNs at this address" prompt). Pricing tab (d_hcn_pricing): dated pricing-plan rows; "select plan" button opens pricing/w_pricing_plan_maintenance_single.

Actions: New HCN defaults (type PPO, code review N, default HCN reason); hard delete with child cleanup and FK-block message; save validated per tab (PRV-15..PRV-19).

w_provider_panel_maintenance — "Provider Panel Maintenance"​

Purpose: maintain panels within an HCN, with panel-level withholds and pricing plans (provider/w_provider_panel_maintenance; tables panels, panel_withholds, panel_pricing).

Validations: panel ID + name + effective date required; expiration after effective + reason (PANELXRSN); withhold vendor/pct(≤100)/type/dates within panel dates; pricing plan + effective date (PRV-18..PRV-20).

w_provider_contract_maintenance — "Provider Contract Maintenance"​

Purpose: maintain per-provider network contracts with per-contract withholds, holds and pricing plans (provider/w_provider_contract_maintenance).

Field groups (d_contracts, one contract per page with scrollbar): HCN, Contract Type (Payable/Capitated/Staff/Fund), Remittance Advice Format (EOB, EOB/EOB, EOB/RA, EDI, Custom, None), Effective/Expiration dates + Expiration Reason (CNTRCTXRSN), Network Provider ID, Enrollment Limit, PCP? Y/N, New Patients Allowed? Y/N, Withholds Allowed? Y/N, DRG Hospital Multiplier, DRG Cap Rate, Capitation Vendor (search → w_provider_vendor_select). Provider located via the same search header as provider maintenance.

Validations: PRV-22/PRV-23; per-contract withhold/hold/pricing validation loops filtered by contract_sys_key (ue_validate).

w_provider_select_urcm / w_provider_select — "Select Provider"​

Purpose: result pick lists for provider searches; w_provider_select_urcm receives the dynamically built SQL/sys-key list from u_provider_sql.of_count_providers_urcm; w_provider_select is the older TIN/company/last-name selector used by other domains (provider/w_provider_select PBExportComments). Both return provider sys key + name; the URCM variant can also return "new" to trigger provider creation.

w_provider_vendor_select — "Select Vendor"​

Purpose: vendor pick list by TIN/name/status used for default vendor, withhold vendor and capitation vendor selection (opened from provider, HCN, panel and contract windows; counts via u_provider_sql.of_count_vendors).

w_provider_hcn_select — "Select HCN"​

Purpose: HCN pick list by name within segment (opened from provider maintenance panels tab; counts via u_provider_sql.of_count_hcns).

w_provider_tin_enter / w_provider_tin_select​

Purpose: capture a TIN (with EIN/SSN type) or choose among a provider's multiple TINs when auto-creating the default vendor (provider/w_provider_maintenance ue_create_default_vendor).

w_1099_print — "Print 1099 Forms"​

Purpose: filter and print vendor 1099/1099-NEC forms from print_1099s (provider/w_1099_print).

Fields: filter row (d_1099_filter): group id, tax year, vendor TIN, original print date range, last print date range, printed indicator; results grid d_1099_print_select (multi-select, sortable).

Actions: print selected → renders d_1099_form (or d_1099nec_form for group 501-069Z); reprints prompt for a reason via w_1099_reason; rows updated with printed flag/dates and committed. A 147c/W-9 request letters exist as DataWindows (d_147c_request, d_w9_request, d_w9_request_2).

w_provider_consolidate_vendors — "Consolidate Vendors"​

Purpose: merge duplicate vendors on a TIN; user marks the surviving "main vendor"; duplicates are snapshotted to consolidated_vendors and all references repointed (contracts, provider address vendors, fund register payees, default vendors), children deleted (provider/w_provider_consolidate_vendors ue_consolidate).

w_hcn_enrollment_dump — "Health Care Network Enrollment Dump"​

Purpose: produce PPO census/eligibility files per HCN in the network's census format (generic, Cigna, Emerald, HFN, HS, MMO, VSP writers n_hcn_dump_*; selection DataWindows d_hcn_dump_select, d_ppo_group_selected, d_ppo_enrollment_selected, d_ppo_census). Menu m_hcn_enrollment_dump.

w_edi_partners / w_edi_partners_select — "EDI Trading Partners"​

Purpose: maintain outbound-EDI repricing trading partners (outbound_edi_trading_partners: id, name, partner type EDIPARTNER, clearinghouse, routing number, allowance days, pay-by days, retention days, no-reply action EDIACTION, status) and their contacts (outb_edi_tradingpart_contacts) (provider/w_edi_partners, provider/d_edi_trading_partners, d_edi_trading_partner_contacts).

w_edi_clearinghouse / w_edi_clearinghouse_select — "EDI Clearinghouse Maintenance"​

Purpose: maintain EDI clearinghouses (outbound_edi_clearinghouses) and contacts (outb_edi_clearhouse_contacts) (provider/w_edi_clearinghouse).

w_provider_open_cant_find_provider_msgs — "Open Provider Messages"​

Purpose: work queue of open "cannot find provider" claim messages produced when automatic provider matching fails, so provider staff can create/fix providers (provider/w_provider_open_cant_find_provider_msgs, d_provider_open_cant_find_provider_msgs; producer clmshare/n_provider_maintenance.of_find_provider).

w_unsearchable_tins — "Unsearchable Tins"​

Purpose: maintain the list of TINs excluded from automatic matching (unsearchable_tins) (provider/w_unsearchable_tins).

w_provider_change_segment / w_provider_segment_user_maintenance / w_provider_segment_group​

Purpose: switch the user's active client segment (response window), maintain which users belong to which client segments (client_segment_users; d_provider_segment_user_maintenance, d_provider_users), and segment-group linkage (provider/w_provider_change_segment, w_provider_segment_user_maintenance, w_provider_segment_group).

w_provider_specialties / w_provider_types_maintenance — reference data​

Purpose: maintain the specialty list (specialties, including anesthesia indicator) and provider types (provider_types) (provider/w_provider_specialties, w_provider_types_maintenance, d_specialties_maintenance, d_provider_types_maintenance).

w_provider_rpt_hcn_pricing_methods — HCN pricing methods report​

Purpose: as-of-date report of HCN → plan package pricing logic → group, joining group_coverages, plan_pkgs, health_care_networks, groups (Medical coverages, segment SFPI) (provider/w_provider_rpt_hcn_pricing_methods, d_provider_rpt_hcn_pricing_methods).

w_provider_caremark_flag_transfer / w_provider_optum_flag_transfer​

Purpose: produce PBM (Caremark / Optum) eligibility flag files with deductible/OOP variants; audited via caremark_report_audit / optum_report_audit (provider/w_provider_caremark_flag_transfer, w_provider_optum_flag_transfer, d_caremark_flag_*, d_optum_flag_*). Peripheral to provider mastering; included for inventory completeness.

w_hms_reporting / w_hms2 — "HMS REPORTING"​

Purpose: ad-hoc HMS export/reporting over enrollment (worksheets d_hms_export_worksheet*, date selection d_hms_dateselect) (provider/w_hms_reporting, w_hms2). Ownership unclear — see Open questions.

w_provider_group_select — group pick list (response popup)​

Purpose: generic selector that lets the user choose an employer group; returns the chosen group_id to the calling screen (provider/w_provider_group_select, DataWindow d_provider_group_select).