UM & CM Screen Catalog — Reference Data, Reports, Vendor Extracts

Screens used by supervisors and administrators: CM potentials and billing, reports, UM reference-data maintenance, and the external vendor extract jobs. All are launched from the application frame menu (homersys/m_sys_frame) unless noted. The day-to-day case screens are in Screen Catalog — Case Work.

Case management operations (um_cm)

CM Potentials Report (um_cm/w_um_cm_potentials_report)

• Purpose: the CM identification work queue — list, resolve, and convert CM potentials.
• Criteria: CM company (entity dddw um_cm/dddw_um_entities, restricted to um_entity_type_cd = 'CM'), Group ID, Member ID, create-date From/Thru, Resolution (CaseOpened / No Case / Unresolved = null / all), Status (codes CMPOTNTLST), Generator (UR / Claim / all). The SQL is assembled dynamically and unions the UR branch (joined to um_cases + first UM diagnosis) with the Claim branch (joined to claims + first claim-entry diagnosis) (ue_retrieve).
• Columns: CM firm display name, generator, generating case/claim link, creator and dates, member, primary diagnosis + description, group, resolution fields, claim status (claim branch), linked CM case (um_cm/d_um_cm_potentials_report; print variant d_um_cm_potentials_report_print).
• Actions: open the generating case (any category) or the linked CM case (wf_open_case), create a new CM case from the potential (wf_create_cm_case — passes the potential key so the case save resolves it CaseOpened), resolve a potential directly (w_cm_potential_resolution), notes.
• Windows opened: all five case workspaces, w_cm_potential_resolution.

CM Potential Create (um_cm/w_um_cm_potential_create)

• Response window opened from the UR workspaces' "Create/Edit Potential CM" button; shares the caller's hidden potential DataWindow (d_um_cm_potential_create).
• On first create: key from sequence; CM firm entity from the plan package; entity_generator_cd = 'UR'; generator link = case number; generating user; status_cd = 'Normal'; procedure_status_cd = 'Proposed'; free-form comments. Display-only context: category, member name, SSN, entity name, group.

CM Potential Resolution (um_cm/w_cm_potential_resolution)

• Response window sharing the selected potential row (d_um_cm_potentials_resolution); resolution dropdown is hard-coded: CaseOpened ("Case Opened"), No Case, null ("Unresolved") (dw_resolution::constructor).

CM Billing (um_cm/w_cm_billing)

• Purpose: review, report and bill the automatically captured CM time.
• Criteria: date range, Group ID (validated; division ids are resolved up to the master group), Member ID, user id prefix, time type (codes UMTIMETYPE; captured values are Consult, Billable, Non-Bill), billed status (codes UMBILLSTTS; "Y" filters unbilled = null). Non-managers see only their own records (wf_retrieve).
• Content: editable grid of billing records (d_cm_billing_records: start time, elapsed minutes, type, case status at capture, user, case, billed status) grouped with computed totals; print composites for external and internal detail/summary formats (d_cm_billing_composite, d_cm_billing_composite_internal, d_cm_billing_report_*).
• Actions: update billing status (save), print the selected format.

Management Cases Report (um_cm/w_um_management_cases)

• Purpose: client-facing UM/CM caseload report.
• Criteria: master group list, case-date overlap range, show-id / show-name / show-referral toggles.
• Content: um_cm/d_um_management_cases — a five-branch UNION over um_cases/um_services with up to two diagnoses per service, patient age/gender, other-coverage flag (COB existence during the case window), CM involvement descriptions, and cases for unassigned dependents (patient_sys_key = -1 reported under the subscriber with an ND suffix); service-status (Serv%) records are excluded. Retrieval is guarded by the View > Retrieve menu enablement.

Reports (um_main)

UM Claim Reports (um_main/w_umclaim_rpts)

• Sheet "UM Claim Reports" (menu m_umclaim_rpts) with a report dropdown:
  • UM Claims On Fund Register (d_umclaims_on_fund_register) — internal-CM claims (claim id like KUMC%) joined to fund register / fund transactions with check number and cleared date.
  • UM Claims Unpaid (d_umclaims_unpaid) — KUMC% claims not in PAID status.
  • UM Claims With Open Messages (d_umclaims_open_messages) — KUMC% unpaid claims having open claim messages.

Possible CM Claim Report (um_main/w_cm_possible_rpt)

• Lists claims flagged as possible CM cases in a create-date range: diagnosis + description, group, subscriber and patient (name, SSN), total claimed amount, message sequence (um_main/d_cm_possible_rpt over um_cm_possible_case_claim joined to claims/members/diagnoses). The rows are produced outside the client application (see module Open questions).

UM Entities Report (um_main/w_um_entities_report)

• Prints the UR/CM entity registry by type (um_main/d_um_entities_report).

Reference-data maintenance (um_maint)

UM Entity Maintenance (um_maint/w_um_entity_maintenance)

• Purpose: maintain UR/CM firms (um_entities), the warnings shown for them, and their medical directors. Menu set m_um_entity_maintenance_menu (+ director/warning variants).
• Field groups (Entity tab, d_um_entity_maintenance): entity type (value list UR, UR/CM, CM), names (name, display name, entity display name), contact person, phone/fax/e-mail, address number, suppress-warning flag, CM trigger assignment (select via w_cm_trigger_select).
• Validations: entity type, name and suppress-warning flag required; a CM entity must have a CM trigger set; changing the entity type of an existing entity warns that all attached warnings will be removed and deletes them on confirmation; the trigger-select button refuses non-CM entities ("CM Trigger Only applies to CM Entities") (ue_validate, itemchanged, buttonclicked).
• Warnings tab (d_um_entity_warnings): attach warnings from the catalog (pick via w_um_warning_select).
• Directors tab (d_um_entity_directors): attach medical directors (pick via w_medical_director_select, typed via dddw_medical_director_types).

Warning Maintenance (um_maint/w_warning_maintenance)

• Catalog editor for um_warnings (warning, type, message — d_warning_maintenance); menu m_warning_maintenance. These warnings appear in the search-time warning display when attached to a member's UR/CM firm.

Medical Director Maintenance (um_maint/w_medical_director_maintenance)

• Registry editor for medical_directors with type codes (d_medical_director, dddw_medical_director_types); duplicate-name lookup helper um_main/u_urcm_sql of_count_medical_directors. Select popup: w_medical_director_select ("pick medical director for um_entity_medical_directors").

CM Trigger Maintenance (um_maint/w_cm_trigger_maintenance)

• Purpose: maintain named CM trigger sets (cm_triggers) and their diagnosis-code and procedure-code lists.
• Content: trigger header (name, description — d_cm_trigger), diag-code tab (d_cm_trigger_diag_codes) and proc-code tab (d_cm_trigger_proc_codes), each row carrying network affiliation, dollar threshold and Inpatient/Outpatient/All scope; new rows default the threshold to 0; a refresh copy function mirrors codes between tabs; codes report (d_cm_trigger_codes_report) printable. Select popup: w_cm_trigger_select.
• Trigger sets are assigned to CM entities (entity maintenance) and drive the claim-side identification of CM candidates (evaluation code external — see module Open questions).

Vendor extract jobs (um_maint)

File-generation windows for external CM / disease-management vendors; each takes a date range and target file names, retrieves an extract DataWindow and writes fixed-format text files:

Window	Purpose
um_maint/w_matria_enrollment_dump	"Create Matria Enrollment Files" — enrollment data file + control file (d_matria_enrollment_dump, d_matria_enrollment_control_file); menu m_matria_dumps.
um_maint/w_matria_claim_dump	Matria claims data + control file (d_matria_claims_dump, d_matria_claims_control_file).
um_maint/w_hcrm_enrollment_transfer, w_hcrm_claims_transfer	HCRM enrollment / claims transfer files (d_hcrm_enrollment_transfer, d_hcrm_claims_transfer, d_hcrm_claims_dump).
um_maint/w_springbuk_enrollment_transfer, w_springbuk_claims_transfer	Springbuk enrollment / claims transfer files (d_springbuk_enrollment_transfer, d_springbuk_claims_transfer).
um_maint/w_dm_enrollment_dump	Generic disease-management dump, opened twice from the menu with parameter "Enrollment" or "Claims"; vendor chosen from the DM entity registry (d_dmentities, d_dmentities_dump_select); writes <prefix><type><MMDDYYhhmm>.TXT for prefixes dmqual / dmhcs (wf_generic_enrollment_export / wf_generic_claims_export), with an "Executing Oracle Procedure..." progress state.
(DataWindows only)	d_bluebook_eligibility_transfer, d_principle_enrollment_transfer — transfer formats with no host window in these libraries.