Generating the List of Entities and its corresponding G/L Accounts using the Transaction code (ZFI_COA). Filtering the data for 1 entity against (1-Series, 2-Series, 3-Series and so on) and download the data from transaction code FAGLLO3. Clearing the Open items for different Company codes and G/L Accounts in SAP using various tcodes. Using the template identifying the list of records to be clear and not to be clear.

Neighborhood Health Plan of Rhode Island, an innovative health plan in partnership with Community Health Centers, secures access to high quality, cost-effective health care for Rhode Island’s at-risk populations.

The Health Rules product suite is the only integrated financial, administrative and clinical software platform for healthcare payers. It is Health Edge product. Incremental file is a standard X12 HIPAA file that is sent by the Exchange to all the Qualified Health Plans including Neighborhood containing the member enrollment data on a daily basis.

Daily incremental 834 exchange file contains addition/changes/termination/cancellation to the Member record - both as an Individual and as an employee in a group The EDI 837 transaction set is the format established to meet HIPAA requirements for the electronic submission of healthcare claim information

This is to give the overall view of AS IS process state, systems and applications used through the process flow and automation requirements. It is validating the document related to E-Recon GL processing for miscellaneous type accounts. Performing the actions with type accounts like downloading the template for previous month or six months.

Coordination of Benefits Agreement file is an 837 claims file containing COB claims that have already been processed by Medicare. COBA claims are applicable only for the dual eligible Members I.e. Members who are covered by both Medicare and Medicaid. Medicare is the Primary payer for the Integrity members (RHO members). Hence, primarily claims will be paid by Medicare (CMS) and then by Medicaid.