Adding a New Coverage Gap Submission

Uploading Files

The Validation Analyst can only upload two files (one data file and one invoice file) to a Coverage Gap Submission. When more than two files are selected a validation error message is displayed:

You can upload files to the Submission using one of the following options:

• Drag and Drop Files:

You can add files from your local machine through the drag-and-drop files option. When you drag and drop an unsupported file format, the below error message is displayed:
”Can’t upload <Name of the file> because its file format is not supported”

• Browse Local Files:

You can browse and add files from your local machine using the Browse Local Files option. Click Browse Local Files. Select the files from your system location.

• Browse File Share:

Using the Browse File Share option, you can add Data, Invoice, and Dispute Return/Resolution files from the file share.

Note:
In the File Share window, you can only select and include files in a submission. You can not delete the files from the file share location.
When you add files during Submission creation but at a later point in time do not proceed with the Submission creation, then those files get stored in the file share.
To upload files from file share:

• Click Browse File Share. The File Share window is displayed. All the Coverage Gap files are listed on this window.
• Select the required files Coverage Gap Data/Invoice to include in the Submission. You can use the select check box at the header level to select all the files.

Note: You can select a maximum of two files to include in the Coverage Gap Submission. When more than two files are selected an error message is displayed.

• The Include button is enabled once the user has selected at least one file. Click Include. The selected file is added to the Included files list table.

Note: When more than two files are selected, the Include button remains disabled.

When the file upload is in progress, an alert message is displayed to notify users that the file upload is in progress, and the user should not close the browser. Based on the file size, the upload process will take time.

Included files

Once you have included files, the selected files are listed on the Include files table. The validation analyst can view the list of files uploaded on the Included files table. On the Included files table for a Coverage Gap Submission, the Validation Analyst can perform and view the following:

File Name:

The File Name column shows the file's name uploaded to the Submission.

File Type:

In the file type column, select the type of the file. Select one of the following options:

• Data

• Invoice

Mapping Set:

You must assign a Mapping Set to the file for importing the file lines to the Validata application. The Mapping Set tells the Validata application the type of data contained in the file and the location in the transaction repository in which to store the data when it is imported. The data import for each file considers the Mapping Set specified against that file.

Note: 

Only the active CG Data/Invoice type Mapping Sets are listed in the drop-down list for the user selection.

To assign a Mapping Set to a file included in the Submission, select the Mapping Set name from the Mapping Set drop-down list.

Included Date

In the Included files table, the Included Date column displays the date and time when the file was added to the Submission. The analyst can only view the date and time and cannot edit this value. If you have included the file using drag and drop or the Browse Local File option, the date and time you included the file are displayed.

Size

In the Included files table, the Size column displays the size of the respective file. The analyst can only view the file size value and not edit this value.

Delete Included Files

When creating a Coverage Gap Submission, if an incorrect file is selected in the File Selection tab, the Validation Analyst can remove the selected file and add another file.

To remove a file on the File Selection tab:

1. Select the File row.

2. The delete icon is displayed above the table. Click the delete icon.

or

1. Right-click on the file row in the table.

2. Select the Delete option.

On the File Selection page, the Next button is enabled when the mandatory field i.e. Mapping Set, has been specified for the included file. Click Next to navigate to the Header Details tab.

Submission header details

Specify the Submission header details for the Submission creation in this section. The user input for all the fields in this section is mandatory. You must provide the Submission Heder information.

• Submission name: Specify the name for the Submission. You can enter the alphanumeric value, including special characters, for the Submission name. This user input supports 256 characters. The name should be a unique value, and if an existing name is specified, an error message is displayed while creating the Submission.

• Rebate period: Specify the Submission's Rebate Period Start Date and Rebate Period End Date for the data contained in the file. Enter a date in valid format (MM/DD/YYYY) or select a date using the calendar widget.
  Note: The Rebate Period End Date value should be later than the Rebate Period Start Date value.

• Submission receipt date/postmark date: Specify the date on which the validation analyst received the file from the PBMs. Enter a date in valid format (MM/DD/YYYY) or select a date using the calendar widget. This date value should be the current day’s date or a past date. The value can not be a future date.

• Dispute due date: This is a read-only field, and the user can not specify or change this value. The Dispute Due Date is a calculated value.
  Dispute due date = Submission receipt date/postmark date+ 60 days.

• Type: By default, the Type value is displayed as Coverage Gap.

• Segment: Select the market segment for the data contained in this Submission. The values are displayed in the drop-down list for user selection based on the values configured during the Validata application configuration by your system administrator.
  Note: You should separate data for multiple segments into different Submissions and add each Submission individually.

Contract details

In the Contract details section, provide the Contract information associated with the claim for which a Submission has been created in Validata for validation.

Note: Once a Coverage Gap Submission is created, the Contract details can not be updated for the Submission.

• Search contract to add contract details: This user input allows you to search and select the ID of the contract associated with the claim. You can enter or select the Contract name from the drop-down list.
  Notes:

  The Contract names are displayed for user selection depending on the Rebate Period Start and End Date and the Contract Type specified in the Submission header details section. All the active Contracts matching the search criteria are displayed in the search options.
  When the Contract ID is selected, all the related Contract details are auto-populated on the page. The Contract details are read-only, and you can not edit the details.

• Contract ID: This is the ID of the contract associated with the claim.

• Contract segment: This is the name of the business segment contained in the Contract.

• Contract name: This is the name of the contract associated with the claim.

• Contract type: This is the type of contract associated with the claim.

• Customer name: Name of the Customer associated with the Contract.

• Customer ID: ID of the Customer associated with the Contract.

Validation automation

In this section, the validation analyst can configure whether validation will run automatically once file import is completed for the Submission or if the analyst needs to trigger the validation manually.

• Start running validation automatically: By default, Start running validation automatically is set to Yes; this means validation will run automatically once file import is completed for the Submission. Set to No, if you do not want the validation to run automatically. You can manually start the validation process once a Submission creation is completed. For more information, see Validating a Submission. 

• Type of validation: When the Start running validation automatically is set to Yes, specify that the validation will be performed using a Single Validation or a Chained Validation. The default value is Single Validation. You can select the Chained Validation Set option when required. This user input is not required when the Start running validation automatically is set to No.

• Run validation on lines with status: The Run validation on lines with status indicates to the application’s validation execution which transactions, based on the Line Status, will be considered. The user input contains the following selectable options matching the Submissions workflow:

  • New: When the user input is selected as ‘New’, the lines with a Line Status value of New will be considered when validating the lines. The ‘New’ value was formerly known as Imported in the previous Transaction File workflow.

  • Included: When the user input is selected as ‘Included’, the lines with a Line Status value of Included will be considered when validating the lines. The ‘Included’ value matches the value of the same name in the previous Transaction File workflow.

  • Excluded: When the user input is selected as ‘Excluded’, the lines with a Line Status value of Excluded will be considered when validating the lines. The ‘Excluded’ value matches the value of the same name in the previous Transaction File workflow.

When creating a new Submission, when the Type of validation is selected as Single Validation (the default selection), all three line status options are in read-only mode by default. When the Type of validation selection is altered and set as Chained Validation, the line status options will be activated mode for user selection. By default, New option is selected and the user can select the other options as needed. User input is mandatory for the Run validation on lines with status field and can not be left blank.

 

• Validation set: When the Start running validation automatically is set to Yes, select the name of the validation Set that will be used to validate the Submission. This user input is not required when the Start running validation automatically is set to No.

• Duplicate check indicator: When the Start running validation automatically is set to Yes, it automatically validates lines with a defined duplicate check status. Select one from the following options:

  • Processed: To validate the Submission Lines that were checked for duplicates previously.  

  • Not Processed: To validate the Submission Lines were not checked for duplicates previously.

  • All: To validate all the Submission Lines irrespective of whether they were checked duplicates previously. This is the default value.

This user input is not required when the Start running validation automatically is set to No.

Note: When the user input for Start running validation automatically is No, then the analyst will provide the validation details in the Validation Options window while manually starting the validation process. For more information, see Validating a Submission. 

View Created Submission

Once the Submission is successfully created, it is listed on the Submission page list table. For more details about the Submission list table, see Viewing the Submissions List.

When a new Coverage Gap Submission is created, on hovering the Workflow, you can see the relevant status details. When the utilization file import is completed, under the Workflow column, the File Status is shown as In progress. When the Validation is run for the Submission, the File status is displayed as File: Completed and Validation.

Open the Submission from the list table and review/verify the following:

• To view the Submission details, see Viewing a Coverage Gap Submission Details.
• Viewing the files added within a Coverage Gap Submission.
• Review the CG data file lines in the Data Lines tab.
• Review the CG invoice file lines in the Invoice Lines tab.