Adding a New Non-Coverage Gap Submission

Uploading Files

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 files from the Disk File System. When you add files for Submission creation but at a later point of time do not proceed with the Submission creation, then those files get stored in the Disk File System. To upload files from Disk File System:

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

Notes: In the File Share window, you can only select and include files to a submission. You can not delete the file from the File Share window.

When the file upload is in progress, an alert message is uploaded 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 the Non-Coverage Gap Submission, the Validation Analyst can perform and view the following:

File Name:

The File Name shows the name of the file uploaded to the Submission.

Medical Benefit Rule Set:

You can assign a Medical Benefit Rule Set to the files in the Submission of ‘Commercial – Medical Benefit’ type to define the conversion that will be applied for the incoming medical benefit lines. The qualified utilization lines in the file will be converted and allocated using the configuration specified in Master Data. By default, the Medical Benefit toggle is set to Off.  This means you can not assign a Medical Benefit Rule Set to the Submission. To assign a Medical Benefit Rule Set to the submission, do one of the following:

• Assign Medical Benefit Rule Set to individual file in the Submission:
  • Click on the Medical Benefit toggle to set it to On.
    
  • Select the Medical Benefit Rule Set name from the Medical Benefit Rule Set drop-down list.
    
  • If you set the Medical Benefit toggle to No, the Rule Set name will disappear from the table.
• Assign the same Medical Benefit Rule Set to all the files or selected files in the Submission:
  • Select all the files or required files row in the Included files table. You can see a new tab displayed on the page.
  • Click Medical Benefit. A popup confirmation window is displayed with Yes and No options.
    
  • Select Yes to set the Medical Benefit Rule Set toggle to Yes for all the selected files.
  • Click Apply. A confirmation message on the page shows “Medical Benefit for <Number of Files> were set to Yes”.
  • The Medical Benefit Rule Set tab is enabled on the page, which allows to select one Medical Benefit Rule Set for all the selected files.
    
  • Select the Rule Set name from the drop-down list. Click Apply.
    

A confirmation message on the page shows, “Medical benefit rule set selection for <Number of Files> were changed”.

Mapping Set:

You must assign a Mapping Set to the utilization file for importing the file lines to the Validata application. The Mapping Set tells the Validata application the type of data contained in the added 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:

• When the Medical Benefit toggle is set to No, only the Mapping set with Category as Pharmacy Benefit/Medicaid appears for user selection in the Mapping Set drop-down list.
• When the Medical Benefit switch is Yes, only the Mapping Set with the category Medical Benefit appears for user selection in the Mapping Set drop-down list.

You can assign one Mapping Set to all the files/selected files or a different Mapping Set to each file row in the Included file table.

• Assign a Mapping Set to one file in the Submission:
  • Select the Mapping Set name from the Mapping Set drop-down list.
    
  • Repeat the above step for each row in the Included files table.
• Assign the same Mapping Set to all the files or selected files in the Submission:
  • Select all the files or required files row in the Included files table. You can see a new tab displayed on the page.
  • Click the Mapping Set tab. A list of available Mapping Sets is displayed for user selection.
  • Select the name of the mapping set and click Apply.
    

    The name of the selected Mapping Set, along with its version, is displayed on the Included files table.

Send for 340B Evaluation

Permits the user to identify whether the subject file should be included in the 340B Risk Assessment processing or not. For details about 340B Risk Assessment details, refer to Risk Assessment Validation Details.

• If the Send for 340B Evaluation toggle is set to On, the Submission file will be sent for 340B Risk Assessment processing.

• If the Send for 340B Evaluation toggle is set to Off, the Submission file will not be sent for 340B Risk Assessment processing.

While deploying the 340B Vigilance license, in the configuration properties file:

• If the default340BSendForEvaluation property is true, this toggle is selected for all the Submission files by default.

• If the default340BSendForEvaluation property is false, this toggle is not selected for all the Submission files by default.

For more information about the default340BSendForEvaluation property, see the Validata Installation Guide.

You can set the Send for 340B Evaluation to On or Off as required.

This input value can be altered up until the time when the batch process occurs. Once a Submission has been processed as part of a risk assessment process, the input for Send for 340B Evaluation can no longer be edited.

Deleting Included Files

When uploading files, if you have selected an incorrect file or do not want to proceed with any file, then you can delete the selected file before proceeding with the next actions. To delete a file:

• Select the file.

• Click the Delete icon.

Note: 

• Files removed from the current submission even before their upload is complete will terminate the upload process to the File Disk System and will not be accessible in the File Disk System in the future. 
• The removed files from the Submission will remain available in the file disk system even if they were added from the local file system. Such files can be added to any future Submission.

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 not 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.

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.

• Rebate due date: This is a read-only field, and the user can not specify or change this value. The Rebate Due Date is a calculated value. The value is calculated and shown after the Contract Name is selected in the Search contract to add contract details user input in the Contract Details section.

• Type: Select the type of the Submission. You can select one of the following options:

  • Commercial

  • Medicaid

  • Tricare

• 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.

All unique Payers that own Commercial or Medicaid contracts in Payer Management will be automatically available within the Search contract to add contract details drop-down in the Submission Creation workflow.

• 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.

Note:

• 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. When creating a Submission of Type Medicaid, the Customer Name value will not auto-populate after the Contract selection. A Medicaid contract can be linked to multiple states simultaneously; hence, when creating a Medicaid Submission, the Validation Analyst can select the Customer name. The Customer Name drop-down list displays the states linked to the chosen contract. The Customer ID field value is populated when the Analyst selects a Customer Name.

• 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 Settings

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.

• Publish status: When the Start running validation automatically is set to Yes, it automatically validates Submission Lines with a particular specified status:

  • Published: To validate the Submission Lines with Published status.

  • Not Published: To validate the Submission Lines with Not Published status.

  • All: To validate all the Submission Lines irrespective of whether they were Published or not.

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

• Include all dates of service: By default, Include all dates of service is set to Yes; this means all the utilization lines, irrespective of their Date of Service, will be validated.
  When the Include all dates of service is set to No, you can specify the Date of Service period. That means all the utilization lines whose Date of Service falls under the specified start and end date will be validated. The utilization lined in the Submission whose Date of Service does not fall under the provided start date and end date period will be ignored during the validation of the Submission.
  Select the Start date and End date of the Date of service period using the calendar widget or enter manually in the MMDDYYYY format.

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. 

Analyst details

The Validation and Contract Analyst details are available in the Analyst details section.

• Assigned validation analyst: By default, the current logged-in validation analyst name is populated in this field. You can change and specify the name of the validation analyst responsible for this submission. All users with Submission Creation/Edit access only are listed in the drop-down list for user selection.
• Assigned contract analyst: This is a read-only value and can not be edited by the analyst. This value is fetched from the selected Contract.