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Viewing a Coverage Gap Submission Details

Coverage Gap Submission Details

This section describes the information and details a Validation Analyst can view for a Coverage Gap Submission. On the Coverage Gap Submission details page, the Analyst can:

Coverage Gap Submission Header Details

The Header section displays the Coverage Gap Submission header details specified during Submission creation on the Submission header section. 

The following details are displayed in this section:

  • Name of the Submission: The name of the Coverage Gap Submission specified during Submission creation.

  • Submission ID: The system generated a unique ID for the Coverage Gap Submission.

  • Submission Status: Next to the Submission name one of the following status value is displayed:

    • New: Specifies the Coverage Gap Submission is newly created and has not been validated yet.

    • Processing: Specifies the Submission is undergoing system action.

    • In Progress: The Submission is awaiting a user action.

    • Review: Submission requires line-level review after validation.

    • Completed: Specifies all lines have a dispute status of “Upheld” and/or the current date has surpassed the dispute due date. When a Submission is marked as Completed, it can not be deleted from the application.

  • Contract name: Contract Name specified during Submission creation.

  • Contract ID: The ID of the Contract selected during Submission creation.

  • Contract segment: The segment of the Contract chosen.

  • Validation analyst: Name of the Validation Analyst.

  • Rebate period: Rebate period specified during Submission creation.

  • Receipt date: The Submission receipt date/postmark date specified during Submission creation.

  • Days to dispute: Number of days left for disputing the Submission.

  • Dispute due date: The Dispute Due Date value.

  • Last Updated: Date and time when the Submission was last updated.
    Note: The value is displayed in the UTC timezone. 

  • Winnings from dispute process: The sum of Reported Gap Discount Current Amount for all the disputed data lines with Dispute Status as “Upheld”. This value is populated when the data lines are processed through the Dispute process flow and assigned with Dispute Status value as Úpheld. For more details about the dispute process, see Coverage Gap Dispute Process. In the absence of the Winnings from dispute process value, '--' is displayed.

Manage Coverage Gap Submission Details

The Manage Details tab lets you edit and update the Submission Header, Contract, and Analyst details information. Click the Manage Details tab; the Manage Details window is displayed. The fields that can be updated are in active mode. The fields that can not be updated are in read-only mode. 

The Validation Analyst can edit the following details:

  • Rebate Period: The Rebate period start and end date for the Submission.

  • Submission receipt date/ postmark date: The Dispute due date value is auto-refreshed based on the revised Submission receipt date/ postmark date

  • Segment: The business segment of the files in the Submission can be updated.

  • Assigned validation analyst: The name of the Validation Analyst can be updated.

Click Save to proceed with saving the revision done to the Submission. A confirmation message is displayed for the Analyst's confirmation when the Analyst saves the changes.

Overview Tab

This is the default tab displayed on the Submission details page. On the overview tab, in the Process and results overview section, the Validata Analyst can view the count of lines and units imported to the application in the Submission. The details displayed here can not be edited.

Note: The metrics displayed in this section are Coverage Gap data file lines. The Coverage Gap invoice file lines are not considered for displaying these KPI values.

When a Coverage Gap Submission is created and the lines are imported successfully, the following metrics are displayed in the Process and results overview section:

  • Total Lines: The count of total utilization lines uploaded to the Submission.

  • Total Units: The count of total units contained in the uploaded utilization lines.

When a Coverage Gap Submission data line is validated and the validation is completed, the following additional metrics are displayed in the Process and results overview section:

  • Lines with error: The count of lines with error after validation completion.

  • Units with errors: The count of units with errors after validation completion.
    Note: When there are no errors associated with any data lines included in the Submission 0 value is displayed for these metrics.

CGSubmissionDetails2.png

When the data lines are processed through the Dispute workflow, the values are displayed for the metrics details in the Process and results overview section:

Total disputed lines: The count of data lines for which the Dispute toggle is set to yes in the Data lines list table. This indicates the count of data lines for which the Manufacturer has identified disputes but has not yet reported them to the TPA.

Submitted lines: The count of data lines with Dispute Status value as Submitted. Indicates the count of data lines for which disputes are identified and have been submitted to the TPA, but no reply has been sent by TPA.

Accepted lines: The count of data lines with Dispute Status value as Accepted. Indicates the count of data lines for which the TPA has accepted the dispute for consideration.

Upheld lines: The count of data lines with Dispute Status value as Upheld. Indicates the count of lines the TPA has reviewed and upheld the dispute.

Dispute rate: Displays the percentage of disputed lines out of the total lines available in the Data Lines tab.
Dispute Rate = ((Lines with a Dispute Status of “Submitted”, “Accepted”, “Upheld”) / (Total Lines)) x 100

Win rate: Displays the percentage of lines that have been Upheld that are considered to be won in the dispute process.
Win rate = ((Lines with a Dispute status of “Upheld”) / (Lines with a Dispute status of “Submitted”, “Rejected”, “Denied”, “Upheld”)) x 100

Dispute amount: The sum of the Reported Gap Discount Current Amount for all the disputed data lines with Dispute Status as “Submitted”. This value is populated when the data lines are processed through the Dispute process flow and assigned with the Dispute Status value as Submitted. For more details about the dispute process, see Coverage Gap Dispute Process.

Win amount: The sum of the Reported Gap Discount Current Amount for all the disputed data lines with Dispute Status as “Upheld”. This value is populated when the data lines are processed through the Dispute process flow and assigned with Dispute Status value as Úpheld. For more details about the dispute process, see Coverage Gap Dispute Process.
Note: The calculation logic for the Win amount and Winnings from dispute process is the same. But when populating the Win amount value the amount is rounded off.

File Tab

When a Submission is created, the Validation Analyst can view all files added within a Submission within the Submission details page on the File tab. On the File tab, the Analyst can see the included files, change the included file settings, add a file, delete a selected file, etc., for the Submission. For detailed documentation, see Viewing the files added within a Coverage Gap Submission.

Data Lines Tab

When a Submission is created, the Validation Analyst can view all the lines imported to the Validata application (utilization file lines) within a Submission within the Submission details page on the Data Lines tab. For detailed documentation, see Viewing the Data Lines.

Duplicates Tab

When DUP validation is run for the Coverage Gap Data File lines, and the validation mechanism finds duplicate lines in the data file, those lines are stamped as duplicates and listed on the Duplicate tab within the Submission details page. The Validation Analyst can view the Duplicate Lines details on the Duplicates list table. For detailed documentation, see Viewing Duplicate Lines in Coverage Gap Submission.

Invoice Lines Tab

When the Coverage Gap Submission contains an Invoice file, on the Invoice Lines Tab, the Analyst can view the Invoice File Line details. For detailed documentation, see Viewing the Coverage Gap Invoice Lines.

 

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