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Configuring a benefit grouper

Suggest edit Updated on September 10, 2021

A benefit grouper contains benefits and organizes them into common medical areas. For example, all Surgery benefits can be organized under a Surgery grouper.

You can use groupers to accumulate visits, units, and dollars assigned to each benefit and configure limits that span the dependent benefits. Also, use groupers to organize these items across benefit accumulators. For example, mental health group counseling and inpatient psychiatrist visits are two separate benefits but they can have a limit of 20 total visits in any combination of the two. You define the limit in the benefit accumulator.

Before you begin

Before you begin, ensure that you have configured a benefit category and the required benefits.

Procedure

  1. In the header of Dev Studio, click Launch web interface > Product Development.
  2. In the left navigation panel of your work space, click New > Grouper.
  3. Click New.
  4. In the Name field, enter Rehabilitation Services.
  5. In the Insurance line list, select Medical.
  6. In the Line of business list, select Commercial.
  7. In the Benefit category list, select In-Patient Hospital Facility.
  8. In the Effective date field, enter 1/1/2019, and in the End date field, enter 12/31/9999.
    This end date means that the benefit grouper might be in use indefinitely. By manually entering 9999 for the year, you do not have to continually update the end date.
  9. In the Description field, enter Benefits associated with hospital rehabilitation.
    Rehabilitation-Services grouper details
  10. Click Continue.
  11. In the Benefit list, select PRO-Speech Therapy and click Add benefit.
  12. Keep the Required check box selected to indicate that a benefit in the grouper is sold as a required part of the product.
    Otherwise, a non-required benefit is considered optional or a rider. For example, if Dental benefits are optional, clear these benefit check boxes in the benefit selection process.
  13. Repeat steps 11 and 12 to add the PRO-Physical Therapy and the PRO-Occupational Therapy benefits.
    Benefits for the Rehabilitation-Services grouper
  14. Click Finish.
  15. Because you have manager credentials, approve the benefit grouper entity by following these steps:
    1. Click Actions > Approve and hold at the top right.
      By selecting Approve and hold instead of Approve, the entity remains in the current stage, but is available for use in other tasks. To advance the entity to the next stage, click Approve.
    2. In the Approve section, click Submit.

What to do next

Configure a benefit set. See Configuring a benefit set.

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