Table of Contents
High Level Overview
The bia application allows the auditing of insurance plans to ensure they have been set up correctly.
Diagram of the BIA Audit Flow
Audit Stages
QR Review
During the first stage of the audit the QR must create and release an intake form. At this stage any number of test scenarios can be added to or removed from any number of benefit options. Once released, a QM can pick up the intake form and continue the audit process. [For more information see QR Review].
QM Review
The QM then reviews the information entered by the QR and assignes a CSE to the audit. The QM has the ability to change any field on the audit. Like the QR, they have the ability to add and remove any number of test scenarios for any number of benefit options. Should the QM find that there are too many changes to be made, the intake can be sent back to the QR for further work. Otherwise, the QM can submit the audit to the assigned CSE. [For more information see QM Review].
External Client Review
During this stage the CSE meets with the client to review the audit. Test scenarios may still be added to the audit, however any test scenarios previously added by the QR or QM can no longer be removed. Additionally, the CSE can add any number of intents, clarifications, or errors ("ICEs") to each test scenario on the audit. Once all test scenarios have been marked as reviewed and all intents and clarifications have a selection made for "resolved with client", the audit can move to IM/CSE review. [For more information see External Client Review].
IM CSE Review
The purpose of this stage is for the CSE to meet with the IM to go over outstanding ICEs from the external client review. No test scenarios or ICEs may be added or removed at this stage, however ICEs of type intent, clarrification or unknown may be changed to error. Once all errors have been assigned a BO team and a BO the audit may be sent to BO 1st review. [For more information see IM/CSE Review].
BO Review
Business owners have the ability to agree or disagree with the errors assigned to them. Audits get routed to the CSE 2nd+ review stages depending on the response of the BO. [For more information see BO Review].