v1.3.0 Release

METL 1.3 is released and represents a big improvement in eligibility loading.

A big focus for the 1.3 release was to make eligibility loading more standardized. At this point, we've loaded eligibility for several TPA's and we wanted to standardize the way we've been doing that. For this release we unified load scripts as much as possible. We hope this can continue to speed up the amount of time it takes to load new eligibility data.

What's new?

• Adds line_item_adjudication_snapshot. This is a point-in-time snapshot of what a TPA is reporting for member responsibility, plan responsibility, not covered amounts, copay, coinsurance, deductible, and much more. These numbers are not yet comparable across TPA
• Adds support for ACS and JP Farley eligibility loading
• Unifies eligibility loading into a single approach. All of our scripts are now almost exactly the same for each TPA. They each have special data conversion functions, but otherwise they are the same. We anticipate being able to reduce the time to load eligibility files to 25% the time as previously.
• Significantly improves the data clarity for eligibility data vs. coverage data. Previously there were a number of pieces of data that fit better as "coverage" data which made it so that finding unique plan members was harder.
• Began populating the member table which represents an individual person. It consists of just a SSN and a DOB and will represents a singe person even across multiple plans, TPA's, etc. We will fill out the remaining pieces to begin using a member next release. This gives us three ways to view a person:
  • member: A person. Represents a human being, specifically a human which happens to be eligible for or enrolled in a health plan. Whether that person is enrolled in one plan or 1000, there will only be one row for that person.
  • member_eligibility: A person at a company. If a person works at 2 different companies, they would have two member_eligibility rows.
  • member_coverage: A person at a company enrolled in a health plan of some sort. Depending on how the TPA sends their data, there can be multiple rows of coverage data for a single person. They could be enrolled in a dental, vision, RX, and medical plan, and there could be a row for each. Likewise, if the member's coverage changes over the year (e.g. they have a baby and go from "Employee Only" to "Employee and Child", there would be a coverage row for each with the begin and end coverage dates for each.)

Detailed moves and changes:

• Moves marital_status and citizenship_status to eligibility_status to simplify
• Moves is_subscriber, relationship_to_subscriber, benefit_status, subscriber_id to member_coverage for improved eligibility uniqueness
• Moves plan_sponsor eligibility_admin fields to eligibility_reference and drops eligibility_admin to reduce complexity
• Moves coverage_status fields to member_coverage and drops coverage_status to reduce complexity
• Moves master_group_or_policy_number and member_group_or_policy_number to coverage_reference. All group_or`_policy_number values are now in one table to reduce confusion. The master and member fields are now better named to indicate that they are only there for EDI purposes due to the ambiguity in the 834
• Moves line_item notes to their own table rather than a JSON field
• Moves repricing fields to their own table line_item_reprice

Release details

Claims: Pull Request, Commit hash: 003a463

METL-deploy: Pull Request, Commit hash: 8d03407

Monorepo (Not public, but added here for documentation. We expect to open source extractor and csvloader in the future): Pull Request