DOL Claims Import
Executive Summary
DOL Claims Import prepares the attachments for Department of Labor (DOL) claims. Billing staff upload two files that belong together: the DAT file (the 837 claim file) and a ZIP file that holds one PDF attachment for each client. For every client in the claim file the system finds that client's PDF in the ZIP and renames it using the claim number, then returns a new ZIP file containing the claim file, the original PDFs and the renamed PDFs. Every import is kept in a list with its status, counts and returned ZIP, and each import can be opened to see which clients were completed and which were skipped, and why.
Key Features
- Upload a DAT file and a ZIP file (both are required) and process them together
- Process and Download saves the returned ZIP to your computer as soon as processing finishes
- Review all earlier imports with their status, client count, skipped count and returned file name
- Open an import to see its Completed and Skipped clients and the reason for each skip
- Download the returned ZIP of any earlier import again
- Export an import with its completed and skipped clients to Excel (when permitted)
- Choose in the page settings whether the renamed PDF file names contain the client information
Typical Workflow
- Select the DAT file in DAT file to process and the ZIP file in ZIP file to process. You can also drop the two files on the upload area.
- Click Process (or Process and Download to also save the returned ZIP). The Processing Files progress panel shows each client as it is handled.
- Check the message that appears: how many clients were processed, or how many were skipped.
- Find the new import at the top of the list and check Status, Clients and Skipped.
- Click the Edit icon on the row to see the Completed and Skipped clients, or right-click the row and choose Download (or use the Download ZIP icon) to get the returned ZIP again.
Use Clear to remove the selected files and start over.
Configurable Settings
Open View Settings or Edit Settings from this screen (when permitted) to change these options.
| Group | Setting | Type | Purpose |
|---|---|---|---|
| File Names | Exclude Client Information From Renamed PDF Filename | Yes/No | When on, the renamed PDFs are named attach_{claim number}.pdf. When off, the original file name is kept and the claim number is added to it. |
Available Permissions
The following permissions are available to be assigned to AlayaCare Roles:
| Attribute | What It Controls |
|---|---|
| View | Open the page |
| Export | Show Export Selected |
| Settings View | Open View Settings |
| Settings Edit | Open Edit Settings |
Main Grid
The grid lists every import, newest first (9 rows per page).
| Column | Description |
|---|---|
| Imported | Date and time of the import, in the tenant time zone. |
| Imported By | User who ran the import. |
| Uploaded DAT File | Name of the DAT file that was uploaded. |
| Uploaded ZIP File | Name of the ZIP file that was uploaded. |
| Returned File | Name of the returned ZIP. Blank when nothing could be renamed. |
| Status | Success, Partial Success or Failed. |
| Status Message | Explains the status (see below). |
| Clients | Number of clients found in the claim file. |
| Skipped | Number of clients that were skipped. |
| Manage Records | Edit icon (opens the import) and Download ZIP icon. |
Status messages:
| Message | Meaning |
|---|---|
| n processed | Every client was processed. The status is Success. |
| n clients skipped | Some clients were skipped. The status is Partial Success. |
| All clients skipped | Every client was skipped. The status is Failed. |
| Unable to open ZIP file | The ZIP file could not be read. The status is Failed. |
| Error reading 837 | The DAT file could not be read as an 837 claim file. The status is Failed. |
Actions
| Button | Description |
|---|---|
| Clear | Removes the selected DAT and ZIP files. |
| Process | Processes the two files. Enabled only when both files are selected. |
| Process and Download | Processes the two files and saves the returned ZIP to your computer when it is ready. Enabled only when both files are selected. |
| Export Selected | Saves an Excel file for the selected import. Shown only with the Export permission; select one row in the grid first. |
| View Settings / Edit Settings | Opens the page settings. Shown only with the Settings View or Settings Edit permission (Edit Settings when both are granted). |
| Edit (row icon, or right-click Edit) | Opens the import to review its clients. |
| Download ZIP (row icon) or right-click Download | Saves the returned ZIP of that import. Nothing happens for an import that has no returned ZIP. |
Export Selected creates an Excel file named after the DAT file and the import date and time, with a Home sheet (file names, status, message, client and skipped counts, start and end time, duration), a Completed sheet and a Skipped sheet. The two sheets list the AlayaCare client UID, client name, status and status message.
Dialog Components
DOL Claims Import (detail page)
Opens from Edit on an import. The heading shows the name of the DAT file; the arrow beside the title returns to the list. The Completed and Skipped tabs choose which clients are shown in the grid below them (14 rows per page).
Tabs
| Tab | Purpose |
|---|---|
| Completed | Clients whose PDF was renamed. |
| Skipped | Clients that were skipped. |
Grid
| Column | Description |
|---|---|
| Client UID | The client number from the claim file. |
| Client Name | Client first and last name. |
| Status | Completed or Skipped. |
| Status Message | The reason for a skip (see below). Blank for completed clients. |
Skip reasons:
| Message | Meaning |
|---|---|
| Duplicate Client found | The same client appears more than once in the claim file. |
| No Claims Found | The client has no claim in the claim file. |
| No PDF found | The ZIP has no file whose name contains the client number between underscores. |
| Multiple PDFs found | The ZIP has more than one such file, so the right one cannot be chosen. |
| Unable to read PDF | The matching file in the ZIP is empty or unreadable. |
A client with several claims is processed and appears once on the Completed tab for each claim.
Processing Overviews
This section describes what happens after you confirm a processing action.
Process / Process and Download
- Checks that both a DAT file and a ZIP file were selected. Otherwise the warning "The system requires a single DAT and a single ZIP file" appears.
- Creates the import in the list with the two file names, the user and the start time.
- Opens the ZIP and reads the DAT file as an 837 claim file. If either cannot be read, the import is marked Failed with the matching message and processing stops.
- Groups the claims by client. A client that appears more than once, or that has no claims, is skipped. A client with several claims is processed, once per claim.
- For each remaining client, looks in the ZIP for a file whose name contains
_{client number}_. A client is skipped when there is no such file, more than one, or the file is empty. - For each processed client, adds the original PDF to the returned ZIP under
original/and, for each claim, a copy underrenamed/named{original file name}.{claim number}.pdf, orattach_{claim number}.pdfwhen Exclude Client Information From Renamed PDF Filename is on. The DAT file is also placed in the returned ZIP. - Records a Completed or Skipped line for the client with the reason.
- Sets the import status (Success, Partial Success or Failed), the Clients and Skipped counts and the end time. When at least one PDF was renamed, saves the returned ZIP named
{DAT file name}_Processed_{import number}_{date}.zipon the import. Process and Download also saves it to your computer. - Clears the selected files and refreshes the list.