Scholl Consulting Group, Inc.

GUI CSIM add-on

What is MHC?
  GUI CSIM add-on
  GUI Membership/Provider add-on
  Claim Processor
  UniBasic Programming
  HIPAA Compliance
  ODBC Setup
  Data Warehousing
  Java Eligibility Verification


CSIM for Windows is a Client Server implementation of the Customer Service and Inquiry Module of the Managed Health Care system (MHC) by CSC. It was designed to work along the existing Terminal solution and uses the same data files.

The connection to the Universe database is accomplished with the Universe ActiveX component that was developed by Ardent software using the Component Object Model (COM) standards. Development language was Microsoft’s Visual Basic.

Logging on

When the program first starts, you are confronted with the log in form.

Here you log into the Unix server. Fill in your username and password and if everything goes fine the login form disappears and you are connected.
If you encounter an error, a message box will pop up and notify you of a problem. Usually it originated from a typo, but should you encounter persistent problems, please contact you system administrator.


Enter a new Call

On the main form click on "Enter/Update Call".
This will bring up first the operator logon form. Just like in the original CSIM module, you will have to logon as an operator.

Enter your operator ID and your operator password and the "Enter/Update Call" form will appear.

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The cursor is blinking in the "Call ID" field. For a new call just hit the >Enter< key and the system will assign a new Call ID and fill in information about the operator and start the timer.

The cursor is now in the Caller Code field. Here you have the option to enter the code for the caller, for example "M" for members or "P" for providers. Hit >Enter< and the system will fill the field with the description of the caller code. If the code that you entered is wrong, the field will be cleared and the cursor jumps back to the beginning of the field.

Another option, if you are not sure about the existing code is to enter a forward slash"/". This will bring up a listbox will all the available caller codes. Just click on the one that applies and the listbox disappears, the caller code field is filled with your selection and the cursor jumps now to the caller ID field.

Now you are at the caller ID field. Of course you can’t know the caller’s ID, therefore a search engine is behind this field. Just enter a forward slash and the first few letters of the name. For example if you are looking for a member with the last name of "Baker", type "/BAKER" and a new window will pop up with a list of all the bakers in the file.

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You can click on the correct name, or if you don’t find the person in the list, you can click on the last line with the word "---more---" and the next 30 records will come up. Once you click on the desired name, the information is filled into the call form and the lookup list disappears.

The cursor is now in the text field. Go ahead and take all the call information. Once you are finished with the person on the line, you can fill in all the other information in the same way as would expect it from the original CSIM product. Either enter the codes for all the fields or type a "/" and select from the list of available options.

To stop the timer, click on the "Stop Clock" button and the duration of the call is displayed.
A few important improvements!
  1. The phone number. A lot of member and provider records are missing the phone information. Now if you enter the phone number of the caller, it will be stored under the caller’s record and pop up the next time this person calls
  2. If a member or provider calls, you can look up their relevant information by clicking on the "Caller Info" button.
  3. Forwarding the call with e-mail. Let's say you marked the call as transferred. While you relied before on reports or your memory to notify other Customer Service Representatives of a transferred call, you can forward now an e-mail to them with the summary information of the call. This way you create a record of when and to whom this call was forwarded. And also the recipient of the forwarded call sees a message pop up on their screen.

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Type in the recipients name and press >Enter<. The mail is sent. If you don’t have the correct spelling, the phone book will come up and you can choose the right name.

Looking up Member Info

There are several ways to end up with the member lookup screen. You can get there from the "Enter/Update Calls" screen or go there directly from the Menu item "Lookup"

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Here you see the most important information on the member as well as on their PCP
Two improvements:

Write a letter to a member
When you select this option from the members form, you are confronted with a list of possible letter formats.

Click on the form letter that you want to choose. Microsoft Word is started and the members information is automatically inserted into the letter head. The salutation is adjusted according to the sex of the member.

You can continue to work from WORD, edit and print your letter.

View on Map
To look up a member or provider on the map, click on the "Show on Map" button. The program will search its database of streets. If it finds a match the Map View form will appear.

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If multiple matches are found, a list with all the findings pops up and you have to choose which one applies.

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If no match is found, you will see a message appearing on the screen. You can Zoom in and out of the map clicking on the image with or without the >CRTL< key pressed.

Looking up a provider

You can look up provider info from the call form if the caller is a provider or from the menu item "Look up"

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This is the basic information on the provider. You can also view them on the map.

Displaying calls

One way to display a call is to type in the call ID into that field when the "Enter/Update call" form comes up. Since it is near impossible to remember these long numbers, there is a way to look for calls by caller code.

In the menu choose à Inquiryà Display calls. This will bring up the "Index Look up" form.

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The process to look up calls is similar to entering a new call.

First you have to enter the caller code. (Those of you who are looking intently at the form will realize that there is a new caller code "MC" This stands for members who have already called. This makes it easier to find existing call records. There is also a new "PC" category for providers who have already called.)

To look up a specific caller, enter "/" and the first letters of the callers last name. Again the look up screen comes up and you can choose whose calls you want to look for. Click on the line in the look up form and the "Index Look up" form is filled.

If there are calls on file you will see them listed. Click on a call record and the information will pop up in the "Enter/Update Calls" screen.

Operator Report
This report display how many calls were handled by each operator for a given time. You can open up a calender by clicking on the "C" button.

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Call Type Analysis
This report tells you what the distribution of calls for a given time frame is.
Fill in the dates and run it.

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Ad Hoc Reporting
This is the most flexible way to create a report. You have the option to define your report with 10 different conditions and can implement 10 sort levels. Let's view this with an example.

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Here you see how the query criteria are selected. We are looking for all the calls handled by member services from members who had membership related calls. The callers were all of the 1FAM region and the summary text is of the LAC#101 type --General information. The time frame is 7/13/98 to 7/17/98. The report is sorted first by LOB and then by operator.

After the report is run, the results are displayed in the "Query Result" screen.
If you need several criteria under one option, separate then with semi-colons. For example to ask for call with call status "C" and "CR" then put those criteria in the box separated by a semi-colon. "C;CR".

Query Result form
Here are the results of the query displayed.

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The view might be confusing, but here is the information displayed. There are a few further functions built in.

Click on a field in the first column and if the caller was a member or provider, the member lookuplook up member info or the provider look uplooking up providers screen will pop up.

If you click a field in the third column, the call will be displayeddisplay calls.

If the caller was a member and has a PCP, you can click on the last field in the query result screen and the provider look uplooking up providers comes up.

If you need to process this report further you can view the result set in Microsoft Excel. Here you have all the possibilities of Excel at hand.

Maintaining files
Under the menu item "Code Entry" you can find the update screens for all the CSIM setup files.
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