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Avaya User Interface Specification
User Interface Design Specification
Veterans Administration and Carousel Speech Self Service Version 1.15 May 19, 2014
Table of Contents
| Table of Contents | 2 | |
| 1 | Document | 6 |
| 1.1 | Revision History | 6 |
| 2 | Call Flow Diagrams | 10 |
| 3 | Global Behavior | 22 |
| 3.1 | Global Commands | 22 |
| 3.2 | Global Prompts | 23 |
| 3.3 | Default Settings | 25 |
| 3.4 | Max Handling | 26 |
| 4 | Dialog States | 27 |
| Start | 27 | |
| 1000_deEval_DNIS | 27 | |
| 2010_ppGreeting | 28 | |
| 2020_iaBene_Or_Prov | 29 | |
| 2025_ppRep_Of_Bene | 30 | |
| 2030_ppOther_Information | 30 | |
| 3100_iaBene_Menu | 31 | |
| 3105_iaDate_Of_Service | 32 | |
| 3110_dbBeneficiary_Claims_Status | 32 | |
| 3111_deLog_ROI_Eval | 33 | |
| 3112_dbROI_Beneficiary_Claim_Status | 33 | |
| 3115_deEval_Claim_Response | 34 | |
| 3116_ppNo_Claims_Found | 34 | |
| 3117_ppMultiple_Claims | 34 | |
| 3118_ppClaim_Info | 35 | |
| 3120_iaRepeat_Claim_Status | 36 | |
| 3125_iaOrder_Form_Or_Claim_Status | 37 | |
| 3126_deValidate_Address | 37 | |
| 3127_dbForm_Request_Claims | 38 | |
| 3128_dbROI_Forms_Request_Claims | 38 | |
| 3130_iaEligibility_Form | 39 | |
| 3131_dbForm_Request_Eligibility | 40 | |
| 3132_dbROI_Form_Request_Eligibility | 40 | |
| 3133_ppForms_Eligibility | 41 | |
| 3134_deValidate_Address | 41 | |
| 3135_iaOrder_Form_Or_Eligibility | 42 | |
| 3140_dbBeneficiary_Eligibility | 42 | |
| 3142_dbROI_Beneficiary_Eligibility_Status | 43 | |
| 3145_ppEligibility_Info | 44 | |
| 3150_iaRepeat_Eligibility_Status | 45 | |
| 3180_ppForms_Claims | 46 | |
| 3190_ppTransition_From_Benefits | 46 | |
| 3210_iaBeneficary_Other | 47 | |
| 3225_iaPharmacy_Order_Form | 48 | |
| 3226_dbForms_MBM | 48 | |
| 3227_dbROI_Forms_MBM | 49 | |
| 3228_ppForms_MBM | 50 | |
| 3229_deValidate_Address | 50 | |
| 3240_dbBeneficiary_Pharmacy_Eligibility_Status | 50 | |
| 3241_ppPharmacy_Info | 51 | |
| 3242_dbROI_Pharmacy_Eligibility_Status | 51 | |
| 3250_dbBeneficiary_Cumulative_Cap_Calculation | 51 | |
| 3251_ppCastastrophic_Cap_Calc | 52 | |
| 3252_dbROI_Catastrophic_Cap_Calculation | 52 | |
| 3260_dbBeneficiiary_Cumulative_Deductible_Calculation | 53 | |
| 3261_ppDeductible_Calc_Info | 53 | |
| 3262_dbROI_Deductible_Calculation | 53 | |
| 3270_ppDental_Coverage | 54 | |
| 3290_iaRepeat_Option | 55 | |
| 3295_deRepeat_Nav | 55 | |
| 3310_dbBeneficiary_Other_Health_Insurance_Status | 55 | |
| 3311_dbBeneficiary_Pharmacy_Eligibility_Status | 56 | |
| 3312_dbROI_Beneficiary_Other_Health_Insurance | 56 | |
| 3320_ppOther_Health_Info | 57 | |
| 3340_iaRepeat_Other_Health | 57 | |
| 3345_ppOther_Health_Info | 58 | |
| 3350_iaOffer_Form | 59 | |
| 3351_dbForms_OtherHealth | 59 | |
| 3352_dbROI_Forms_OtherHealth | 60 | |
| 3353_ppForms_Other_Health | 60 | |
| 3354_deValidate_Address | 61 | |
| 3510_deEval_BeneGetSSN_JustValidated | 61 | |
| 3515_ppGet_SSN_Intro | 61 | |
| 3520_iaReuse_SSN | 62 | |
| 3530_iaBene_SSN | 63 | |
| 3540_dbSSN_Validation_Beneficiary | 63 | |
| 3541_deAddress_Validation | 64 | |
| 3542_ppAddress_Invalid | 64 | |
| 3550_ppInvalid_SSN | 64 | |
| 3560_deEval_Menu_Option | 65 | |
| 4100_iaTIN | 65 | |
| 4105_iaProvider_Options | 66 | |
| 4110_deEval_Prior_SSN | 67 | |
| 4111_iaBene_SSN | 67 | |
| 4112_deEval_Menu_Option | 68 | |
| 4113_dbSSN_Validation_Provider | 68 | |
| 4114_ppInvalid_SSN | 68 | |
| 4115_iaReuse_SSN | 69 | |
| 4120_iaDate_Of_Service | 70 | |
| 4125_dbProvider_Claims_Status | 70 | |
| 4127_dbROI_Claims_Status_Via_Provider | 71 | |
| 4130_deEval_Claim_Response | 71 | |
| 4131_ppMultiple_Claims | 72 | |
| 4132_ppNo_Claims_Found | 72 | |
| 4133_deLog_ROI | 72 | |
| 4155_dbProvider_Eligibility | 72 | |
| 4156_dbProvider_Cumulative_Cap_Calculation | 73 | |
| 4157_dbROI_Eligibility_Status_via_Provider | 73 | |
| 4158_dbProvider_Cumulative_Deductible_Calculation | 74 | |
| 4160_ppClaim_Status_Info | 75 | |
| 4165_iaRepeat_Claim_Status | 76 | |
| 4170_ppEligibility_Info | 77 | |
| 4175_iaRepeat_Eligibiliy_Status | 78 | |
| 4210_iaOther_Provider | 79 | |
| 4220_ppBenefits_Info | 80 | |
| 4221_iaTransfer_For_Pre_Auth | 80 | |
| 4235_ppPayment_Info | 81 | |
| 4240_iaTransfer_For_Payments | 82 | |
| 4245_ppHowTo_FileAClaim | 83 | |
| 4260_iaTransfer_For_FileAClaim | 84 | |
| 5020_ppPreAuth | 85 | |
| 5040_iaTransfer_For_Pre_Auth | 86 | |
| 5060_deEval_Return_Location | 86 | |
| 5070_ppTransition_To_Provider_MM | 87 | |
| 6020_ppGreeting | 87 | |
| 6040_iaCaregiver_MM | 88 | |
| 6120_iaRepeat_Stipend_Info | 89 | |
| 6140_ppStipend_Information | 90 | |
| 6510_ppSpina_Bifida_Greeting | 90 | |
| 6515_iaAgent_Group | 91 | |
| 6580_ppForeign_Medical_Greeting | 92 | |
| 9020_ppTransfer_Message | 92 | |
| 5 | Customer Approval | 93 |
Document Revision History
This dialogue specification document is produced and controlled by Avaya. All requests to make changes to this document should be directed to the authors so that changes are made by the authors through Avaya’s version control procedures.
| Date |
| Version |
| Details of changes |
| Author |
| 12/10/2013 |
| .01 |
| First Draft |
| Randell Neuman |
| 12/11/2013 |
| 1.0 |
| First Review Copy |
| Randell Neuman |
| 01/22/2014 |
| 1.1 and 1.2 |
| Second Review |
| Randell Neuman |
| 01/23/2014 |
| 1.3 |
| Third Review - Preliminary version provided to Brandi/Tony |
| Randell Neuman |
| 01/29/2014 |
| 1.4 |
| Fourth Review |
| Randell Neuman |
| 01/30/2014 |
| 1.5 |
| Fifth Review |
| Randell Neuman |
| 01/31/2014 |
| 1.6 |
| Sixth Review |
| Randell Neuman |
| 02/02/2014 |
| 1.7 |
| Seventh Review - add ROI transactions and other minor updates |
| Randell Neuman |
| 02/04/2014 |
| 1.8 |
| VA change requests: |
- Pre Authorization no longer is a direct in-bound call. It's selected off the Beneficiary and Provider main menu. A new common routine in the 5000 series was created to handle Pre-Auth for both Beneficiary and Provider. With the new menu option on the Provider Main Menu, the option for Pre-Auth was removed from the Provider Other option.
Post internal Avaya design review
- Dev notes were added for each data transaction that should continue (instead of performing a call transfer) if a failure/timeout were to occur. New message was added in the global prompts for 'Data_Issue' message that will be played prior to transferring the call.
Within the benefits, data transaction 3110 does not provide Rejection Code values, as provided within the Provider transaction. Therefore, the reference to a Rejection Code message within 3118 was removed.
Randell Neuman
| 02/05/2014 |
| 1.9 |
| Data Transaction updates |
3118 updates
- Field for CRC (rejection code) was added to the data transaction; therefore, the field is being included here and playing just as referenced in the Provider play state of 4160.
- For consistency with state 4160 (Provider), the field for 'Date_of_Service' for 3118 was changed to 'date_paid'.
4160 update
- The data field and message for 'patient responsibility' was removed as this field is not available via the existing data transactions.
3345 update
- message for type_of_coverage = 3 was updated, per VA direction.
Randell Neuman
| 02/06/2014 |
| 1.10 |
| Document redlines for Dev. |
Added Avaya Diagnostic report logging reference at 1000
6530 (for direct line to PreAuth) was removed. During the prior revision, it was determined that there is no direct inbound call. PreAuth is accessed via CHAMPVA menu selection. Therefore, this play form and the call transfer were deleted.
Randell Neuman
| 03/3/2014 |
| 1.11 |
| Updates for grammar build. |
3340 and 6515: Incorrect names were assigned to the grammars for states 3340 and 6515 for both ASR and DTMF. Those were corrected in this version.
4120: Missing grammar names were corrected
4140 data transaction renamed to properly match the name in the Transaction Document. The new name is 4127_ROI_Claim_Status_Via_Provider Randell Neuman
| 03/26/2014 |
| 1.12 |
| 4170 - duplicate message numbers were found at this state for messages ending in "Info10" and "Info11". |
Orginally "4170_ppEligibility_Info10", the message for "The amount of..." was updated to 4170_ppEligibility_Info12" Orginally "4170_ppEligibility_Info11", the message for "Eligibility for this beneficiary is currently pending." was updated to 4170_ppEligibility_Info13"
4113 - the instruction to increment BeneEntry_Count was on the incorrect line. It's now incremented on the 'Else' condition.
4156 and 4158: added the output parameters so subsequent use of variables would be clear.
4170:
The following changes were made:
--Reference to <4155_end_date> was changed to <4155_expiration_date> --For condition, "If 4155_type_of_coverage = 'primary' and 4157_Record_Count > 0" was updated to "If 4155_type_of_coverage = 'primary' and 4158_Record_Count > 0" --Reference to <4155_amount_of_deductible> was changed to <4158_deductible> --Reference to <4156_amount_of_cap> was changed to <4156_cap> --'else if' was missing for condition: "If 4155_result = 0 and 4155_eligibility_status = 'pending'" Randell Neuman
| 04/15/2014 |
| 1.13 |
| Transfer - Added Set UUI node to populate UUI at call transfer |
| Mark Steptoe |
| 04/25/2014 |
| 1.14 |
| Documentation Redlines: |
Corrected the input fields for data transactions 3128 and 3132.
The variable for 'goal' was set in 1000, 2020, 3100, 4105 and 6040. The values for goals are now:
spina_bifida foreign_medical caregiver fee champva champva_bene champva_prov champva_else bene_claim bene_eligibility bene_pre_auth bene_else prov_general prov_pre_auth prov_claims prov_eligibility caregiver_apply caregiver_stipend champva Randell Neuman
| 05/19/2014 |
| 1.15 |
| Message corrections... |
Zip Code corrrections 3116_ppNo_Claims_FoundI1 4132_ppNo_Claims_FoundI2 4245_ppHowTo_FileAClaimI1 Originally omitted messages from first prompt list.
3145_ppEligibility_InfoI7 3145_ppEligibility_InfoI8 Randell Neuman
| 06/06/2014 |
| 1.16 |
| 'xfer' values updated for English/Spanish VDN |
1000 - reset the xfer default value for CHAMPVA 2020 - reset the xfer values for Beneficiary and Providers (with variation based on language) 6040 - reset the xfer values for Apply Benefits, default Caregiver and CHAMPVA (with variation based on language) Randell Neuman
Call Flow Diagrams
Global Behavior Global Commands
Global commands are commands that can be used in all interaction states. The global commands are not listed in the interaction state, but are available as responses within the interaction dialog state.
Option
| Vocabulary |
| DTMF |
| Conditions-Actions |
| Confirm? |
| representative |
| agent, customer service,representative |
| 0 |
| Go To: 9020_ppTransfer_Message |
| If necessary |
Confirmation Prompts
| Option |
| Type |
| Wording |
| Prompt ID |
| representative |
| Initial |
| You want to speak with an representative, right? |
| agent_confirm_init |
| Retry |
| Please reply with a Yes or No. You're requesting a representative, is that right? |
| agent_confirm_rty |
Global Prompts
Global prompts are prompts that can be used for default handling. Global prompts are not listed in every interaction state but are available for use within the interaction dialog state. Anywhere a prompt type is played (i.e. Initial, Timeout, Retry, Help, etc.), the behavior will be such that the global version of it will precede the local version. A global rRetry prompt of “my mistake, let’s try again” would play ahead of the local version “what’s your zip code?”
Prompts
| Type |
| Conditions and Wording |
| Prompt ID |
| Sorry, I didn't get that. |
| REJApology1 |
| I still didn't understand. |
| REJApology2 |
| Please make your entry now. |
| NSPApology2 |
| Sorry, my mistake. |
| DenyApology1 |
| My mistake again. |
| DenyApology2 |
| WS_TRANSITIONDELAY |
| WS_TRANSITIONDELAY exceeded |
| [transitional audio] |
| WSTransition |
| WS_TIMEOUT |
| WS_TIMEOUT exceeded |
| We are experiencing a technical issue with our system. |
| WSTimeout |
| Data_Issue |
| Sorry, I've experienced a problem and will need to transfer you. |
| I5000 |
| RC_9 |
| This claim was denied because services rendered are not a covered service and/or benefit. |
| RC_9 |
| RC_27 |
| This claim was denied because services rendered are not a covered service and/or benefit for the diagnosis listed. |
| RC_27 |
| RC_65 |
| This claim was denied as a Duplicate claim that was previously processed. |
| RC_65 |
| RC_78 |
| This claim denied because CHAMPVA is the secondary payor, the EOB from the other health insurance is required. When resubmitting this information please enclose the CHAMPVA EOB. |
| RC_78 |
| RC_124 |
| This claim was denied because it was not timely filed. |
| RC_124 |
| RC_137 |
| This claim was denied because the Beneficiary is not eligible on date of service claimed. |
| RC_137 |
| RC_159 |
| This claim was denied as a duplicate of a previously processed claim. |
| RC_159 |
| RC_177 |
| This claim was denied as a duplicate of a previously processed claim. |
| RC_177 |
| RC_202 |
| This claim was denied because an Appeal must be filed within one year of the date of decision. |
| RC_202 |
| RC_206 |
| This claim was denied because Pre Authorization approval is required, please call 1-800-424-4018 to obtian preauthorization. |
| RC_206 |
| RC_207 |
| This claim was denied because services are limited to 23 visits per fiscal year, unless pre authorization is obtained. Please call 1-800-424-4018 to obtian preauthorization. |
| RC_207 |
| RC_218 |
| This claim was denied because clarification of OHI information is required, a certification form has been sent to the beneficiary. |
| RC_218 |
| RC_219 |
| This claim was denied because OHI clarification is pending, a certification form has been resent to the beneficiary. |
| RC_219 |
| RC_220 |
| This claim was denied because the Requested OHI clarification has not been received. |
| RC_220 |
| RC_222 |
| This claim was denied. Please send a copy of the patient’s Medicare card to determine Medicare status. |
| RC_222 |
| RC_224 |
| This claim was denied, please provide medical history documentation to support treatment for care. |
| RC_224 |
| RC_239 |
| This claim was denied because CHAMPVA reimbursed your provider, the amount billed represents your cost share. |
| RC_239 |
| RC_262 |
| This claim was denied. Please submit a current updated treatment plan or progress report. |
| RC_262 |
| RC_272 |
| This claim was denied because the National Drug Code is missing or unreadable When resubmitting this information, please enclose the CHAMPVA EOB. |
| RC_272 |
| RC_277 |
| This claim was denied because the services and supplies are included in Hospice per diem. |
| RC_277 |
| RC_278 |
| This claim was denied because our records indicate there are Multiple primary insurance coverages, please resubmit the claim with EOBs from each payer. |
| RC_278 |
| RC_331 |
| This claim was denied. Please resubmit the claim with a valid service supply code for the date of service. |
| RC_331 |
| RC_333 |
| This claim was denied. Please resubmit the claim with the appropriate CPT code combination. |
| RC_333 |
| RC_1008 |
| This claim was denied for bundling, please resubmit with the appropriate CPT code combination. |
RC_1008
| RC_9999 |
| This claim was denied. The denial reason is unavailable. |
| RC_9999 |
Default Settings
The default settings are applied to all the interaction and play states. The settings listed are the typical settings. Each interaction and play state has a table section for Special Settings. The default setting are superseded the local special setting.
App Name
| Prompt ID Format |
| Full (1000_aa<Module Name>I00) |
| Retries in Total Errors |
| Y |
| Timeouts in Total Errors |
| Y |
| Disconfirms in Total Errors |
| Y |
Max Handling
The Max Handling settings identify the global behavior for max retry and timeout conditions within the interaction state. The table values indicate the maximum number of retries or timeouts, the action that is taken for the condition and the next dialog state for the condition (goto). The Max Handling settings are the default behavior but may be modified for specific dialog states. Changes from the default can be made in the Max Handling Override tab of the interaction state.
| Max Condition |
| Count |
| Action |
| Max Timeouts |
| 2 |
| Go To: 9020_ppTransfer_Message |
| Max Retries |
| 2 |
| Go To: 9020_ppTransfer_Message |
| Max Disconfirms |
| 2 |
| Go To: 9020_ppTransfer_Message |
| Max Total Errors |
| 5 |
| Go To: 9020_ppTransfer_Message |
Dialog States
Start
First State
1000_deEval_DNIS
Initial Assignments
| ID |
| (unique id given to the IVR) |
Previous State
Start
| If DNIS_App = Spina Bifida |
| xfer = spina_bifida |
goal = spina_bifida Go To: 6510_ppSpina_Bifida_Greeting
| Else If DNIS_App = Foreign Medical |
| xfer = foreign_medical |
goal = foreign_medical Go To: 6580_ppForeign_Medical_Greeting
| Else If DNIS_App = Caregiver |
| xfer = caregiver |
goal = caregiver Go To: 6020_ppGreeting
| Else If DNIS_App = Fee |
| xfer = fee |
goal = fee Go To: 9020_ppTransfer_Message
goal = champva Go To: 2010_ppGreeting
Developer Notes
Reference DNIS_App via CAV
Reference the VA Logging worksheet for report logging points.
| 2010_ppGreeting |
| Play Prompt |
Previous State
1000_deEval_DNIS, 6040_iaCaregiver_MM
Prompts
| Conditions and Wording |
| Prompt ID |
| Thank you for calling the CHAMPVA Program. |
| 2010_ppGreetingI1 |
| (spoken in Spanish) For instructions in Spanish, say 'espanol' or press 9. |
| 2010_ppGreetingI2 |
Go To: 2020_iaBene_Or_Prov
Special Settings
Developer Notes
| 2020_iaBene_Or_Prov |
| Interaction |
Previous State
2020_iaBene_Or_Prov, 2010_ppGreeting
Prompts
| Type |
| Conditions and Wording |
| Prompt ID |
| Initial |
| If you're a beneficiary or representing a beneficiary, say 'beneficiary'. If you are a health care provider, say 'health care provider'. If none of these apply, say 'something else'. |
| 2020_iaBene_Or_ProvI3 |
| Retry 1/Timeout 1 |
| If you're a beneficiary or representing a beneficiary, say 'beneficiary'. If you are a health care provider, say 'health care provider'. Or if none of these apply, say 'something else'. |
| 2020_iaBene_Or_ProvR1 |
| Retry 2/Timeout 2/Disconfirm 1/Disconfirm 2 |
| If you're a Beneficiary or representing a beneficiary, say Beneficiary or press 1. If you're a Heath Care Provider, say provider or press 2. Or, if your call is for another reason, say 'something else' or press 3. To speak with a customer service representative, say 'representative'. |
| 2020_iaBene_Or_ProvR2 |
| Exit_BeneProv |
| Okay... |
| 2020_iaBene_Or_ProvE1 |
| Option |
| Vocabulary |
| DTMF |
| Condition-Action |
| Confirm? |
| Benefiicary |
| beneficiary, representing a beneficiary |
| 1 |
| Play Exit_BeneProv |
BeneMenuOption = 'Start' BeneGetSSN_JustValidated = true goal = champva_bene If language = English xfer = CHAMPVABene Else xfer = CHAMPVABeneSpa Go To: 2025_ppRep_Of_Bene If necessary
| Provider |
| provider, health care provider |
| 2 |
| Play Exit_BeneProv |
goal = champva_prov If language = English xfer = CHAMPVAProv Else xfer = CHAMPVAProvSpa Go To: 4100_iaTIN If necessary
| Something Else |
| something else, i'm calling for something else, other reason, none of them apply |
| 3 |
| goal = champva_else |
Go To: 2030_ppOther_Information If necessary
| Spanish |
| spanish, espanol |
| 9 |
| If Language = English |
Set language set to Spanish xfer = ChampVABeneSpa Go To: 2020_iaBene_Or_Prov If necessary
| Active Grammar |
| Barge-In |
| NBest |
2020_Bene_Or_Prov_ASR
2020_Bene_Or_Prov_DTMF
Confirmation Prompts
| Option |
| Type |
| Wording |
| Prompt ID |
| Benefiicary |
| Initial |
| You're a beneficiary or representing a beneficiary, right? |
| 2020_iaBene_Or_ProvC1 |
| Retry |
| Please reply with a Yes or No. You are a beneficiary or representing a beneficiary, right? |
| 2020_iaBene_Or_ProvC2 |
| Provider |
| Initial |
| That was 'provider', right? |
| 2020_iaBene_Or_ProvC5 |
| Retry |
| Please reply with a Yes or No. You are a provider, right? |
| 2020_iaBene_Or_ProvC6 |
| Spanish |
| Initial |
| You're wanting to hear the prompts in Spanish, right? |
| 2020_iaBene_Or_ProvC7 |
| Retry |
| Please reply with a Yes or No. You're wanting to hear prompts in Spanish, right? |
| 2020_iaBene_Or_ProvC8 |
| Max Handler Override |
| Count |
| Action |
Special Settings
Developer Notes
Spanish will only be offerred/recognized if previous state is 2010 (start of call)
| 2025_ppRep_Of_Bene |
| Play Prompt |
Previous State
2020_iaBene_Or_Prov
Prompts
| Conditions and Wording |
| Prompt ID |
| If you’re representing a beneficiary, please answer the questions for the beneficiary. |
| 2025_ppRep_Of_BeneI1 |
Go To: 3515_ppGet_SSN_Intro
Special Settings
Developer Notes
Turn barge-in off for this state
| 2030_ppOther_Information |
| Play Prompt |
Previous State
2020_iaBene_Or_Prov
Prompts
| Conditions and Wording |
| Prompt ID |
| The CHAMPVA program is for the dependents of a service connected permanently and totally disabled veteran who is not eligible for Tricare. To learn more about eligibility criteria and how to apply for benefits please visit www.va.gov/hac , again that’s www.va.gov/hac. |
| 2030_ppOther_InformationI1 |
Go To: 9020_ppTransfer_Message
Special Settings
Developer Notes
Turn barge-in off for this state.
| 3100_iaBene_Menu |
| Interaction |
Previous State
3190_ppTransition_From_Benefits, 3125_iaOrder_Form_Or_Claim_Status, 3130_iaEligibility_Form, 3135_iaOrder_Form_Or_Eligibility, 3210_iaBeneficary_Other, 3560_deEval_Menu_Option
Prompts
| Type |
| Conditions and Wording |
| Prompt ID |
| Initial |
| If Previous State = 3560 |
| Which of these is the purpose of your call today? Claims, Eligibility, Pre Authorization, or something else. |
| 3100_iaBene_MenuI1 |
Else
| Which of these would you like? Claims, Eligibility, Pre Authorization, or something else. |
| 3100_iaBene_MenuI2 |
| Retry 1/Timeout 1/Disconfirm 1 |
| Please say one of the following that you'd like: Claims, Eligibility, Pre Authorization, or say 'something else'. |
| 3100_iaBene_MenuR1 |
| Retry 2/Timeout 2/Disconfirm 2 |
| Please select from one of the following: If you're call is about claims, say 'claims' or press 1. For eligibilty, say 'eligibility' or press 2. For Pre Authorization, say 'Pre Authorization' or press 3. If you're calling about something else, say 'something else' or press 4. Or, to speak with a representative, say 'representative' or press 0. |
| 3100_iaBene_MenuR2 |
| Option |
| Vocabulary |
| DTMF |
| Condition-Action |
| Confirm? |
| Claims |
| i'm calling about claims |
| 1 |
| BeneMenuOption = Claim |
goal = bene_claim Go To: 3510_deEval_BeneGetSSN_JustValidated If necessary
| Eligibility |
| i'm calling about eligibility |
| 2 |
| BeneMenuOption = Eligiblity |
goal = bene_eligibility Go To: 3510_deEval_BeneGetSSN_JustValidated If necessary
| Pre Auth |
| i'm calling about pre authorization, pre authorization |
| 3 |
| PreAuthMenu = Beneficiary |
goal = bene_pre_auth Go To: 5020_ppPreAuth If necessary
| Something Else |
| i'm calling about something else, i need something else |
| 4 |
| goal = bene_else |
Go To: 3210_iaBeneficary_Other If necessary
| Active Grammar |
| Barge-In |
| NBest |
3100_Bene_Options_ASR
3100_Bene_Options_DTMF
Confirmation Prompts
| Option |
| Type |
| Wording |
| Prompt ID |
| Claims |
| Initial |
| That was 'claims', right? |
| 3100_iaBene_MenuC1 |
| Retry |
| Please reply with a Yes or No. Your call is about claims, right? |
| 3100_iaBene_MenuC2 |
| Eligibility |
| Initial |
| That was 'eligibility', right? |
| 3100_iaBene_MenuC3 |
| Retry |
| Please reply with a Yes or No. You want to check eligibility, right? |
| 3100_iaBene_MenuC4 |
| Something Else |
| Initial |
| That was 'something else', right? |
| 3100_iaBene_MenuC5 |
| Retry |
| Please reply with a Yes or No. You asked for 'something else', right? |
| 3100_iaBene_MenuC6 |
| Pre Auth |
| Initial |
| That was 'pre authorization', right? |
| 3100_iaBene_MenuC7 |
| Retry |
| Please reply with a Yes or No. That was 'pre authorization', right? |
| 3100_iaBene_MenuC8 |
| Max Handler Override |
| Count |
| Action |
Special Settings
Developer Notes
| 3105_iaDate_Of_Service |
| Interaction |
Previous State
3125_iaOrder_Form_Or_Claim_Status
Prompts
| Type |
| Conditions and Wording |
| Prompt ID |
| Initial |
| Okay, and what's the date of service? |
| 3105_iaDate_Of_ServiceI1 |
| Retry 1/Timeout 1/ Disconfirm 1 |
| Please say or enter the date of service. For example, you could say January 15, 2014 or enter 01-15-2014 on your keypad. |
| 3105_iaDate_Of_ServiceR1 |
| Retry 2/Timeout 2/Disconfirm 2 |
| Say or enter the date of service. For example, you could say January 15, 2014 or enter 01-15-2014 on your keypad. |
| 3105_iaDate_Of_ServiceR2 |
| Option |
| Vocabulary |
| DTMF |
| Condition-Action |
| Confirm? |
| Go To: 3110_dbBeneficiary_Claims_Status |
| Always |
| Active Grammar |
| Barge-In |
| NBest |
3105_Date_Of_Service_ASR
3105_Date_Of_Service_DTMF
Confirmation Prompts
| Option |
| Type |
| Wording |
| Prompt ID |
| Date_of_Service |
| Initial |
| That was... |
| 3105_iaDate_Of_ServiceC1 |
| Initial |
| <Date_of_Service> |
| Initial |
| Is that correct? |
| 3105_iaDate_Of_ServiceC2 |
| Retry |
| Please reply with a Yes or No. I got... |
| 3105_iaDate_Of_ServiceC3 |
| Retry |
| Is that correct? |
| 3105_iaDate_Of_ServiceC4 |
| Max Handler Override |
| Count |
| Action |
Special Settings
Developer Notes
| 3110_dbBeneficiary_Claims_Status |
| Data Source |
Previous State
3105_iaDate_Of_Service
SSN
Date_of_Service
ssn date_of_service result date_paid check_number check_amount pay_to claim_status
Go To: 3115_deEval_Claim_Response
Developer Notes set 3110_Record_Count = the number of records returned.
For SQL information, see CHAMPVA Transaction documentation.
If a data error/timeout is experienced, transfer the caller after playing 'Data_Issue' message.
| 3111_deLog_ROI_Eval |
| Branch |
Previous State
3118_ppClaim_Info, 3117_ppMultiple_Claims, 3115_deEval_Claim_Response
| If Log_ROI = true |
| Go To: 3112_dbROI_Beneficiary_Claim_Status |
| Else |
| Go To: 3118_ppClaim_Info |
Developer Notes
| 3112_dbROI_Beneficiary_Claim_Status |
| Data Source |
Previous State
3111_deLog_ROI_Eval
vp session id
SSN
date paid_x check_amount_x pay_to_whom_x claim_status_x check_number_x calling_app_x date_stamp_x
Go To: 3118_ppClaim_Info
Developer Notes
If a data error/timeout is experienced, continue to the next step.
| 3115_deEval_Claim_Response |
| Branch |
Previous State
3110_dbBeneficiary_Claims_Status, 3120_iaRepeat_Claim_Status
| If 3110_Record_Count = 0 |
| Go To: 3116_ppNo_Claims_Found |
| Else If 3110_Record_Count = 1 |
| Go To: 3111_deLog_ROI_Eval |
| Else |
| Go To: 3117_ppMultiple_Claims |
Developer Notes
| 3116_ppNo_Claims_Found |
| Play Prompt |
Previous State
3115_deEval_Claim_Response
Prompts
| Conditions and Wording |
| Prompt ID |
| We have no record of your claim. If you recently mailed your claim, it may take up to 20 days to be recorded in our system. All claims should be submitted to the CHAMPVA Program P.O. Box 469064 Denver, Colorado 80246-9064, that’s the CHAMPVA Program P.O. Box 469064 Denver, Colorado 80246-9064 |
| 3116_ppNo_Claims_FoundI1 |
<200ms silence>
Go To: 3120_iaRepeat_Claim_Status
Special Settings
Developer Notes
Turn barge-in off for this state
| 3117_ppMultiple_Claims |
| Play Prompt |
Previous State
3115_deEval_Claim_Response
Prompts
| Conditions and Wording |
| Prompt ID |
| I've found more than one claim. The status of these claims will be given in the order they were received by our office. (pause). Here's the first claim... |
| 3117_ppMultiple_ClaimsI1 |
<200ms silence>
Go To: 3111_deLog_ROI_Eval
Special Settings
Developer Notes
Turn barge-in off for this state.
| 3118_ppClaim_Info |
| Play Prompt |
Previous State
3112_dbROI_Beneficiary_Claim_Status, 3111_deLog_ROI_Eval
Prompts
| Conditions and Wording |
| Prompt ID |
If 3110_date_paid_x is blank and CRC is null
| Your claim is currently being processed. Processing may take 30 to 45 days. |
| 3118_ppClaim_InfoI1 |
If 3110_date_paid_x is blank and CRC is not null
<Play the corresponding message of rejection codes. The wav files will be named "RC_#.wav". If message is not found in the CAV list, play RC_9999 (default). See list of Claim Reject messages in the Global Prompts section. >
If 3110_date_paid_x is not blank
| Your claim has been completed and was paid on |
| 3118_ppClaim_InfoI2 |
<3110_date_paid_x>
| ...by check number... |
| 3118_ppClaim_InfoI3 |
<3110_check number_x>
| ...for... |
| 3118_ppClaim_InfoI4 |
<3110_check_amount_x>
If 3110_pay_to_x = 'provider'
| ...to the provider. |
| 3118_ppClaim_InfoI5 |
If 3110_pay_to_x = 'beneficiary'
| ...to the beneficiary. |
| 3118_ppClaim_InfoI6 |
Always
<200ms silence>
| If 3110_Record_Count = 1 or All records read |
| Log_ROI = false |
Go To: 3120_iaRepeat_Claim_Status
| Else |
| Go To: 3111_deLog_ROI_Eval |
Special Settings
Developer Notes
Looping through 1 to x claims.
| 3120_iaRepeat_Claim_Status |
| Interaction |
Previous State
3118_ppClaim_Info, 3116_ppNo_Claims_Found
Prompts
| Type |
| Conditions and Wording |
| Prompt ID |
| Initial |
| Do you want to hear that again? |
| 3120_iaRepeat_Claim_StatusI1 |
| Retry 1/Timeout 1 |
| Please reply with a Yes or No. Would you like to hear the claim status information again? |
| 3120_iaRepeat_Claim_StatusR1 |
| Retry 2/Timeout 2 |
| If you'd like to hear the claim status information again, say yes or press 1. If not, say no or press 2. |
| 3120_iaRepeat_Claim_StatusR2 |
| Exit_Repeat |
| OK... |
| 3120_iaRepeat_Claim_StatusE1 |
| Option |
| Vocabulary |
| DTMF |
| Condition-Action |
| Confirm? |
| Yes |
| yes, repeat that |
| 1 |
| Go To: 3115_deEval_Claim_Response |
| Never |
Go To: 3190_ppTransition_From_Benefits Never
| Active Grammar |
| Barge-In |
| NBest |
3120_Repeat_Claim_Status_ASR
3120_Repeat_Claim_Status_DTMF
Confirmation Prompts
| Option |
| Type |
| Wording |
| Prompt ID |
| Max Handler Override |
| Count |
| Action |
Special Settings
Developer Notes
| 3125_iaOrder_Form_Or_Claim_Status |
| Interaction |
Previous State
3560_deEval_Menu_Option
Prompts
| Type |
| Conditions and Wording |
| Prompt ID |
| Initial |
| Would you like to 'order a claim form', or would you like to hear a 'claim status'? |
| 3125_iaOrder_Form_Or_Claim_StatusI1 |
| Retry 1/Timeout 1/Disconfirm 1 |
| To order a claim form, say 'order a claim form'. To hear the status of a claim, say 'claim status'. To return to the previous menu, say 'previous menu'. |
| 3125_iaOrder_Form_Or_Claim_StatusR1 |
| Retry 2/Timeout 2/Disconfirm 2 |
| To order a claim form, say 'order a claim form' or press 1. To hear the status of a claim, say 'claim status' or press 2. To return to the previous menu, say 'previous menu' or press 9. |
| 3125_iaOrder_Form_Or_Claim_StatusR2 |
| Option |
| Vocabulary |
| DTMF |
| Condition-Action |
| Confirm? |
| Claim Forms |
| order claim forms |
| 1 |
| form = claim status |
Go To: 3126_deValidate_Address If necessary
| Claims Status |
| hear claim status, claim status |
| 2 |
| Go To: 3105_iaDate_Of_Service |
| If necessary |
| Previous Menu |
| go to the previous menu |
| 9 |
| Go To: 3100_iaBene_Menu |
| If necessary |
| Active Grammar |
| Barge-In |
| NBest |
3125_Order_Form_Or_Claim_Status_ASR
3125_Order_Form_Or_Claim_Status_DTMF
Confirmation Prompts
| Option |
| Type |
| Wording |
| Prompt ID |
| Claim Forms |
| Initial |
| That was 'order a claim form', right? |
| 3125_iaOrder_Form_Or_Claim_StatusC1 |
| Retry |
| Please reply with a Yes or No. You want to 'order a claim form', right? |
| 3125_iaOrder_Form_Or_Claim_StatusC2 |
| Claims Status |
| Initial |
| That was 'hear a claim status', right? |
| 3125_iaOrder_Form_Or_Claim_StatusC3 |
| Retry |
| Please reply with a Yes or No. You want to 'hear a claim status', right? |
| 3125_iaOrder_Form_Or_Claim_StatusC4 |
| Previous Menu |
| Initial |
| You want to go to the previous menu, right? |
| 3125_iaOrder_Form_Or_Claim_StatusC5 |
| Retry |
| Please reply with a Yes or No. You're wanting to return to the previous menu, right? |
| 3125_iaOrder_Form_Or_Claim_StatusC6 |
| Max Handler Override |
| Count |
| Action |
Special Settings
Developer Notes
| 3126_deValidate_Address |
| Branch |
Previous State
3125_iaOrder_Form_Or_Claim_Status
| If 3540_address_correct = 1 |
| Go To: 3127_dbForm_Request_Claims |
| Else |
| Go To: 3180_ppForms_Claims |
Developer Notes
| 3127_dbForm_Request_Claims |
| Data Source |
Previous State
3126_deValidate_Address
| ID |
| Unique ID representing a request from the IVR |
SSN
| Form |
| form = 1 (Claim Form) |
Go To: 3128_dbROI_Forms_Request_Claims
Developer Notes
For SQL information, see CHAMPVA Transaction documentation.
Set form = 1 (claim form) If a data error/timeout is experienced, continue to the next step.
| 3128_dbROI_Forms_Request_Claims |
| Data Source |
Previous State
3127_dbForm_Request_Claims
vp_session_id ssn elg_status calling_app date_stamp
Go To: 3180_ppForms_Claims
Developer Notes
For SQL information, see CHAMPVA Transaction documentation.
Set form = 1 (claim form)
| 3130_iaEligibility_Form |
| Interaction |
Previous State
3135_iaOrder_Form_Or_Eligibility
Prompts
| Type |
| Conditions and Wording |
| Prompt ID |
| Initial |
| Which form would you like? 'CHAMPVA Program Guide'', 'Release of Information package', or 'CHAMPVA school form'.? If you don't want a form and wish to exit, say 'go to the previous menu'. |
| 3130_iaEligibility_FormI1 |
| Retry 1/Timeout 1/Disconfirm 1 |
| If you don't want a form and wish to exit, say 'go to the previous menu'. Otherwise, please tell me which form that you'd like to order. Say 'CHAMPVA Program Guide', 'Release of Information package', or 'CHAMPVA school form'. |
| 3130_iaEligibility_FormR1 |
| Retry 2/Timeout 2/Disconfirm 2 |
| If you don't want a form and wish to exit, say 'go to the previous menu' or press 9. Otherwise, please tell me which form that you'd like to order. Say 'CHAMPVA Program Guide' or press 1. 'Release of Information package' or press 2. Or say 'CHAMPVA school form' or press 3. If you would like to speak to a representative, say 'representative' or press 0. |
| 3130_iaEligibility_FormR2 |
| Exit_PrevMenu |
| Alright... |
| 3130_iaEligibility_FormE1 |
| Option |
| Vocabulary |
| DTMF |
| Condition-Action |
| Confirm? |
| CHAMPVA Program Guide |
| CHAMPVA program guide |
| 1 |
| form = 3 (handbook) |
Go To: 3134_deValidate_Address If necessary
| ROI |
| release of information package, ROI package |
| 2 |
| form = 7 (release of information) |
Go To: 3134_deValidate_Address If necessary
| CHAMPVA School Form |
| CHAMPVA school certificate form, CHAMPVA school form, school form |
| 3 |
| form = 6 (school certificate form) |
Go To: 3134_deValidate_Address If necessary
| Previous Menu |
| go to the previous menu. |
| 9 |
| Play Exit_PrevMenu |
Go To: 3100_iaBene_Menu If necessary
| Active Grammar |
| Barge-In |
| NBest |
3130_Eligibility_Form_ASR
3130_Eligibility_Form_DTMF
Confirmation Prompts
| Option |
| Type |
| Wording |
| Prompt ID |
| CHAMPVA Program Guide |
| Initial |
| You're wanting the CHAMPVA Program Guide, right? |
| 3130_iaEligibility_FormC1 |
| Retry |
| Please reply with a Yes or No. You're wanting the CHAMPVA Program Guide, right? |
| 3130_iaEligibility_FormC2 |
| ROI |
| Initial |
| You're wanting the Release of Information package, right? |
| 3130_iaEligibility_FormC3 |
| Retry |
| Please reply with a Yes or No. You're wanting the Release of Information package, right? |
| 3130_iaEligibility_FormC4 |
| CHAMPVA School Form |
| Initial |
| You're wanting the CHAMPVA School Form, right? |
| 3130_iaEligibility_FormC5 |
| Retry |
| Please reply with a Yes or No. You're wanting the CHAMPVA School Form, right? |
| 3130_iaEligibility_FormC6 |
| Previous Menu |
| Initial |
| You want to go to the previous menu, right? |
| 3130_iaEligibility_FormC7 |
| Retry |
| Please reply with a Yes or No. You want to go to the previous menu, right? |
| 3130_iaEligibility_FormC8 |
| Max Handler Override |
| Count |
| Action |
Special Settings
Developer Notes
| 3131_dbForm_Request_Eligibility |
| Data Source |
Previous State
3134_deValidate_Address
ID
SSN
| form |
| ('form' value is set in a prior menu - at 3130) |
Go To: 3132_dbROI_Form_Request_Eligibility
Developer Notes
See 3127 transaction Set form = value that set in prior steps
| 3132_dbROI_Form_Request_Eligibility |
| Data Source |
Previous State
3131_dbForm_Request_Eligibility
vp_session_id ssn elg_status calling_app date_stamp
Go To: 3133_ppForms_Eligibility
Developer Notes
Use same transaction as 3128
| 3133_ppForms_Eligibility |
| Play Prompt |
Previous State
3134_deValidate_Address, 3132_dbROI_Form_Request_Eligibility
Prompts
| Conditions and Wording |
| Prompt ID |
If 3540_address_correct <> 1
| I'm sorry. I was unable to complete your form request at this time. Our records indicate that there is a problem with the current address on file. Please ask for a representative if you would like assistance. |
| 3133_ppForms_EligibilityI1 |
Else If form request was successful
| Your request has been received and your item will be mailed to the address that is currently on file. Please allow seven to ten business days for receipt. |
| 3133_ppForms_EligibilityI2 |
Else
| I'm sorry. I was unable to complete your form request at this time. |
| 3133_ppForms_EligibilityI3 |
Always
<200ms silence>
Go To: 3190_ppTransition_From_Benefits
Special Settings
Developer Notes
| 3134_deValidate_Address |
| Branch |
Previous State
3130_iaEligibility_Form
| If 3540_address_correct = 1 |
| Go To: 3131_dbForm_Request_Eligibility |
| Else |
| Go To: 3133_ppForms_Eligibility |
Developer Notes
| 3135_iaOrder_Form_Or_Eligibility |
| Interaction |
Previous State
3560_deEval_Menu_Option
Prompts
| Type |
| Conditions and Wording |
| Prompt ID |
| Initial |
| Would you like the option to 'order eligibility forms', or would you like to hear 'eligibility status'? |
| 3135_iaOrder_Form_Or_EligibilityI1 |
| Retry 1/Timeout 1/Disconfirm 1 |
| To order eligibility forms, say 'order a eligibility forms'. To hear the eligibility status, say 'eligibility status'. Or to return to the previous menu, say 'previous menu'. |
| 3135_iaOrder_Form_Or_EligibilityI2 |
| Retry 2/Timeout 2/Disconfirm 2 |
| To order eligibility forms, say 'order a eligibility forms' or press 1. To hear the eligibility status, say 'eligibility status' or press 2. Or to return to the previous menu, say 'previous menu' or press 3. To speak to a representative, say 'representative' or press 0. |
| 3135_iaOrder_Form_Or_EligibilityR1 |
| Exit_PrevMenu |
| Alright... |
| 3135_iaOrder_Form_Or_EligibilityE1 |
| Option |
| Vocabulary |
| DTMF |
| Condition-Action |
| Confirm? |
| Eligibility Forms |
| order eligibility forms |
| 1 |
| Go To: 3130_iaEligibility_Form |
| If necessary |
| Eligibility Status |
| hear eligibility status |
| 2 |
| Go To: 3140_dbBeneficiary_Eligibility |
| If necessary |
| Previous Menu |
| go to the previous menu |
| 9 |
| Play Exit_PrevMenu |
Go To: 3100_iaBene_Menu If necessary
| Active Grammar |
| Barge-In |
| NBest |
3135_Order_Form_Or_Eligibility_ASR
3135_Order_Form_Or_Eligibility_DTMF
Confirmation Prompts
| Option |
| Type |
| Wording |
| Prompt ID |
| Eligibility Forms |
| Initial |
| You want 'eligibility forms', right? |
| 3135_iaOrder_Form_Or_EligibilityC1 |
| Retry |
| Please reply with a Yes or No. You want 'eligibility forms', right? |
| 3135_iaOrder_Form_Or_EligibilityC2 |
| Eligibility Status |
| Initial |
| You want 'eligibility status', right? |
| 3135_iaOrder_Form_Or_EligibilityC3 |
| Retry |
| Please reply with a Yes or No. You want 'eligibility status', right? |
| 3135_iaOrder_Form_Or_EligibilityC4 |
| Previous Menu |
| Initial |
| You want to go to the previous menu, right? |
| 3135_iaOrder_Form_Or_EligibilityC5 |
| Retry |
| Please reply with a Yes or No. You want to go to the previous menu, right? |
| 3135_iaOrder_Form_Or_EligibilityC6 |
| Max Handler Override |
| Count |
| Action |
Special Settings
Developer Notes
| 3140_dbBeneficiary_Eligibility |
| Data Source |
Previous State
3135_iaOrder_Form_Or_Eligibility
SSN
ssn result eligibility_status effective_date end_date issue_date
Go To: 3142_dbROI_Beneficiary_Eligibility_Status
Developer Notes set 3140_Record_Count = the number of records returned.
| 3142_dbROI_Beneficiary_Eligibility_Status |
| Data Source |
Previous State
3140_dbBeneficiary_Eligibility
vp session id
SSN
elg_status date_eligible date_eligibility_expires date_card_was_issued calling_app date_stamp
Go To: 3145_ppEligibility_Info
Developer Notes
If a data error/timeout is experienced, continue to the next step.
| 3145_ppEligibility_Info |
| Play Prompt |
Previous State
3150_iaRepeat_Eligibility_Status, 3142_dbROI_Beneficiary_Eligibility_Status
Prompts
| Conditions and Wording |
| Prompt ID |
If 3140_result = 0 and 3140_eligibility_status = 'eligible'
| You are currently eligible for the CHAMPVA program effective... |
| 3145_ppEligibility_InfoI1 |
<3140_effective_date>
| ...through... |
| 3145_ppEligibility_InfoI2 |
<3140_end_date>
| School certifications must be submitted on an annual basis for children between the age of 18 and 23 to continue coverage under the CHAMPVA program. (pause) If you become eligible for Medicare part A, you are required to purchase Medicare part B to maintain your eligibility for CHAMPVA benefits. |
| 3145_ppEligibility_InfoI7 |
Else If 3140_result = 0 and 3140_eligibility_status = 'ineligible'
| Currently, you are not eligible for the CHAMPVA program. |
| 3145_ppEligibility_InfoI3 |
| School certifications must be submitted on an annual basis for children between the age of 18 and 23 to continue coverage under the CHAMPVA program. (pause) If you become eligible for Medicare part A, you are required to purchase Medicare part B to maintain your eligibility for CHAMPVA benefits. |
| 3145_ppEligibility_InfoI8 |
Else If 3140_result = 0 and 3140_eligibility_status = 'pending'
| Your application has been received and is in process in our system. |
| 3145_ppEligibility_InfoI4 |
Else (default)
| We have no record of receiving your application. |
| 3145_ppEligibility_InfoI5 |
Always
<200ms silence>
Go To: 3150_iaRepeat_Eligibility_Status
Special Settings
Developer Notes
For SQL information, see CHAMPVA Transaction documentation.
| 3150_iaRepeat_Eligibility_Status |
| Interaction |
Previous State
3145_ppEligibility_Info
Prompts
| Type |
| Conditions and Wording |
| Prompt ID |
| Initial |
| Do you want to hear that again? |
| 3150_iaRepeat_Eligibility_StatusI1 |
| Retry 1/Timeout 1 |
| Please reply with a Yes or No. Would you like the eligibility status again? |
| 3150_iaRepeat_Eligibility_StatusR1 |
| Retry 2/Timeout 2 |
| If you'd like to hear the eligibility status again, say yes or press 1. If not, say no or press 2. |
| 3150_iaRepeat_Eligibility_StatusR2 |
| Exit_Repeat |
| OK... |
| 3150_iaRepeat_Eligibility_StatusE1 |
| Option |
| Vocabulary |
| DTMF |
| Condition-Action |
| Confirm? |
| Yes |
| yes, yes repeat that |
| 1 |
| Go To: 3145_ppEligibility_Info |
| Never |
Go To: 3190_ppTransition_From_Benefits Never
| Active Grammar |
| Barge-In |
| NBest |
3150_Repeat_Eligibility_Status_ASR
3150_Repeat_Eligibility_Status_DTMF
Confirmation Prompts
| Option |
| Type |
| Wording |
| Prompt ID |
| Max Handler Override |
| Count |
| Action |
Special Settings
Developer Notes
| 3180_ppForms_Claims |
| Play Prompt |
Previous State
3126_deValidate_Address, 3128_dbROI_Forms_Request_Claims
Prompts
| Conditions and Wording |
| Prompt ID |
If 3540_address_correct <> 1
| I'm sorry. I was unable to complete your form request at this time. Our records indicate that there is a problem with the current address on file. Please ask for a representative if you would like assistance. |
| 3180_ppForms_ClaimsI1 |
Else If form request was successful
| Your request has been received. Please allow seven to ten business days. |
| 3180_ppForms_ClaimsI2 |
Else
| I'm sorry. I was unable to complete your form request at this time. |
| 3180_ppForms_ClaimsI3 |
Always
<200ms silence>
Go To: 3190_ppTransition_From_Benefits
Special Settings
Developer Notes
| 3190_ppTransition_From_Benefits |
| Play Prompt |
Previous State
3120_iaRepeat_Claim_Status, 3150_iaRepeat_Eligibility_Status, 3133_ppForms_Eligibility, 3180_ppForms_Claims, 3290_iaRepeat_Option, 3225_iaPharmacy_Order_Form, 3228_ppForms_MBM, 3340_iaRepeat_Other_Health, 3350_iaOffer_Form, 3353_ppForms_Other_Health, 5060_deEval_Return_Location
Prompts
| Conditions and Wording |
| Prompt ID |
| If that's it for your call, you may hang up. Or if you need to speak to a representative, say representative. Otherwise, let's go back to the start. |
| 3190_ppTransition_From_BenefitsI1 |
<500ms silence>
Go To: 3100_iaBene_Menu
Special Settings
Developer Notes
| 3210_iaBeneficary_Other |
| Interaction |
Previous State
3100_iaBene_Menu
Prompts
| Type |
| Conditions and Wording |
| Prompt ID |
| Initial |
| Here are some other options: Say Pharmacy Eligibility, Catastrophic Cap Calculation, Deductible Calculation, Dental Coverage, or Other Health Insurance. To go back to the previous menu, say 'previous menu'. |
| 3210_iaBeneficary_OtherI1 |
| Retry 1/Timeout 1/Disconfirm 1 |
| Please select from one of these options, or say 'return to the previous menu'. Say Pharmacy Eligibility, Catastrophic Cap Calculation, Deductible Calculation, Dental Coverage, or Other Health Insurance. |
| 3210_iaBeneficary_OtherR1 |
| Retry 2/Timeout 2/Disconfirm 2 |
| For Pharmacy Eligibility, say Pharmacy Eligibility or press 1. For Catastrophic Cap Calculation, say Catastrophic Cap Calculation, or press 2. For Deductible Calculation, say Deductible Calculation, or press 3. For Dental Coverage, say Dental Coverage, or press 4. For Other Health Insurance, say Other Health Insurance, or press 5. To return to the previous menu, say 'previous menu' or press 9. Or to speak with a representative, say 'representative' or press 0. |
| 3210_iaBeneficary_OtherR2 |
| Option |
| Vocabulary |
| DTMF |
| Condition-Action |
| Confirm? |
| Pharmacy |
| pharmacy, pharmacy eligibility |
| 1 |
| BeneMenuOption = Pharmacy |
Go To: 3510_deEval_BeneGetSSN_JustValidated If necessary
| Catastrophic |
| catastrophic cap, catastrophic cap calculation |
| 2 |
| BeneMenuOption = Catastrophic |
Go To: 3510_deEval_BeneGetSSN_JustValidated If necessary
| Deductible |
| deductible |
| 3 |
| BeneMenuOption = Deductible |
Go To: 3510_deEval_BeneGetSSN_JustValidated If necessary
| Dental Coverage |
| dental coverage |
| 4 |
| BeneMenuOption = Dental |
Go To: 3270_ppDental_Coverage If necessary
| Other |
| other health insurance |
| 5 |
| BeneMenuOption = Other |
Go To: 3510_deEval_BeneGetSSN_JustValidated If necessary
| Previous Menu |
| go to the/return to the previous menu, previous menu |
| 9 |
| Go To: 3100_iaBene_Menu |
| If necessary |
| Active Grammar |
| Barge-In |
| NBest |
3210_Beneficary_Other_ASR
3210_Beneficary_Other_DTMF
Confirmation Prompts
| Option |
| Type |
| Wording |
| Prompt ID |
| Pharmacy |
| Initial |
| You wanted Pharmacy Eligibility, right? |
| 3210_iaBeneficary_OtherC1 |
| Retry |
| Please reply with a Yes or No. You're requesting Pharmacy Eligibility, right? |
| 3210_iaBeneficary_OtherC2 |
| Catastrophic |
| Initial |
| You wanted Catastrophic Cap Calculation, right? |
| 3210_iaBeneficary_OtherC3 |
| Retry |
| Please reply with a Yes or No. You're requesting Catastrophic Cap Calculation, right? |
| 3210_iaBeneficary_OtherC4 |
| Deductible |
| Initial |
| You wanted Deductible Calculation, right? |
| 3210_iaBeneficary_OtherC5 |
| Retry |
| Please reply with a Yes or No. You're requesting Deductible Calculation, right? |
| 3210_iaBeneficary_OtherC6 |
| Dental Coverage |
| Initial |
| You wanted Dental Coverage, right? |
| 3210_iaBeneficary_OtherC11 |
| Retry |
| Please reply with a Yes or No. You're wanting Dental Coverage, right? |
| 3210_iaBeneficary_OtherC12 |
| Other |
| Initial |
| You're wanting Other Health Insurance, right? |
| 3210_iaBeneficary_OtherC7 |
| Retry |
| Please reply with a Yes or No. You're requesting Other Health Insurance, right? |
| 3210_iaBeneficary_OtherC8 |
| Previous Menu |
| Initial |
| You want to go to the previous menu, right? |
| 3210_iaBeneficary_OtherC9 |
| Retry |
| Please reply with a Yes or No. You're wanting to return to the previous menu, right? |
| 3210_iaBeneficary_OtherC10 |
| Max Handler Override |
| Count |
| Action |
Special Settings
Developer Notes
| 3225_iaPharmacy_Order_Form |
| Interaction |
Previous State
3241_ppPharmacy_Info
Prompts
| Type |
| Conditions and Wording |
| Prompt ID |
| Initial |
| Would you like to order a Meds by Mail form and have it mailed to you? Please say Yes or No. |
| 3225_iaPharmacy_Order_FormI1 |
| Retry 1/Timeout 1 |
| If you want to order a Meds by Mail form, say Yes. Otherwise, say No. |
| 3225_iaPharmacy_Order_FormR1 |
| Retry 2/Timeout 2 |
| To order a Meds by Mail form to be mailed to you, say Yes or press 1. If not, say No or press 2. |
| 3225_iaPharmacy_Order_FormR2 |
| Exit_Repeat |
| Alright... |
| 3225_iaPharmacy_Order_FormE1 |
| Option |
| Vocabulary |
| DTMF |
| Condition-Action |
| Confirm? |
| Yes |
| yes, yes i want to order a form |
| 1 |
| Go To: 3229_deValidate_Address |
| Never |
| No |
| no, no i don't want a form |
| 2 |
| Play Exit_Repeat |
Go To: 3190_ppTransition_From_Benefits Never
| Active Grammar |
| Barge-In |
| NBest |
3225_Pharmacy_Order_Form_ASR
3225_Pharmacy_Order_Form_DTMF
Confirmation Prompts
| Option |
| Type |
| Wording |
| Prompt ID |
| Max Handler Override |
| Count |
| Action |
Special Settings
Developer Notes
| 3226_dbForms_MBM |
| Data Source |
Previous State
3229_deValidate_Address
ID
SSN
| form |
| value will be set to 5 (Web by Mail Presecription form) |
Go To: 3227_dbROI_Forms_MBM
Developer Notes
See 3127 transaction Set form = 5 (web by mail prescription reorder form)
| 3227_dbROI_Forms_MBM |
| Data Source |
Previous State
3226_dbForms_MBM
ID
SSN
| Form |
| value will be set to 5 (Web by Mail Presecription form) |
Go To: 3228_ppForms_MBM
Developer Notes
Use same transaction as 3128
| 3228_ppForms_MBM |
| Play Prompt |
Previous State
3229_deValidate_Address, 3227_dbROI_Forms_MBM
Prompts
| Conditions and Wording |
| Prompt ID |
If 3540_address_correct <> 1
| I'm sorry. I was unable to complete your form request at this time. Our records indicate that there is a problem with the current address on file. Please ask for a representative if you would like assistance. |
| 3228_ppForms_MBMI1 |
Else If form request was successful
| Your request has been received and your item will be mailed to the address that is currently on file Please allow seven to ten business days for receipt. |
| 3228_ppForms_MBMI2 |
Else
| I'm sorry. I was unable to complete your form request at this time. |
| 3228_ppForms_MBMI3 |
Always
<200ms silence>
Go To: 3190_ppTransition_From_Benefits
Special Settings
Developer Notes
| 3229_deValidate_Address |
| Branch |
Previous State
3225_iaPharmacy_Order_Form
| If 3540_address_correct = 1 |
| Go To: 3226_dbForms_MBM |
| Else |
| Go To: 3228_ppForms_MBM |
Developer Notes
| 3240_dbBeneficiary_Pharmacy_Eligibility_Status |
| Data Source |
Previous State
3560_deEval_Menu_Option
SSN
result eligibility_status effective_date end_date
Go To: 3242_dbROI_Pharmacy_Eligibility_Status
Developer Notes set 3240_Record_Count = the number of records returned.
| 3241_ppPharmacy_Info |
| Play Prompt |
Previous State
3295_deRepeat_Nav, 3242_dbROI_Pharmacy_Eligibility_Status
Prompts
| Conditions and Wording |
| Prompt ID |
If 3240_Record_Count = 1 and 3240_eligibility_status = 'eligible'
| You are eligible for pharmacy benefits provided by the program to include Meds by Mail. |
| 3241_ppPharmacy_InfoI1 |
Else If 3240_Record_Count = 1 and 3240_eligibility_status = 'inelgible'
| You are ineligible to utilize pharmacy benefits provided by the program to include Meds by Mail; however, you can file a claim for reimbursement of your out of pocket pharmacy expenses. |
| 3241_ppPharmacy_InfoI2 |
Else (no record)
| We do not have a record of your social security number. |
| 3241_ppPharmacy_InfoI3 |
Always
<200ms silence>
| If 3240_Record_Count = 1 and eligibility_status = 'eligible' |
| Go To: 3225_iaPharmacy_Order_Form |
| Else |
| Go To: 3290_iaRepeat_Option |
Special Settings
Developer Notes
Turn barge-in off for this state
| 3242_dbROI_Pharmacy_Eligibility_Status |
| Data Source |
Previous State
3240_dbBeneficiary_Pharmacy_Eligibility_Status
vp session id
SSN
elg_status date_eligible date_eligibility_expires calling_app date_stamp
Go To: 3241_ppPharmacy_Info
Developer Notes
If a data error/timeout is experienced, continue to the next step.
| 3250_dbBeneficiary_Cumulative_Cap_Calculation |
| Data Source |
Previous State
3560_deEval_Menu_Option
SSN
result cap
Go To: 3252_dbROI_Catastrophic_Cap_Calculation
Developer Notes set 3250_Record_Count = the number of records returned.
| 3251_ppCastastrophic_Cap_Calc |
| Play Prompt |
Previous State
3295_deRepeat_Nav, 3252_dbROI_Catastrophic_Cap_Calculation
Prompts
| Conditions and Wording |
| Prompt ID |
If 3250_Record_Count = 1
| Your catastrophic cap has... |
| 3251_ppCastastrophic_Cap_CalcI1 |
<3250_cap>
| ...met toward a maximum of $3,000.00. This amount does not include claims that are currently processing. This amount will reset on January 1 of each year. |
| 3251_ppCastastrophic_Cap_CalcI2 |
| In most circumstances CHAMPVA will pay 75 percent of the allowed amount and you will be responsible for 25 percent of the allowed amount until your catastrophic cap has been satisfied for the calendar year. There is no way to determine your cost share prior to the submission and processing of a claim. |
| 3251_ppCastastrophic_Cap_CalcI3 |
Else
| We do not have a record of your social security number. |
| 3251_ppCastastrophic_Cap_CalcI4 |
Always
<200ms silence>
Go To: 3290_iaRepeat_Option
Special Settings
Developer Notes
| 3252_dbROI_Catastrophic_Cap_Calculation |
| Data Source |
Previous State
3250_dbBeneficiary_Cumulative_Cap_Calculation
vp session id
SSN
amount_of_cap calling_app date_stamp
Go To: 3251_ppCastastrophic_Cap_Calc
Developer Notes
If a data error/timeout is experienced, continue to the next step.
| 3260_dbBeneficiiary_Cumulative_Deductible_Calculation |
| Data Source |
Previous State
3560_deEval_Menu_Option
SSN
result deductible
Go To: 3262_dbROI_Deductible_Calculation
Developer Notes set 3260_Record_Count = the number of records returned.
| 3261_ppDeductible_Calc_Info |
| Play Prompt |
Previous State
3295_deRepeat_Nav, 3262_dbROI_Deductible_Calculation
Prompts
| Conditions and Wording |
| Prompt ID |
If 3260_Record_Count = 1
| Your deductible has... |
| 3261_ppDeductible_Calc_InfoI1 |
<3260_deductible>
This is the start of the file's text. The full file is on GovTribe.
