Admin: Insurance

Page Description

Use the Insurance page to view, create, or edit insurance company and plan information, including host codes, routing information, and required patient information. In addition, you may validate insurance companies and plans, as well as inactivate insurance, if appropriate. Note that you must have the "View insurance company" right in order to use this page.

Copia applies insurance company and insurance plan-based routing rules to determine the testing lab for an order choice when appropriate according to the routing rule hierarchy. See the Order Patient Samples topic.

Note that non-validated insurance companies or plans are not the same as inactive insurance companies or plans. If a company or plan is inactive, Copia will not allow you to select it when creating an insurance set, and, when placing an order, you will not be able to assign any patient insurance set that contains an inactive company or plan. If a company or plan is non-validated, you will be able to assign it to any patient insurance set, and you will be able to add the non-validated company or plan to patients' insurance sets; however, Copia will only send validated insurance information when it transmits orders.

For more help, click one of the following links:


Accessing this Page

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Selecting a Practice

  1. By default, Copia selects the "System Maintained Insurance" option for the practice. This option allows you to work with all insurance records that exist in the system.
  2. Click the Search button to select a specific practice in the Practice Search page. See the Admin: Practice Search topic.
  3. If you have selected a specific practice, click the Clear button to return to the "System Maintained Insurance" option.
  4. When you search for and select a new practice, Copia clears any displayed insurance company and insurance plan search results. See "Searching for an Insurance Company or Plan" below.

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Searching for an Insurance Company or Plan
  1. There are two ways to search for insurance companies or plans:
  2. To search for all insurance companies and/or plans, enter an asterisk (*) in either the Insurance Company field or the Insurance Plan field, or both.
  3. To further narrow your search, use the insurance company and/or plan filters. See "Setting the Company and Plan Filters" below.
  4. If your search generates one or more matches, the matching company or plan names are displayed in the Insurance Companies and Plans section when the page refreshes. Each active insurance record is listed with the company name, plan name, phone number, contact name, contact phone number, company address, and the company and plan active and validation statuses. If you select a different practice, Copia clears the list of insurance companies and plans.
  5. Click the desired company or plan link to view more details. See "Accessing Insurance Details" below.
  6. Select or clear the Active or Validated checkboxes in the Company and/or Plan columns to indicate the active/inactive and validated/non-validated statuses for the insurance companies and insurance plans. Note that Copia only displays the checkboxes for insurance plans if your search included one or more characters in the Insurance Plan search field (see above). Once you have made your changes, click the Apply all status changes button to have Copia save the new active and validated statuses to the appropriate insurance records.

    For companies with multiples plans, the checkboxes only appear for the first row on the page on which that insurance company appears.

    IMPORTANT: Applying the changes causes Copia to redo the search. This means that if you change the status of a plan or company such that it no longer fits the filter, then it will no longer appear on the page.

  7. If no search results are found, or if the desired company or plan is not found, search again or click the New Insurance Company button to add insurance information. See "Adding or Editing Insurance Company Information" or "Adding or Editing Insurance Plan Information" below.

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Setting the Company and Plan Filters

  1. The filters for both insurance companies and insurance plans default to showing only active companies and plans.
  2. Select or clear the checkboxes for Active, Inactive, Validated, and Non-validated for either the Company Filter or the Plan Filter to limit the results of your search to your selections. Note that if you select neither active nor inactive or neither valid nor non-valid for a plan or company, then Copia does not put any restrictions on that field for the search, and it will function as if both are checked.
  3. Select the Missing Host Code option and select a host from the drop-down list for either the Company Filter or the Plan Filter to limit the results of your search to entries with missing host codes.
  4. You may update the active/inactive and validated/non-validated status for insurance companies and insurance plans in the Insurance Companies and Plans section once you perform a search (see "Searching for an Insurance Company or Plan" above), or when you are updating an individual insurance company's or insurance plan's details (see "Adding or Editing Insurance Company Information" below).

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Accessing Insurance Details

  1. Use the Insurance search page to access the insurance company and plan details pages, where you may add or edit company and plan information, including name, required patient information, routing, and host codes.
  2. To create new insurance company information, click the New Insurance Company button in the Insurance search page. This opens a blank record in the Insurance details page to create new insurance information. See "Adding or Editing Insurance Company Information" below.
  3. To create new insurance plan information, search for and select the insurance company the plan is assigned to. See "Searching for an Insurance Company or Plan" above. Once you have opened the details for the insurance company, click the New Insurance Plan button in the Insurance Plans section of the Insurance details page. This opens a blank record in the Insurance plan details page to record new insurance plan information. See "Adding or Editing Insurance Plan Information" below. This button is only enabled if your assigned role contains the necessary rights to add new insurance.
  4. To edit existing insurance information, click the name of the company or plan in the Insurance search page. Note that you may also select a plan name from the Insurance Plans section of the Insurance details page to access insurance plan information.
  5. If you cancel out of editing or adding insurance information, Copia returns to the page of search results you were viewing before you selected an insurance company or insurance plan.

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Adding or Editing Insurance Company Information

  1. The Insurance Company Information section of the Insurance details page enables you to add or edit insurance company information.

    IMPORTANT: If there was a plan associated with your selected insurance company, then Copia also displays the Insurance Plan Information section on this page (see "Adding or Editing Insurance Plan Information" below). Select the Display Page Side By Side option to view the insurance company and plan information side by side. Clear this option to view the company information above the plan information. If you choose to view the information side by side, then Copia displays the Align Company and Plan Sections option. Select this option to have Copia space the sections within the company and plan information so that they line up for easier comparison.

  2. Click the Change Log button to view the change log for the selected insurance company. See the Admin: Change Log topic. Note that you must have the necessary security right to access the Change Log page.
  3. Enter the company name into the Company Name field. This field is required.
  4. Enter the company ID into the Company ID field. This field is required.
  5. Select the validation set to use for the insurance company from the Validation Set for Orders drop-down list. Copia assigns to each new insurance company you create the New Insurance Company Default Validation Set value set in the System Defaults administration page (see the Admin: System Defaults topic) or the selected practice's New Insurance Company Default Validation Set value set in the Practices administration page (see the Admin: Practices topic); however, you may use this field to assign an alternate validation set for the insurance company. If you do not assign a validation set to the insurance company for all practices in the system, then Copia will consider all ICD-9 codes invalid, and require an ABN for the order. If you do not assign a validation set to the insurance company for the selected practice, then Copia uses the system default diagnosis validation selection.
  6. Click the Internal Billing Status Rules button to select the appropriate billing status rule and set any ordering location-based exceptions in the Internal Billing Status administration page. See the Internal Billing Status topic. Copia uses this billing status rule when the patient uses this insurance company. You may also assign billing status rules for specific hosts for this insurance company in the Insurance Company Host Codes section of the page (see below). You may define additional billing status rules in the Billing Status Rules administration page. Note that when rules or exceptions are set, the button text will turn green and italic. See the Admin: Billing Status Rules topic.
  7. Click the Add button in the Company Order Choice Restriction List section to add, using the Order Choice List Search page, the order choice lists that you want to make available on the Order Patient Samples page for patients with the selected insurance company. See the Admin: Order Choice List Search topic. To delete an order choice list from the list, click the X button that corresponds to the order choice list name.
  8. When you select one or more order choice lists and enable the order choice restriction feature on the Locations administration page, then users will only be able to select order choices that are on the selected lists when placing orders. Note that Copia will use the order choice restriction lists for the insurance plan level, if set, instead of this restriction list; however, it uses this restriction list instead of the one defined for the ordering location's practice, if set.

  9. Select the Active checkbox to enable users to select the insurance company as the primary, secondary, or tertiary company in a patient's insurance set. Clear this checkbox to restrict users from selecting the insurance company. See the Insurance Search topic. In addition, if an insurance company or plan within a patient insurance set is marked as inactive, you will not be able to assign the insurance set to a new order. See the Patient Insurance Sets topic. Copia displays or clears the company or plan from the insurance search results list, depending on your settings for the company and/or plan active/inactive filters. See "Setting the Company and Plan Filters" above.
  10. Select the Is Validated checkbox to indicate this company is validated. Note that insurance company information must be validated to be sent with an order, unless the ability to send non-validated insurance is enabled for the host interface. See the Admin: Interface Configuration topic. You may view non-validated companies in the Validate Insurance page. See the Admin: Validate Insurance topic. Copia displays or clears the company or plan from the insurance search results list, depending on your settings for the company and/or plan validated/non-validated filters. See "Setting the Company and Plan Filters" above.
  11. Select the Is Preferred checkbox to specify that the insurance company is the one that is preferred over others in the system. Preferred companies will appear in bold and filter to the top of the search.
  12. Select the Allow Client Bill option to allow practices or providers to bill the client for testing. If the Allow Client Bill for Medicare for this practice setting is enabled on the Practices administration page, then that setting supersedes this setting; otherwise, this setting determines if the insurance can be Client Bill based on any practice, location, or user administration settings. If neither of the allow client bill settings are enabled, the default status will always be Direct Bill. Note that this option must be enabled in order to use client bill as the default for locations or practices.
  13. Select the Use Medicare ABN checkbox to have Copia generate all ABNs for the selected insurance company using the Medicare format; otherwise, the ABNs will use the non-Medicare format. Copia automatically updates this checkbox as you modify the Insurance Type field (see below); however, you may manually override the automatic setting by either selecting or clearing the checkbox. Note that Copia only applies the 2008 ABN format to Medicare insurance types. It uses the previous format for non-Medicare insurance types. Also, the Preview button on the System Defaults administration page always uses the new ABN format, no matter what kind of insurance the patient has.
  14. Select the insurance type from the Insurance Type drop-down list (Unknown, Medicare, Medicaid, or Private). Copia uses this setting when performing medical necessity checking and determining when to print ABNs. Copia determines whether an Advance Beneficiary Notice (ABN) is required based on the selected diagnosis and the patient's insurance, the frequency limits for the order choice, and whether the order choice is set as a research/experimental order choice. In addition, if the setting to fail all diagnosis codes is set for the order choice, then Copia always triggers an ABN for that order choice, no matter what the diagnosis code is. Once it determines an ABN is necessary, Copia uses the Use Medicare ABN setting (see above) to determine whether to print the Medicare ABN or non-Medicare ABN.
  15. To edit the company information fields, select different options or highlight or delete text already displayed in the field, then modify as desired.
  16. If your modifications are complete, click Save to record all changes. Otherwise, complete the remaining sections, and then click Save. Copia alerts you if you attempt to save an insurance company or insurance plan record that contains a duplicate host code.

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Adding or Deleting Insurance Company Routing Information

  1. The Insurance Company Routing section enables you to add or edit the default routing information for the insurance company, as well as assign routing for specific practices or for specific locations.
  2. Select the default routing for the insurance company from the Default Routing drop-down list. Copia only displays the routing rules available for the practice associated with your signed in location. Note that if there is a default insurance routing setting on the System Defaults administration page, then Copia selects that routing rule by default.
  3. To assign routing information for a specific practice, click the Add button for practices to search for and select a practice associated with the insurance company in the Practice Search page. See the Admin: Practice Search topic. Repeat this step for each practice that should have specific routing information.
  4. To assign routing information for a specific location, click the Add button for locations to search for and select a location associated with the insurance company in the Location Search page. See the Admin: Location Search topic. Repeat this step for each location that should have specific routing information.
  5. Select a routing rule for each practice and location from the Routing drop-down list. Note that if there is a default insurance routing setting in the Practices administration page for the selected practice, then Copia selects that routing rule by default. Also note that location-specific routing takes precedence over practice-specific routing configurations.
  6. To delete assigned routing rules, select the blank option from the Routing or Default Routing drop-down lists, and click Save. Copia removes the company's default routing or the practice or location name and assigned routing when the page refreshes.
  7. If your modifications are complete, click Save to record all changes. Otherwise, complete the remaining sections, and then click Save.
  8. Copia applies insurance company-based routing rules to determine the testing lab for an order choice when appropriate according to the routing rule hierarchy. See the Order Patient Samples topic.

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Adding or Editing Insurance Company Patient Insurance Fields

  1. Use the Insurance Company Required Patient Insurance Fields section to create required fields for insurance information on the Insurance or Insurance Plan pages based on the patient's insurance company. See the Insurance or Insurance Plan topics. These settings override the field requirement settings on the System Defaults and Locations administration pages. Note that you only need to use this section if Copia's default or location settings do not meet the insurance company's information requirements.
  2. Click the show link in the section title bar to display the potentially required fields. To hide the fields, click the hide settings link that appears in the section title bar.
  3. Select an option to determine the required insurance company fields:
  4. If you are defining the required fields, select the checkbox for each field that should be required on the Insurance or Insurance Plan pages. Clear the checkboxes to remove the requirement. Copia adds an asterisk (*) next to each required field on the Insurance or Insurance Plan pages.
  5. For the Policy, Group, and Group Number fields, you may define numeric/alphanumeric patterns (up to 100 characters) in the Match Pattern fields that Copia applies to ensure users enter valid policy numbers, groups, and group numbers. You may set these at the system (see the Admin: System Defaults topic), location (see the Admin: Locations topic), insurance company, and insurance plan (see "Adding or Editing Insurance Plan Patient Insurance Fields" below) levels. Click the Test button to display a field where you may enter characters and have Copia display "Pass" or "Fail" to indicate if what you entered matches the pattern you set. Once you are finished testing, click the X button to hide the field.

    Match Pattern Examples:

    Medicare Policy: \d{9}[a-zA-Z]{1} -This allows 9 numbers, followed by 1 letter (upper or lower case)
    Railroad Medicare Policy: [a-zA-Z]{2}\d{9} -This allows 2 letters (upper or lower case) followed by 9 numbers
    Medicaid: \d{11} -This allows 11 numbers

  6. To return to Copia's default settings, select the Use default required fields option.
  7. If your modifications are complete, click Save to record all changes. Otherwise, complete the remaining sections, and then click Save.

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Adding, Editing, or Deleting Insurance Company Host Codes
  1. The Insurance Company Host Codes section of the Insurance details page provides the fields to create or modify insurance company host code information.
  2. Click the show link in the section title bar to display the host information. To hide the host information, click the hide link that appears in the section title bar.
  3. Copia displays the list of available hosts with their host type and active status.
  4. Add or edit the host name, type, and active status in the Host Details section of the Hosts details page. See the Admin: Hosts topic.
  5. Select the Show active hosts only checkbox to restrict the view to active hosts. Set the active/inactive status in the Host Details section of the Hosts details page. See the Admin: Hosts topic.
  6. To add a Host Code, click the Add Code button, and enter the host code in the Host Code field.
  7. To edit the host code, highlight or delete text already displayed in the field, then modify as desired.
  8. If you have added a host code, then Copia displays the Internal Billing Status Rules button to select the appropriate billing status rule and set any ordering location-based exceptions in the Internal Billing Status administration page. See the Internal Billing Status topic. Copia uses the selected billing status rule when the patient uses this insurance company and testing is performed at the selected host. You may define additional billing status rules in the Billing Status Rules administration page. Note that when rules or exceptions are set, the button text will turn green and italic. See the Admin: Billing Status Rules topic.
  9. To delete the host code, click the X button that corresponds to the host code. Copia prompts you to confirm the deletion. Click OK to continue.
  10. If your modifications are complete, click Save to record all changes. Otherwise, complete the remaining sections, and then click Save.

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Adding or Editing Insurance Plan Information
  1. The Insurance Plans section of the Insurance plan details page enables you to add or edit insurance plan information and assign plans to a different company, if needed.

    IMPORTANT: Copia also displays the Insurance Company Information section on this page (see "Adding or Editing Insurance Company Information" above). Select the Display Page Side By Side option to view the insurance company and plan information side by side. Clear this option to view the company information above the plan information. If you choose to view the information side by side, then Copia displays the Align Company and Plan Sections option. Select this option to have Copia space the sections within the company and plan information so that they line up for easier comparison.

  2. Click the New Insurance Plan button to create a new insurance plan. This button is only enabled if your assigned role contains the necessary rights to add new insurance.
  3. Complete the Insurance Plan Information fields listed below.
  4. Click the Internal Billing Status Rules button to select the appropriate billing status rule and set any ordering location-based exceptions in the Internal Billing Status administration page. See the Internal Billing Status topic. Copia uses this billing status rule when the patient uses this insurance plan. You may also assign billing status rules for specific hosts for this insurance plan in the Insurance Plan Host Codes section of the page (see below). You may define additional billing status rules in the Billing Status Rules administration page. See the Admin: Billing Status Rules topic.
  5. Click the Change Log button to view the change log for the selected insurance plan. See the Admin: Change Log topic.
  6. Click the Add button in the Plan Order Choice Restriction List section to add, using the Order Choice List Search page, the order choice lists that you want to make available on the Order Patient Samples page for patients with the selected insurance plan. See the Admin: Order Choice List Search topic. To delete an order choice list from the list, click the X button that corresponds to the order choice list name.
  7. When you select one or more order choice lists and enable the order choice restriction feature on the Locations administration page, then users will only be able to select order choices that are on the selected lists when placing orders. Note that Copia will use the order choice restriction lists for the insurance plan level, if set, instead of the lists defined for the insurance company or the ordering location's practice, if set.

  8. Select the Active checkbox to enable users to select the insurance plan as the primary, secondary, or tertiary plan in a patient's insurance set. Clear this checkbox to restrict users from selecting the insurance plan. See the Insurance Search topic. In addition, if an insurance company or plan within a patient insurance set is marked as inactive, you will not be able to assign the insurance set to a new order. See the Patient Insurance Sets topic. If the insurance plan is inactive, Copia clears it from the insurance search results list. See "Searching for an Insurance Company or Plan" above.
  9. Select the Is Validated checkbox to indicate this plan is valid. Note that insurance plan information must be validated to be sent with an order. You may view non validated companies in the Validate Insurance page. See the Admin: Validate Insurance topic.
  10. Select the Is Preferred checkbox to specify that the insurance plan is the one that is preferred over others in the system. Preferred plans will appear in bold and filter to the top of the search.
  11. If your modifications are complete, click Save to record all changes. Otherwise, complete the remaining sections, and then click Save.

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Adding or Deleting Insurance Plan Routing Information

  1. The Insurance Plan Routing section of the Insurance plan details page enables you to add or edit the default routing information for the insurance plan, as well as assign insurance plan-based routing rules for specific practices or for specific locations.
  2. Select the default routing for the insurance plan from the Default Routing drop-down list. Note that Copia only displays the routing rules available for the practice associated with your signed in location. Note that if there is a default insurance routing setting in the System Defaults administration page, then Copia selects that routing rule by default.
  3. To assign routing information for a specific practice, click the Add button for practices to search for and select a practice associated with the insurance plan in the Practice Search page. See the Admin: Practice Search topic. Repeat this step for each practice that should have specific routing information.
  4. To assign routing information for a specific location, click the Add button for locations to search for and select a location associated with the insurance plan in the Location Search page. See the Admin: Location Search topic. Repeat this step for each location that should have specific routing information.
  5. Select a routing rule for each practice and location from the Routing drop-down list. Note that if there is a default insurance routing setting in the Practices administration page for the selected practice, then Copia selects that routing rule by default. Also note that location-specific routing takes precedence over practice-specific routing configurations.
  6. To delete assigned routing rules, select the blank option from the Routing or Default Routing drop-down list, and click Save. Copia removes the plan's previously assigned default routing, or the practice or location name and assigned routing when the page refreshes.
  7. If your modifications are complete, click Save to record all changes. Otherwise, complete the remaining sections, and then click Save.
  8. Copia applies insurance plan-based routing rules to determine the testing lab for an order choice when appropriate according to the routing rule hierarchy. See the Order Patient Samples topic.

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Adding or Editing Insurance Plan Patient Insurance Fields

  1. Use the Insurance Plan Required Patient Insurance Fields section to create specialized information fields in the Insurance page. Note that you only need to use this section if Copia's system default insurance fields do not meet the insurance plan's information requirements. See the Insurance topic.
  2. Click the show link in the section title bar to display the potentially required fields. To hide the fields, click the hide settings link that appears in the section title bar.
  3. Select an option to determine the required insurance plan fields on the Insurance page:
  4. If you are defining the required fields, select the checkboxes for all fields that should be required on the Insurance page. Clear the checkboxes to remove the requirement.
  5. For the Policy, Group, and Group Number fields, you may define numeric/alphanumeric patterns (up to 100 characters) in the Match Pattern fields that Copia applies to ensure users enter valid policy numbers, groups, and group numbers. You may set these at the system (see the Admin: System Defaults topic), company (see "Adding or Editing Insurance Company Patient Insurance Fields" above), and plan levels. Click the Test button to display a field where you may enter characters and have Copia display "Pass" or "Fail" to indicate if what you entered matches the pattern you set. Once you are finished testing, click the X button to hide the field.

    Match Pattern Examples:

    Medicare Policy: \d{9}[a-zA-Z]{1} -This allows 9 numbers, followed by 1 letter (upper or lower case)
    Railroad Medicare Policy: [a-zA-Z]{2}\d{9} -This allows 2 letters (upper or lower case) followed by 9 numbers
    Medicaid: \d{11} -This allows 11 numbers

  6. To return to Copia's default settings, select the Use default required fields option.
  7. If your modifications are complete, click Save to record all changes. Otherwise, complete the remaining sections, and then click Save.

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Adding, Editing, or Deleting Insurance Plan Host Codes
  1. The Insurance Plan Host Codes section of the Insurance plan details page provides the fields to create or modify insurance plan host code information.
  2. Click the show link in the section title bar to display the host information. To hide the host information, click the hide link that appears in the section title bar.
  3. Copia displays the list of available hosts with their host type and active status.
  4. Add or edit the host name, type, and active status in the Host Details section of the Hosts details page. See the Admin: Hosts topic.
  5. Select the Show active hosts only checkbox to view active hosts only. You set the active/inactive status in the Host Details section of the Hosts details page. See the Admin: Hosts topic.
  6. To add a Host Code, click the Add Code button and enter the host code for the insurance company in the Host Code field.
  7. To edit the host code, highlight or delete text already displayed in the field, then modify as desired.
  8. If you have added a host code, then Copia displays the Internal Billing Status Rules button to select the appropriate billing status rule and set any ordering location-based exceptions in the Internal Billing Status administration page. See the Internal Billing Status topic. Copia uses the selected billing status rule when the patient uses this insurance plan and testing is performed at the selected host. You may define additional billing status rules in the Billing Status Rules administration page. See the Admin: Billing Status Rules topic.
  9. To delete the host code, click the X button that corresponds to the host code.
  10. Click Cancel to return to the Insurance search page without saving any changes.
  11. Click Save to record all changes.

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Assigning an Insurance Plan to Another Company

  1. Click the Assign Plan to a different Company button located at the bottom of the Insurance plan details page to search for and select the desired company name in the Insurance Search page. See the Insurance Search topic.
  2. Once you select the desired company, Copia displays the new insurance company information in the Insurance Company Information section of the Insurance details page.
  3. Click Cancel to return to the Insurance search page without saving any changes.
  4. Click Save to confirm the reassignment and record the changes.

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Viewing and Removing Mapped Insurance Plans

  1. If you are viewing a system-maintained plan, this section is called "Mapped Practice Specific Insurance Plan(s)." If you are viewing a practice-specific insurance plan, this section is called "Mapped System Plan." This section displays either the system plan the practice-specific plan is mapped to, or the practice plan(s) mapped to the system plan.
  2. Click the Remove Mapping button next to the desired plan to remove a mapping between the selected plans.
  3. Click Cancel to return to the Insurance search page without saving any changes.
  4. Click Save to confirm the changes in mapping and record the changes.

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Harvest LIS Synchronization for this Insurance

  1. The Harvest LIS Synchronization for this Insurance section of the Insurance details page displays Harvest LIS synchronization information for the selected insurance.
  2. Click the Unsynch Selected button to unsynch selected items in the section. A host must be selected for this button to be enabled. Click the Synch Selected button to synch selected items in the section. A host must be selected for this button to be enabled. Clicking either of these buttons will display the Synch Options pop-up with the two buttons on the pop-up. Click the Close button to close the pop-up.
  3. Select the Show active hosts only checkbox to have Copia only display active hosts contained within the system.
  4. The table displays columns for the host's name, version number, active status, selection ability, and a non-synch option. In the "Host Name" column, the name of the host is displayed; in the "Version" column, the version is displayed; in the "Host is Active" column, the active status is displayed; select the Select checkbox in the "Select" column to select the specific host; and select the Do Not Synch (Synch 2) checkbox to specify that Copia should not synch that specific host.
  5. Click the < Back to List button to return to the Insurance list page without saving any changes, or click the Save button to record changes and return to the Insurance list page.

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