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Data Entry Overview - Risk

Data Entry Overview - Risk

Here you can perform data entry, see chase information, read comments, view documents, pend, and view a historical timeline.


TABLE OF CONTENTS

Risk Data Entry Page Overview

  1. Review: This is where you review the chart and perform Data Entry
  2. Chase: This is key information about this chase. 
  3. Member tab: This is a list of all chases associated to this Member
  4. HCC Health Card: The HCC Health Card is an accumulation of all member chases combined within the Project for viewing which HCCs have or have not been substantiated from your claim load file. You can also see any Net New HCC Diagnosis that were not provided on claims. Expand each row to view Diagnosis information.
  5. Comments Tab: This is where you can read and add comments about this Chase. Comments will show Username, date, time, and message. 
  6. Timeline tab: This is a complete history of the Chase. It is organized by date, newest to oldest. All timeline entries include the Action taken, User, Date, Time
  7. Audit Log: This is a historical view of what a user has data entered during MRR, OR and OR2
  8. Member Details: These are your Member Details. Here you will see Measure ID, Client Chase Key, DOB, Age, Sex, Project, Review Period, Client Member ID, Member Name, and Enrollee ID
  9. Chase Tools: Assign Chase, Create/Update Pend, or Add/Remove Chase Tags
  10. Document Viewer: This is where the members Medical Records can be viewed. 
  11. Document Management: Expand for document tools such as Add New, Request Additional, Sort Pages, Manage Individual Pages, See large thumbnails with quick access back to the chart. 
  12. Data Entry: This is where you perform Data Entry  

 

Chase Info tab Overview

  1. Chase info: This is key information about this chase. Here you can locate: Measure, Chase Status, Last Coded By, Project, Project ID, Client, Product, Assigned To, Member ID, Client Chase Key, Address ID, Pend Code (if applicable), and Gender
  2. Document Requests: This displays all document requests for this chase, when the request was made, and by whom.  The Document Request ID links to the Address
  3. Latest Pend:  This displays the latest pend associated to this Chase, pend owner, and pend description. The pend ID is linked to the Pend Info Page
  4. Pursuits: This displays all Pursuits, the chase ID links to the pursuit Chase
  5. Latest Comment: This displays the latest comment regarding this chase, who left the comment, when and what time
  6. Chase Timeline: This is a brief history of this Chase. It is organized by date, newest to oldest. All timeline entries include the Action taken, User, Date, Time. Click See All for full history, or click Timeline tab 

 

 

HCC Health Card

The HCC Health Card is an accumulation of all member chases combined within the Project for viewing which HCCs have or have not been substantiated from your claim load file. You can also see any Net New HCC Diagnosis that were not provided on claims. Expand each row to view Diagnosis information.

 

The follow HCC models are supported and will only show ICDs that are relevant to each HCC model:

  • HCC Model for Medicare Advantage
  • HCC Model for Commercial

 

The HCC will display the following statuses:

  • Open: The diagnosis is part of a chase but has not been reviewed yet
  • Substantiated: At least 1 diagnosis has been validated for that HCC
  • Unsubstantiated: The diagnosis could not be validated for that HCC

 

  1. HCC: These are the HCCs that were provided on the claims file and/or and Net New HCC found by EVE or Coder
  2. Chase table: All of the chases that have diagnoses that map to that HCC
  3. VRC: This is what determines whether or not a diagnosis is submittable 
  4. Source: The data source (Admin, Coder, EVE)
  5. New New HCC: Any new diagnosis that were foung by Coder or EVE that map to an HCC that was not provided on the claims load file
  6. HCC Dx Count: This shows how many times a diagnosis maps to an HCC, meaning it is submittable 
  7. Status:
    1. Open: The diagnosis is part of a chase but has not been reviewed yet
    2. Substantiated: At least 1 diagnosis has been validated for that HCC
    3. Unsubstantiated: The diagnosis could not be validated for that HCC

 


Document Viewer

  1. Document Viewer: This is where the members medical records display
  2. Medical Record: Here is where the medical records will display. You can click and drag it within the document viewer.
  3. Expand: Use this to expand the size of the medical record
  4. Zoom in/out: Use this to zoom in and out on the medical record
  5. Rotate: Use this to rotate the Medical Record clockwise or counter-clockwise
  6. Highlight: Use this to show and hide highlights, add new highlights, and remove highlights.
  7. Search chart: Use this to search all text on a medical record. Your results will be highlighted on the medical record.
  8.  Jump to page: Use this to jump to a specific page on the medical record
  9.  Navigate forward/back: Use these arrows to navigate forward and back through the medical records

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Data Entry Overview

  1. Validate Member: This is where you validate the member. You must validate the member before performing data entry.
  2. Validate DOB: This is where you validate if a member's DOB is present/valid. If DOB is not present/valid a DOB/GEN pursuit will be created. 
  3. Validate Gender: Here is where you validate if gender is present or not. If Gender is not present a DOB/GEN pursuit will be created. 
  4. Encounter Table: The Encounters table displays: Claim ID, DOS (from and thru), Provider Name, Encounter Validation, Source (where the information came from), and Total Diagnosis for that Encounter.
  5. Encounter Totals: These are your Total Encounters and their source breakdown by Admin, or Coder.
  6. Add: Click here to add additional fields
  7. Clear: Click here to clear out the data entry for those fields
  8. Diagnosis Totals: These are your Total Diagnoses per Encounter and their source breakdown by Admin, or Coder.
  9. Diagnosis Table: The Diagnoses table displays: Clickable page number, DOS (from and thru), ICD, HCC Category, VRC, and Source (where the information came from)
  10. Research: If configured by your Administer, this is your checklist prior to submission. 
  11. Submit: When data entry is complete, click submit

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Create Pend

1. Click Create Pend.

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2. Select Pend Code

3. Select Pend Owner

4. Select Severity

5. Leave a note about Pend

6. To finalize, click Save

7. To cancel, click Cancel

 

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Request Additional Documentation

1. Click the Documents tab

2. Click Request Additional Documentation

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3. Select Document Request Type

4. Select which document(s) are missing

5. Enter a note about why you are requesting additional documentation

6. To finalize, click Request

7. To cancel, click Cancel

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Upload Medical Record

1. Click the Documents tab

2. Click Choose Medical Records

3. Select file from local computer

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4. Click Submit

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5. Your upload will process under Jobs and notify you when complete

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Note: 

If DOB is not Present/Valid a DOB/GEN Pursuit will be created

 

If Gender is not present a DOB/GEN Pursuit will be created

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