HEDIS NLP for Overread

Julie Glass

Modified on: Mon, 20 Dec, 2021 at 1:18 PM

The HEDIS NLP bot performs Overread for 18 Measures. This tool is how you review the bot’s findings.

TABLE OF CONTENTS

Note:

All findings by the Bot will be highlighted

You can move this modal freely on page
Collapse / Expand the view
Stats: These are the total number of Bot Overread results that were a Match, No Match, or Partial Match
Gaps: These are the member Gaps
MR DOS: This is the medical record date of service
Results: These are results related to the Gap
Bot Pg #: This is the page the bot was able to find a Match. This will anchor to the page when clicked
MR Pg #: This is the page the Medical Record Reviewer found the Gap
System Results: These are the Bot Overread Results. They will display as Match, No Match, or Partial Match
Acceptance: This is where you can Agree or Disagree with the Bots Overread results
Submit: When you have completed your review, click here to finalize submission

Verify Member and click Submit
Click Review
You will be presented with the System Results Modal
Click each row to access the Bot results. If the bot did not find a page, it will default to the Abstractors findings.
If you Agree with the Bots results, click Agree
If you Disagree with the Bots results, click Disagree
Once you have reviewed all Bot results, click Submit

Note:

You cannot change your feedback once you click Submit

You must review all System Results and Submit Feedback before the chart can be submitted

Agree with a Match:

Agree with a No Match:

Upon Submission, Data Entry input will be deleted
If Medical Record Reviewer user highlighted the page, the Overreader will need to manually delete the highlight

Agree with a Partial Match:

Disagree with a Match:

Disagree with a No Match:

Nothing will change on Data Entry, we are agreeing with Medical Record Reviewer Data Entry input

Disagree with a Partial Match:

User Permissions
Administrator

Lead: Client Lead, Clinical Lead

Manager: Medical Record Review Manager, Overread Manager, Client Overread Manager

Employee: Abstractor Employee, Overread Employee