Product Release Notes 01.18.2023

Analytics

NEW: Chase Sub-Measure Report

Clinical managers can use Chase Sub-Measure Report to view detailed compliance information for sub-measures so that they can ensure higher compliance rates for their programs.

NEW: Health Plan & Contract Filters

Analytics users now have the ability to filter data on Health Plan and Contract Number for a variety of reports so they can better understand their program success. 

UPDATE: Enrollee ID added to Chase Status Underlying Report and Life of a Chase

Enrollee ID is now available in Chase Status Underlying Report and Life a Chase so that managers can match AIDs to Chases for easier EMR Segmentation.

UPDATE: Column Header Updated in Chase Status Underlying Report and Life of a Chase

Data field names are now updated in these reports for a cleaner user experience.

Admin

Project Settings

NEW: Projects with MY 2023

New projects with MY 2023 and Reporting Year 2023/2024 can be created. User must select Product Type: Full Workflow V2023 (HEDIS Projects Only). This Product Type is disabled for the RISK/IVA projects.

Additionally, Users can request documents for the year 2023

UPDATE: Users can Configure QA Sampling Prior to Project Load 

Once a project has been created, users can immediately configure the QA sampling rates that they would like applied without waiting to load their chase file.

UPDATE: Users can Configure Clinical Get Next during Project Creation 

Once a project has been created, users can immediately configure Clinical Get Next that they would like to be applied. These settings are different for Quality & RISK/IVA Projects. Users can also reconfigure these settings in the middle of project and the new settings affect will take place after 3 hours.

UPDATE: Quality Projects: Users can Configure Criteria for Chase Move Back when New Pages are attached to a chase after MRR 

Once a project has been created and the chases have been loaded for different measures, users can immediately configure chase move back when new pages are attached to a chase. “HOW DO YOU WANT TO HANDLE NEW CHASE CREATION FROM ADDITIONAL PAGES” has been hidden for all Quality projects.

Update: User Specialty Setup displays complete Measure name

Admin will be able to select the measure easily while setting a new user or editing a user specialty

Clinical

Quality

NEW: MRR Clinical GetNext

The "Get Next" functionality for the Quality Projects can be toggled OFF or ON.

1. If toggled ON and the Project does not have data...
   1. "Select Priority" dependent field will appear
   2. "Select Priority" will default to "First Chart Available" option and the users will be assigned charts which are first in queue when they request additional work
   3. "Measures" option will be disabled and has a footnote: The project must have data to prioritize by measure.

1. If toggled ON and the Project does have data...
   1. "Select Priority" dependent field will appear
   2. "Select Priority" will default to "First Chart Available" option and the users will be assigned charts which are first in queue when they request additional work 
   3. "Measures" option is enabled

1. If toggled ON and the "Measures" option is selected...
   1. List of all measures associated to project will appear and the users will be assigned charts based upon assigned priority
   2. "Instruction" text appears: Rank the measures you wish to prioritize (1 is the highest priority)
   3. Number inputs default to placeholder value of 0
   4. Number inputs have minimum and maximum values
      1. Minimum = 0
      2. Maximum = N (total number of the measures)
      3. Number inputs support multiple instances of the same number
          e.g., Users can specify three measures with priority of 1.

1. If number input value changes from a positive number down to zero, it will be the lowest priority.
2. Tool Tip for Enable Clinical Get Next: This is our automated clinical assignment functionality. When enabled, users can request new work assignments without manager intervention. Managers can still perform manual assignments, if needed.
3. Tool Tip Text for Select Priority: Now that you've enabled Get Next, you can select the chase priority based on different measures

NEW: Chase Move Back when New Pages are attached to a chase after MRR 

Instead of reviewing new documents in the approval center as they arrive, users can configure at the beginning of the project which new pages should be abstracted based on measure and sample compliance. This setting will apply for HEDIS projects only at this time.

Chase move back criteria when the new pages are attached to a member chase:

1. Admin Compliant Chases: These chases will never move back when the new pages are attached
2. Compliant/Non-Compliant Chases: Compliant includes compliant and supplemental compliant chases. Non-Compliant includes Non-Compliant and Partial Compliant chases. If the user has checked Compliant for any measure, then:
   1. If the chase has been through OR1 and/or OR2 and is in delivery: Chase will move back to MRR
   2. If the chase has not been selected for OR1/OR2 and is in delivery: Chase will move back to MRR
   3. If the chase has been selected for OR1/OR2 and has not been through QA: Chase will NOT move back to MRR as Senior Coder will have chance to update Data Entry. 

Note: If new pages are added once the chart is in OR1/OR2 – the overreader would be expected to abstract the new pages. If the compliance is changed when the new pages are abstracted in OR1/OR2: Chase will be exempted from QA Score for abstractor.

NEW: NID (Nephropathy in Members with Diabetes)

EVE NLP is available for NID Overread. If EVE for Overread is enabled at Projects\EVE Settings, the user can select the charts go through NLP in OR1/OR2 based upon the compliance

Under Project\HEDIS Settings, the user can select the percentage of charts go through NLP in OR1/OR2 based upon the compliance

NEW: AIS (Adult Immunization Status) for MY 2023

New HEDIS measure AIS is available for MY 2023. EVE NLP for Overread is not available for this measure.

UPDATE: HEDIS MY 2023

Following measures have been updated for HEDIS MY 2023.

BPD, BCS, CBP, CCS, CIS, COA, COL, EED, IMA, LSC, PPC, TRC, WCC

RISK 2.0

NEW: MRR Clinical Get Next: Automated clinical assignment functionality. When enabled, users can request new work assignments without manager intervention. Managers can still perform manual assignments, if needed.

The "Get Next" functionality for the Quality Projects can be toggled OFF or ON.

1. If toggled ON:
   1. "Select Priority" dependent field will appear
   2. "Select Priority" will default to "First Chart Available" option and the users will be assigned charts which are first in que when they request additional work
   3. User can select the chase priority based on 4 different criteria: 
      1. First Chart Available
      2. All HCCs (Admin + EVE Suggested)
      3. Admin HCCs
      4. EVE suggested HCCs. 

NEW: ANNOTATIONS – Allows the user to add annotations to highlighted items in the document both in Single view and Split view

Highlights are linked to the annotations , users can add, edit or delete an annotation 

UPDATE: Encounters dropdown remains visible when user scrolls to bottom of screen

UPDATE:  EVE Encounter Card Component Clean-Up – Valid encounter dropdown replaced with buttons, Claim ID cell removed

UPDATE: When an Admin ENC is validated by EVE (green icon), but Admin Dx has no evidence returned by EVE (red icon). In Split screen view, thumbnails of the Encounter/DOS being reviewed will be visible, pages not part of Encounter/DOS will be hidden. Coder can review at the DOS level and not have to find the encounter pages through the entire chart.

Invoices

UPDATE: Download Invoices from Invoice Approval

Users now can perform an invoice download from the invoice approval center. This can be done the same way as on the other invoice pages, and the functionality will remain the same.

Retrieval

NEW: Sunset Approval Center

The document approval center will now be replaced by the ‘New Pages’ setting for all Quality projects. Additionally, the chase move approval center has been removed (this was in the December release). The pursuit approval center will remain; however it is being oved to the clinical module, allowing the removal of the Approval Module from the navigation

UPDATE: Chase Move Call Notes

When performing a chase move after investigating the location of particular chases, the latest ‘research call’ will be carried over to the new AID that the chases are moved to. This will create a record of the research call that led to the chase move which can be helpful information when performing retrieval or auditing sites.

UPDATE: Default PC130 Owner

When a PC130 is created, it will default to ‘client’ as the pend owner

UPDATE: Remove PC116, PC123 and PC124

When chases are created upon data load, there will no longer be a PC116, PC123 or PC124 created based on ‘chart action’ values. Chases that formerly would have had a PC116 will now use ‘retriever’ to identify chases that the customer is responsible for retrieving. Chases that would have formally had a PC123 or PC124 will now automatically appear at sites with their respective retrieval methods without the use of a pend code.

UPDATE: ‘Chart Lake’ as chase retrieval method

When Chart Lake Matches is used to retrieve chases, the chases will now be identified with ‘Chart Lake’ as the retrieval method in analytics as well as the chase timeline.

UPDATE: Chase Move Comments

When moving chases from one site to another, the comment entered with the chase move will now appear as a comment at the AID where the chases are moved to.

UPDATE: We now persist file names when downloading documents

UPDATE: We added ‘Incorrect number’ as call result/reason option to better track inaccurate numbers

UPDATE: We now prompt users to finish their call workflows for outgoing calls from AIDs. 

Previously users may have forgotten to submit their call notes, finish their workflow, etc when making outgoing calls from an AID and that work would get lost. Now we provide helpful popups to prompt them to finish their workflows and fill out the required information. If all information is filled in and valid, we will automatically submit the call notes for the user.

UPDATE: We now support the ability to Bulk tag documents

UPDATE: We updated the contact history to include the commitment date that was added during the call.

UPDATE: Retrieval pends/Clinical pends- Forward backward arrows have been removed

Provider Gateway

NEW: Email Failure Notification

When sending an email from an AID and it is ultimately unsuccessfully delivered, users will now be notified in two different ways. First, a notification will appear under the ‘notifications’ icon which will inform the user of the AID and email that failed. Additionally, it will appear as an unsuccessful email delivery in the contact history of the AID.

NEW: View All Provider Addresses

This tool will show users the current AIDs for any given provider and can be helpful when investigating provider locations or moving chases towards the beginning of your project. This new functionality will be available when navigating to the ‘providers’ grid once in an AID. In the grid there is now a column labeled ‘Addresses’ which contains the number of AIDs where that provider currently has chases. By clicking this number, you will be presented with a pop up which displays all of these AIDs, which can be clicked on to directly navigate to that particular AID.

NEW: Added dynamic 'Due Date' on provider packet cover letters

At the project level there is a new field that can be configured to show up that shows the ‘Due Date’ for the record request. It will pull in the earliest commitment date at the AID and if no commitment dates exist, it will default to T+7 days.

UPDATE: We now Auto populate password/pin if jumping to medical record request or chart drop via email containing credentials

UPDATE: We updated chart drop to have helpful troubleshooting tips, be able to copy/paste a provider pin, notify user file size limit, etc.