Event Descriptions and Recommended User Responses

This section outlines the Event Descriptions you will encounter in the Claim Maker alert email and the recommended User responses for these descriptions.

Event Descriptions and Recommended User Responses

• Documents Received for Closed Case in Open Batch –
  New documentation was received for a case previously marked “code completed”, “ignored”, or “not coded” in an active batch. New text documents will be extracted and saved in place of existing text documents. Existing text documents will be concatenated and saved to a new “SUPERSEDED ON [DATE]” document. Existing manual attachments will be retained. The affected case will be updated to On Hold / Ready to Code to prompt an additional review by the coder. All previously assigned codes will be retained in place. Concerned Roles: Reconcilers, RCM Admins, Coders, and Coding Admins.
• Documents Received for Existing Case in Closed Batch –
  New documentation was received for a “Code Completed” case in a “Closed” batch. The new document will be added to the existing case as a PDF with title “POSTED LATE – [DATE]”. No further action (outside of the associated notification) will be taken automatically. An RCM user should review the newly attached PDF to determine if additional action is required, be it revising a claim, coding the new record as an independent case, or simply deleting the new attachment if it contains no additional information of value. Concerned Roles: Reconcilers, Coders, and Charge Entry Specialists.
• Batch Updated Post-Reconciliation: Case Documentation Updated –
  New documentation was received for a case in a reconciled batch before the case was coded. New text documents will be extracted and saved in place of the existing text documents. Existing text documents will be concatenated and saved to a new “SUPERSEDED ON [DATE]” document. Existing manual attachments will be retained. An RCM user should review the new documents to ensure all data is present and accounted for following the update. Concerned Roles: Reconciler.
• Batch Updated Post-Reconciliation: New Case Added –
  Documentation of a heretofore unknown patient encounter was discovered in the feed from the facility leading to the creation of a new case in the existing batch. An RCM user should review the new case to ensure all data is present and accounted for in the new case, and any external records concerning Hank coding activities on behalf of the client should be updated to reflect the addition. Concerned Roles: Reconciler (all) and Coder (if batch is “In Progress”).
• Duplicate Batch Created for DOS: New Case Documentation Received –
  Documentation of a heretofore unknown patient encounter was discovered in the feed from the facility, but the batch to which it logically belongs is closed. An additional batch will be created for the same facility / DOS, and the new case will be posted there. For clients who run concurrency checks, a charge entry specialist should track the progress of the new batch and rerun the concurrency check for all cases in both the original and new batch whenever coding is completed. The remainder of the workflow should work as normal. Concerned Roles: Coding Admin and Reconciler.