An Important Message From Our Encounter Data Team About the January and March Sweeps

Hello SCAN Provider Partners,

The January CMS Encounter Data Sweep is approaching. We are 4 weeks away from SCAN’s Target Date! This is the FINAL CMS sweep impacting 2016 DOS (2017 payment) and requires the submission of encounters for DOS range 01/01/2016 à12/31/2016. CMS currently plans a 75% RAPS and Fee for Service and 25% EDS and Fee for Service blended risk score based on 2016 DOS.

Additionally, we are now 8 weeks away from SCAN’s Target Date for the March CMS Encounter Data Sweep, which requires the submission of encounters for DOS range 01/01/2017 à12/31/2017. CMS currently plans a 85% RAPS and Fee for Service and 15% EDS and Fee for Service blended risk score based on 2017 DOS.

SCAN has two dates for you to manage towards for the January 2018 sweep:

Ø  SCAN Target Date for Provider Partners: EOB Friday, December 29, 2017

o   This target date ensures that SCAN has adequate time to complete processing prior to the health plan cut-off date by CMS

Ø  SCAN Deadline for Provider Partners: EOB Friday, January 26, 2018

o   After this deadline, SCAN will NOT process any files received for the January CMS sweep

SCAN has two dates for you to manage towards for the March 2018 sweep:

Ø  SCAN Target Date for Provider Partners: EOB Friday, January 26, 2018

o   This target date ensures that SCAN has adequate time to complete processing prior to the health plan cut-off date by CMS

Ø  SCAN Deadline for Provider Partners: EOB Friday, February 23, 2018

o   After this deadline, SCAN will NOT process any files received for the March CMS sweep

7 STEPS YOU CAN TAKE TO PREPARE:

1. Review your SCAN monthly Encounter Submission Reports
1. November reports were uploaded to the SCAN Encounter Data Portal on 12/01/2017. The next ESRs will be uploaded the first week of January 2018.

2.       Review your SCAN Encounter HCC Reconciliation Reports

1. This report is available to you monthly. If you would like to utilize this report for the January and/or March Sweep, please access the EDP SCAN Documents tab -> HCCs and Encounters.

  

3. Review your SCAN All DX Reconciliation reports
1. This report is available to you monthly. If you would like to utilize this report for the January and/or March Sweep, please access the EDP SCAN Documents tab -> HCCs and Encounters.

§ QUESTION: What is the All Diagnoses (DX) Reconciliation report?

§ ANSWER: A report containing all diagnosis codes received from your group for dates of service 01/01/2016 à 12/31/2016 or 01/01/2017 à 12/31/2017.

2. This report can be leveraged along with the HCC Reconciliation report to match up to your database and ensure all of your encounter data has been sent to SCAN.

4. Review your SCAN PCN Reconciliation reports
1. This report is available to you monthly. If you would like to utilize this report for the January and/or March Sweep, please access the EDP SCAN Documents tab -> HCCs and Encounters.

§  QUESTION: What is the Patient Control Number (PCN) Reconciliation report?

§  ANSWER: A report containing a list of all the PCNs received from your group for dates of service 01/01/2016 à 12/31/2016 or 01/01/2017 à 12/31/2017. The PCN field provides you with the ID received from you for each encounter (a.k.a. claim ID). You may reconcile the list of PCNs against your system to ensure that SCAN has received all of your PCNs. If any are missing on our list that exist in your system, then you can identify those as needing to be submitted to SCAN immediately

2. If you are already reconciling against the PCN report, then continue to do so and provide an update on results as soon as available.

*The above reports are designed to help you ensure that all possible encounter data for SCAN members has been sent to SCAN to meet the CMS health plan cut-off date of January 31, 2018 for the January Sweep and March 2, 2018 for the March Sweep.

Additional Steps:

5. Work your clearinghouse rejections via OfficeAlly, Ability Network, or Change Healthcare

6. Upload all ICE alternative submission files to SCAN via the Encounter Data Portal (providerportal.scanhealthplan.com) using the File Transmission link
1. It is your responsibility to ensure that the file uploaded is processed successfully. Due to the larger number of files received during sweep timeframes, it becomes very difficult to provide 1:1 attention on these files. Please refer to the SCAN ICE file specifications located on the SCAN Encounter Data portal or you may email me to request the documents to ensure the success of your file upload.
2. Send these files sooner than later; please do not to wait until December 29, 2017 to upload your 2016 DOS files for the January Sweep. Additionally, please do not wait until January 26^th to upload your 2017 DOS files for the March Sweep.
3. ICE files should only be used to submit additional DX codes or deletes of DX codes.

§ SCAN expects to receive all original encounter data records via your normal clearinghouse workflow.

7. Follow up on additional cleanup requests (contact your respective HCI representative with your direct questions)
1. Provider Name Mismatch (PNM) rejection reports
2. Rendering Provider/Entity (RPX) rejection reports
3. EDS Full Encounter Data rejection reports
4. Invalid DX rejection reports
5. ICE File Pend reports

What are the Timelines?

1. Submit all 01/01/2016 à 12/31/2016 DOS encounters to your Clearinghouse: 12/29/2017
2. Last day for ICE file submissions of additions/deletions of DX codes for 01/01/2016 à 12/31/2016 to SCAN: 12/29/2017
3. January CMS Sweep deadline for SCAN: 01/31/2018
4. Submit all 01/01/2017 à 12/31/2017 DOS encounters to your Clearinghouse: 01/26/2018
5. Last day for ICE file submissions of additions/deletions of DX codes for 01/01/2017 à 12/31/2017 to SCAN: 02/23/2018
6. March CMS Sweep deadline for SCAN: 03/02/2018

* Remember: SCAN has two dates for provider partners to manage towards for the January and March Sweep:

Ø  January Sweep SCAN Target Date for Provider Partners: EOB Friday, December 29, 2017

o   This target date ensures that SCAN has adequate time to complete processing prior to the health plan cut-off date by CMS

Ø  January Sweep SCAN Deadline for Provider Partners: EOB Friday, January 26, 2018

o   After this deadline, SCAN will NOT process any files received for the January CMS sweep

Ø  March Sweep SCAN Target Date for Provider Partners: EOB Friday, January 26, 2018

o   This target date ensures that SCAN has adequate time to complete processing prior to the health plan cut-off date by CMS

Ø  March Sweep SCAN Deadline for Provider Partners: EOB Friday, February 23, 2018

o   After this deadline, SCAN will NOT process any files received for the March CMS sweep

Please be prepared for continued communication from SCAN. We look forward to supporting and working with you during this upcoming sweep period!

  

If you have any questions or concerns, please feel free to contact me directly or reach out to SCAN’s HCI Representative:

o   Michelle Nguyen: MNguyen3@scanhealthplan.com

Best regards,

Christina Cabiltes

Supervisor, HCI Projects

A Special Message From Our Encounter Data Team About Data Submission

Hello SCAN Provider Partners,

The January CMS Encounter Data Sweep is approaching. We are 5 weeks away from SCAN’s Target Date! This is the FINAL CMS sweep impacting 2016 DOS (2017 payment) and requires the submission of encounters for DOS range 01/01/2016 à 12/31/2016. CMS currently plans a 75% RAPS and Fee for Service and 25% EDS and Fee for Service blended risk score based on 2016 DOS.

SCAN has two dates for you to manage towards:

Ø  SCAN Target Date for Provider Partners: EOB Friday, December 29, 2017

o   This target date ensures that SCAN has adequate time to complete processing prior to the health plan cut-off date by CMS

Ø  SCAN Deadline for Provider Partners: EOB Friday, January 26, 2018

o   After this deadline, SCAN will NOT process any files received for the January CMS sweep

7 STEPS YOU CAN TAKE TO PREPARE:

1. Review your SCAN monthly Encounter Submission Reports
1. November reports were uploaded to the SCAN Encounter Data Portal on 11/01/2017. The next ESRs will be uploaded the first week of December 2017.

2.       Review your SCAN Encounter HCC Reconciliation Reports

1. This report is available to you monthly. If you would like to utilize this report for the January Sweep, please access the EDP SCAN Documents tab -> HCCs and Encounters.

b.      Reports with dates specific to the January CMS sweep dates 01/01/2016 à 12/31/2016 will be uploaded before end of week 11/13/17.

  

3. Review your SCAN All DX Reconciliation reports
1. This report is available to you monthly. If you would like to utilize this report for the January Sweep, please access the EDP SCAN Documents tab -> HCCs and Encounters.

§ QUESTION: What is the All Diagnoses (DX) Reconciliation report?

§ ANSWER: A report containing all diagnosis codes received from your group for dates of service 01/01/2016 à 12/31/2016.

2. This report can be leveraged along with the HCC Reconciliation report to match up to your database and ensure all of your encounter data has been sent to SCAN.

4. Review your SCAN PCN Reconciliation reports
1. This report is available to you monthly. If you would like to utilize this report for the January Sweep, please access the EDP SCAN Documents tab -> HCCs and Encounters.

§  QUESTION: What is the Patient Control Number (PCN) Reconciliation report?

§  ANSWER: A report containing a list of all the PCNs received from your group for dates of service 01/01/2016 à 12/31/2016. The PCN field provides you with the ID received from you for each encounter (a.k.a. claim ID). You may reconcile the list of PCNs against your system to ensure that SCAN has received all of your PCNs. If any are missing on our list that exist in your system, then you can identify those as needing to be submitted to SCAN immediately

2. If you are already reconciling against the PCN report, then continue to do so and provide an update on results as soon as available.

*The above reports are designed to help you ensure that all possible encounter data for SCAN members has been sent to SCAN to meet the CMS health plan cut-off date of January 31, 2018.

Additional Steps:

5. Work your clearinghouse rejections via OfficeAlly, Ability Network, or Change Healthcare

6. Upload all ICE alternative submission files to SCAN via the Encounter Data Portal (providerportal.scanhealthplan.com) using the File Transmission link
1. It is your responsibility to ensure that the file uploaded is processed successfully. Due to the larger number of files received during sweep timeframes, it becomes very difficult to provide 1:1 attention on these files. Please refer to the SCAN ICE file specifications located on the SCAN Encounter Data portal or you may email me to request the documents to ensure the success of your file upload.
2. Send these files sooner than later; please do not to wait until December 29, 2017 to upload your files.
3. ICE files should only be used to submit additional DX codes or deletes of DX codes.

§ SCAN expects to receive all original encounter data records via your normal clearinghouse workflow.

7. Follow up on additional cleanup requests (contact your respective HCI representative with your direct questions)
1. Provider Name Mismatch (PNM) rejection reports
2. Rendering Provider/Entity (RPX) rejection reports
3. EDS Full Encounter Data rejection reports
4. Invalid DX rejection reports
5. ICE File Pend reports

What are the Timelines?

1. Submit all 01/01/2016 à 12/31/2016 DOS encounters to your Clearinghouse: 12/29/2017
2. Last day for ICE file submissions of additions/deletions of DX codes for 01/01/2016 à 12/31/2016 to SCAN: 12/29/2017
3. CMS Sweep deadline for SCAN: 01/31/2018

* Remember: SCAN has two dates for provider partners to manage towards:

Ø  SCAN Target Date for Provider Partners: EOB Friday, December 29, 2017

o   This target date ensures that SCAN has adequate time to complete processing prior to the health plan cut-off date by CMS

Ø  SCAN Deadline for Provider Partners: EOB Friday, January 26, 2018

o   After this deadline, SCAN will NOT process any files received for the January CMS sweep

Please be prepared for continued communication from SCAN. We look forward to supporting and working with you during this upcoming sweep period!

  

If you have any questions or concerns, please feel free to contact me directly or reach out to SCAN’s HCI Representative:

o   Michelle Nguyen: MNguyen3@scanhealthplan.com

Best regards,

Christina Cabiltes

Supervisor, HCI Projects

AHRQ and HealthIT.Gov Post EMR Information

The Agency for Healthcare Research and Quality (AHRQ) has posted an Electronic Health Record (EHR)  primer for physicians and hospitals.  This primer provides guidance for providers in the use of EMRs.  The AHRQ’s mission:

The Agency for Healthcare Research and Quality's (AHRQ) mission is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work within the U.S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used.

The AHRQ primer references the Safety Assurance Factors for EHR Resilience (SAFER) guides, developed by HealthIT.gov, the official site for Health IT Information.  Because certified EHRs are part of CMS’ quality programs in FFS Medicare, the guides were developed to aid providers in the implementation and use of them.   

The SAFER guides provide  an additional resource for providers seeking information on EHRs.  The following SAFER guides are available:

·         High Priority Practice

·         Contingency Planning

·         System Interfaces

·         Computerized Provider Order Entry with Decision Support

·         Clinician Communication

·         Organizational Responsibilities

·         System Configuration

·         Patient Identification

·         Test Results Reporting and Follow Up

Finally, AHRQ has developed free CME (1 CME unit for American Board of Internal Medicine) and Medical Knowledge/Patient Safety credit (up to 45 MOC points).   There is a related CME program, The Hazards of Distraction: Ticking All the EHR Boxes available on the AHRQ site (registration required).

We hope this information is helpful.

Encounter Data Updates

In addition to the reminder from our Encounter Data Team (below) regarding sweep dates, we have several important updates posted to HCC University to help make your Encounter Data Submission more successful.  These three files have been posted to the Encounter Data/ICD-10 page on HCC U:

Encounter Data Processing

Duplicate Logic

Last Updated: 8/7/2017 222 KB

One page guide to assist encounter data staff submit compliant encounters for CMS processing, and avoid duplicate line/encounter rejects.

Swing Bed SNF Conditions Not Met

Last Updated: 8/7/2017 183 KB

One page guide to assist encounter data staff submit compliant SNF swing bed encounters for CMS processing.

Occurrence Code 55 and DOD Required

Last Updated: 8/7/2017 184 KB

One page guide to assist encounter data staff submit compliant encounters when the discharge status code is 20 (expired), 40 (expired at home), 41 (expired in a medical facility), or 42 (expired – place unknown) for CMS processing.

---------------------------------------------------------------

UPDATE On Sweep Dates

*IMPORTANT* -- SCAN Dates for Upcoming September 2017 Encounter Data CMS Sweep

Hello SCAN Provider Partners,

The September CMS Encounter Data Sweep is approaching. We are 1 weeks away from SCAN’s Target Date! This is the INITIAL CMS sweep impacting 2017 DOS (2018 payment) and requires the submission of encounters for DOS range:

• 07/01/2016 à 06/30/2017

SCAN has two dates for you to manage towards:

Ø  SCAN Target Date for Provider Partners: EOB Friday, August 11, 2017

o   This target date ensures that SCAN has adequate time to complete processing prior to the health plan cut-off date by CMS

Ø  SCAN Deadline for Provider Partners: EOB Friday, September 1, 2017

o   After this deadline, SCAN will NOT process any files received for the September CMS sweep

7 STEPS YOU CAN TAKE TO PREPARE:

1. Review your SCAN monthly Encounter Submission Reports
1. June reports were uploaded to the SCAN Encounter Data Portal on 06/13/2017. The next ESRs will be uploaded the first week of July 2017.

2.       Review your SCAN Encounter HCC Reconciliation Reports

1. This report is available to you monthly. If you would like to utilize this report for the September Sweep, please access the EDP SCAN Documents tab -> HCCs and Encounters.

b.      Reports with dates specific to the September CMS sweep dates 07/01/2016 à 06/30/2017 will be uploaded before end of week 07/14/17.

  

3. Review your SCAN All DX Reconciliation Reports
1. This report is available to you monthly. If you would like to utilize this report for the September Sweep, please access the EDP SCAN Documents tab -> HCCs and Encounters.

§ QUESTION: What is the All Diagnoses (DX) Reconciliation report?

§ ANSWER: A report containing all diagnosis codes received from your group for dates of service 07/01/2016 à 06/30/2017.

2. This report can be leveraged along with the HCC Reconciliation report to match up to your database and ensure all of your encounter data has been sent to SCAN.

4. Review your SCAN PCN Reconciliation Reports
1. This report is available to you monthly. If you would like to utilize this report for the September Sweep, please access the EDP SCAN Documents tab -> HCCs and Encounters.

§  QUESTION: What is the Patient Control Number (PCN) Reconciliation report?

§  ANSWER: A report containing a list of all the PCNs received from your group for dates of service 07/01/2016 à 06/30/2017. The PCN field provides you with the ID received from you for each encounter (a.k.a. claim ID). You may reconcile the list of PCNs against your system to ensure that SCAN has received all of your PCNs. If any are missing on our list that exist in your system, then you can identify those as needing to be submitted to SCAN immediately

2. If you are already reconciling against the PCN report, then continue to do so and provide an update on results as soon as available.

*The above reports are designed to help you ensure that all possible encounter data for SCAN members has been sent to SCAN to meet the CMS health plan cut-off date of September 8, 2017.

Additional Steps:

5. Work your clearinghouse rejections via OfficeAlly, Ability Network, or Change Healthcare

6. Upload all ICE alternative submission files to SCAN via the Encounter Data Portal (providerportal.scanhealthplan.com) using the File Transmission link
1. It is your responsibility to ensure that the file uploaded is processed successfully. Due to the larger number of files received during sweep timeframes, it becomes very difficult to provide 1:1 attention on these files. Please refer to the SCAN ICE file specifications located on the SCAN Encounter Data portal or you may email me to request the documents to ensure the success of your file upload.
2. Send these files sooner than later; please do not to wait until September 1, 2017 to upload your files.
3. ICE files should only be used to submit additional DX codes or deletes of DX codes.

§ SCAN expects to receive all original encounter data records via your normal clearinghouse workflow.

7. Follow up on additional cleanup requests (contact your respective encounter data representative with your direct questions)
1. Provider Name Mismatch (PNM) rejection reports
2. Rendering Provider/Entity (RPX) rejection reports
3. EDS Full Encounter Data rejection reports

What are the Timelines?

1. Submit all 07/01/2016 à 06/30/2017 DOS encounters to your Clearinghouse: 08/11/2017
2. Last day for ICE file submissions of additions/deletions of DX codes for 07/01/2016 à 06/30/2017 to SCAN: 08/11/2017
3. CMS Sweep deadline for SCAN: 09/08/2017

* Remember: SCAN has two dates for provider partners to manage towards:

Ø  SCAN Target Date for Provider Partners: EOB Friday, August 11, 2017

o   This target date ensures that SCAN has adequate time to complete processing prior to the health plan cut-off date by CMS

Ø  SCAN Deadline for Provider Partners: EOB Friday, September 1, 2017

o   After this deadline, SCAN will NOT process any files received for the September CMS sweep

Please be prepared for continued communication from SCAN. We look forward to supporting and working with you during this upcoming sweep period!

  

If you have any questions or concerns, please feel free to contact me directly or reach out to your assigned SCAN HCI Project Representative:

o   Michelle Nguyen: MNguyen3@scanhealthplan.com

Best regards,

Christina Cabiltes

Supervisor, HCI Projects

Updated Reminder from our Encounter Team

Hello SCAN Provider Partners,

The September CMS Encounter Data Sweep is approaching. We are 3 weeks away from SCAN’s Target Date! This is the INITIAL CMS sweep impacting 2017 DOS (2018 payment) and requires the submission of encounters for DOS range:

• 07/01/2016 à 06/30/2017

SCAN has two dates for you to manage towards:

Ø  SCAN Target Date for Provider Partners: EOB Friday, August 11, 2017

o   This target date ensures that SCAN has adequate time to complete processing prior to the health plan cut-off date by CMS

Ø  SCAN Deadline for Provider Partners: EOB Friday, September 1, 2017

o   After this deadline, SCAN will NOT process any files received for the September CMS sweep

7 STEPS YOU CAN TAKE TO PREPARE:

1. Review your SCAN monthly Encounter Submission Reports
1. June reports were uploaded to the SCAN Encounter Data Portal on 06/13/2017. The next ESRs will be uploaded the first week of July 2017.

2.       Review your SCAN Encounter HCC Reconciliation Reports

1. This report is available to you monthly. If you would like to utilize this report for the September Sweep, please access the EDP SCAN Documents tab -> HCCs and Encounters.

b.      Reports with dates specific to the September CMS sweep dates 07/01/2016 à 06/30/2017 will be uploaded before end of week 07/14/17.

  

3. Review your SCAN All DX Reconciliation Reports
1. This report is available to you monthly. If you would like to utilize this report for the September Sweep, please access the EDP SCAN Documents tab -> HCCs and Encounters.

§ QUESTION: What is the All Diagnoses (DX) Reconciliation report?

§ ANSWER: A report containing all diagnosis codes received from your group for dates of service 07/01/2016 à 06/30/2017.

2. This report can be leveraged along with the HCC Reconciliation report to match up to your database and ensure all of your encounter data has been sent to SCAN.

4. Review your SCAN PCN Reconciliation Reports
1. This report is available to you monthly. If you would like to utilize this report for the September Sweep, please access the EDP SCAN Documents tab -> HCCs and Encounters.

§  QUESTION: What is the Patient Control Number (PCN) Reconciliation report?

§  ANSWER: A report containing a list of all the PCNs received from your group for dates of service 07/01/2016 à 06/30/2017. The PCN field provides you with the ID received from you for each encounter (a.k.a. claim ID). You may reconcile the list of PCNs against your system to ensure that SCAN has received all of your PCNs. If any are missing on our list that exist in your system, then you can identify those as needing to be submitted to SCAN immediately

2. If you are already reconciling against the PCN report, then continue to do so and provide an update on results as soon as available.

*The above reports are designed to help you ensure that all possible encounter data for SCAN members has been sent to SCAN to meet the CMS health plan cut-off date of September 8, 2017.

Additional Steps:

5. Work your clearinghouse rejections via OfficeAlly, Ability Network, or Change Healthcare

6. Upload all ICE alternative submission files to SCAN via the Encounter Data Portal (providerportal.scanhealthplan.com) using the File Transmission link
1. It is your responsibility to ensure that the file uploaded is processed successfully. Due to the larger number of files received during sweep timeframes, it becomes very difficult to provide 1:1 attention on these files. Please refer to the SCAN ICE file specifications located on the SCAN Encounter Data portal or you may email me to request the documents to ensure the success of your file upload.
2. Send these files sooner than later; please do not to wait until September 1, 2017 to upload your files.
3. ICE files should only be used to submit additional DX codes or deletes of DX codes.

§ SCAN expects to receive all original encounter data records via your normal clearinghouse workflow.

7. Follow up on additional cleanup requests (contact your respective encounter data representative with your direct questions)
1. Provider Name Mismatch (PNM) rejection reports
2. Rendering Provider/Entity (RPX) rejection reports
3. EDS Full Encounter Data rejection reports

What are the Timelines?

1. Submit all 07/01/2016 à 06/30/2017 DOS encounters to your Clearinghouse: 08/11/2017
2. Last day for ICE file submissions of additions/deletions of DX codes for 07/01/2016 à 06/30/2017 to SCAN: 08/11/2017
3. CMS Sweep deadline for SCAN: 09/08/2017

* Remember: SCAN has two dates for provider partners to manage towards:

Ø  SCAN Target Date for Provider Partners: EOB Friday, August 11, 2017

o   This target date ensures that SCAN has adequate time to complete processing prior to the health plan cut-off date by CMS

Ø  SCAN Deadline for Provider Partners: EOB Friday, September 1, 2017

o   After this deadline, SCAN will NOT process any files received for the September CMS sweep

Please be prepared for continued communication from SCAN. We look forward to supporting and working with you during this upcoming sweep period!

  

If you have any questions or concerns, please feel free to contact me directly or reach out to SCAN’s Encounter Data Specialist:

o   Steve Vo: svo@scanhealthplan.com

Best regards,

Christina Cabiltes

Supervisor, HCI Projects