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