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.
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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:
- Review your SCAN monthly Encounter Submission Reports
- 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
- 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.
- Review your SCAN All DX Reconciliation Reports
- 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.
- 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.
- Review your SCAN PCN Reconciliation Reports
- 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
- 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:
- Work your clearinghouse rejections via OfficeAlly,
Ability Network, or Change Healthcare
- Upload all ICE alternative submission files to SCAN via
the Encounter Data Portal (providerportal.scanhealthplan.com) using the File Transmission link
- 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.
- Send these files sooner than later; please do
not to wait until September 1, 2017 to upload your files.
- 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.
- Follow up on additional cleanup requests (contact your
respective encounter data representative with your direct questions)
- Provider Name Mismatch (PNM) rejection reports
- Rendering Provider/Entity (RPX) rejection reports
- EDS Full Encounter Data rejection reports
What are the Timelines?
- Submit all 07/01/2016 à 06/30/2017 DOS encounters to your Clearinghouse: 08/11/2017
- 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
- 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:
Best regards,
Christina Cabiltes
Supervisor, HCI
Projects
