Monday, January 29, 2018

Important Reminder from Our Encounter Data Department

Hello SCAN Provider Partners,

The January CMS Encounter Data Sweep is coming to a close. TODAY is the Final Deadline Date to submit the remainder of your 2016 DOS Encounter Data! 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 4 weeks away from SCAN’s Final Deadline 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 - closed
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. January reports were uploaded to the SCAN Encounter Data Portal on 1/5/2018. The next ESRs will be uploaded the first week of February 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.
  
  1. 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 -> 12/31/2016 and 01/01/2017 -> 12/31/2017.
    1. 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.

  1. 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 -> 12/31/2016 and 01/01/2017 -> 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
    1. 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:
  1. Work your clearinghouse rejections via OfficeAlly, Ability Network, or Change Healthcare

  1. 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 January 26, 2017 to upload your 2016 DOS files for the January Sweep. Additionally, please do not wait until February 23, 2018 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.

  1. 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
f.     POS 21 reports

What are the Timelines?
  1. Last day to submit all 01/01/2016 -> 12/31/2016 DOS encounters to your Clearinghouse: 01/26/2018
  2. Last day for ICE file submissions of additions/deletions of DX codes for 01/01/2016 -> 12/31/2016 to SCAN: 01/26/2018
  3. January CMS Sweep deadline for SCAN: 01/31/2018
  4. Submit all 01/01/2017 -> 12/31/2017 DOS encounters to your Clearinghouse: 02/23/2018
  5. Last day for ICE file submissions of additions/deletions of DX codes for 01/01/2017 -> 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- closed
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
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