tag:blogger.com,1999:blog-24649133477310096292024-03-18T02:48:49.800-07:00HCC UniversitySCAN is committed to partnering with our physician providers in offering high quality geriatric care to our members. A significant part of that effort is to assist our providers in the provision of accurate coding that will contribute to the quality of care and support the expected revenue from the Medicare program. To this end, we present the following tools and education for all the physicians and groups providing care to our members.Unknownnoreply@blogger.comBlogger153125tag:blogger.com,1999:blog-2464913347731009629.post-67573224872823029752019-11-25T11:58:00.000-08:002019-11-25T11:58:16.008-08:00Free Continuing Medical Education for Physicians from CMS<br />
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Attention Physicians:<o:p></o:p></div>
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CMS is providing free Continuing Medical Education through
the completion of online training modules.<span style="mso-spacerun: yes;">
</span>All modules apply to <b style="mso-bidi-font-weight: normal;">Medicare
Fee-for-Service Quality Payment Programs</b>.<span style="mso-spacerun: yes;">
</span>CMS sent the email below to subscribers to Medlearn Matters.<span style="mso-spacerun: yes;"> </span>If you would like to receive future
notifications directly, you can sign up one the <a href="https://www.cms.gov/Outreach-and-Education/Outreach/FFSProvPartProg/Electronic-Mailing-Lists.html">Medlearn
Matters Electronic Mailing List Page</a>.<o:p></o:p></div>
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<h1 style="margin-bottom: 3.75pt; margin-left: 0in; margin-right: 0in; margin-top: 0in;">
<span style="color: black; font-family: "Arial Black",sans-serif; font-size: 13.5pt; mso-fareast-font-family: "Times New Roman";">Learn More About MIPS
and Earn CME Credit with These 2019 CME Modules<o:p></o:p></span></h1>
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<span style="color: black; font-family: "Arial",sans-serif; font-size: 10.5pt;">CMS has posted 6 continuing medical
education (CME) modules on the Merit-based Incentive Payment System (MIPS). You
can access them by logging into your </span><a href="https://urldefense.proofpoint.com/v2/url?u=https-3A__lnks.gd_l_eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDAsInVyaSI6ImJwMjpjbGljayIsImJ1bGxldGluX2lkIjoiMjAxOTEwMjQuMTE5NjU5NjEiLCJ1cmwiOiJodHRwczovL2xlYXJuZXIubWxubG1zLmNvbS9EZWZhdWx0LmFzcHgifQ.1jT1Yohphm-5FVaDfFtRlT0SgChN2iJ2A9m3Xg5aGO1lM_br_70495452415-2Dl&d=DwMFAA&c=ay4DezFOFbDj-FQ_Ll6HHd73nukvvb42gL6BcQ6H_T0&r=vmDmCXhDlfc5ZYdNNWqnen8E7zA9gfAJPlXD-tt8VqI&m=Fe-tWKJYaQ3sPbV89Unnb3jVKBhhDkbq7gOELz1O3f8&s=e-IfhSaUiDGe8eDcAcvdp5Zcv-2COWRKWtwUGc0Dqbw&e="><span style="color: #052bff; font-family: "Arial",sans-serif; font-size: 10.5pt;">Medicare
Learning Network (MLN) account</span></a><span style="color: black; font-family: "Arial",sans-serif; font-size: 10.5pt;"> or creating one </span><a href="https://urldefense.proofpoint.com/v2/url?u=https-3A__lnks.gd_l_eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDEsInVyaSI6ImJwMjpjbGljayIsImJ1bGxldGluX2lkIjoiMjAxOTEwMjQuMTE5NjU5NjEiLCJ1cmwiOiJodHRwczovL2xlYXJuZXIubWxubG1zLmNvbS9EZWZhdWx0LmFzcHgifQ.L5prLH6qxBFDbNHFE5qswUkw-2DBZ9wK3XN1httYiN7Mg_br_70495452415-2Dl&d=DwMFAA&c=ay4DezFOFbDj-FQ_Ll6HHd73nukvvb42gL6BcQ6H_T0&r=vmDmCXhDlfc5ZYdNNWqnen8E7zA9gfAJPlXD-tt8VqI&m=Fe-tWKJYaQ3sPbV89Unnb3jVKBhhDkbq7gOELz1O3f8&s=zeQznhWZ6PAlf4GMvdOcjPdhwkgwnz4p7eCEvmIHwIA&e="><span style="color: #052bff; font-family: "Arial",sans-serif; font-size: 10.5pt;">here</span></a><span style="color: black; font-family: "Arial",sans-serif; font-size: 10.5pt;">. Once
logged in, type the name of the module into the search bar at the top of the
website to find it.<o:p></o:p></span></div>
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<span style="color: black; font-family: "Arial",sans-serif; font-size: 10.5pt;">The new MIPS CME modules include:<o:p></o:p></span></div>
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<li class="MsoNormal" style="color: black; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-list: l0 level1 lfo1; mso-margin-top-alt: auto; tab-stops: list .5in;"><strong><span style="font-family: "Arial",sans-serif; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman";">Quality
Payment Program 2019 Overview</span></strong><span style="font-family: "Arial",sans-serif; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman";">
– Provides information on the origin and objectives of the program as well
as an overview of the MIPS and Advanced Alternative Payment Models.<o:p></o:p></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-list: l0 level1 lfo1; mso-margin-top-alt: auto; tab-stops: list .5in;"><strong><span style="font-family: "Arial",sans-serif; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman";">Quality
Payment Program Merit-based Incentive Payment System (MIPS): Participation
in 2019</span></strong><span style="font-family: "Arial",sans-serif; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman";"> – Details MIPS eligibility and
participation options, including the new opt-in policy, and how to report
MIPS data.<o:p></o:p></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-list: l0 level1 lfo1; mso-margin-top-alt: auto; tab-stops: list .5in;"><strong><span style="font-family: "Arial",sans-serif; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman";">Quality
Payment Program Merit-based Incentive Payment System (MIPS): Quality
Performance Category in 2019</span></strong><span style="font-family: "Arial",sans-serif; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman";">
– Explains the requirements, data submission and collection types, and scoring
for the Quality performance category.<o:p></o:p></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-list: l0 level1 lfo1; mso-margin-top-alt: auto; tab-stops: list .5in;"><strong><span style="font-family: "Arial",sans-serif; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman";">Quality
Payment Program Merit-based Incentive Payment System (MIPS): Promoting
Interoperability Performance Category in 2019</span></strong><span style="font-family: "Arial",sans-serif; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman";"> – Provides information on reporting requirements,
measures, and reweighting for the Promoting Interoperability performance
category.<o:p></o:p></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-list: l0 level1 lfo1; mso-margin-top-alt: auto; tab-stops: list .5in;"><strong><span style="font-family: "Arial",sans-serif; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman";">Quality
Payment Program Merit-based Incentive Payment System (MIPS): Improvement
Activities in 2019</span></strong><span style="font-family: "Arial",sans-serif; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman";">
– Explains the requirements, reporting steps, and scoring for the
Improvement Activities performance category.<o:p></o:p></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-list: l0 level1 lfo1; mso-margin-top-alt: auto; tab-stops: list .5in;"><strong><span style="font-family: "Arial",sans-serif; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman";">Quality
Payment Program Merit-based Incentive Payment System (MIPS): Cost
Performance Category in 2019 </span></strong><span style="font-family: "Arial",sans-serif; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman";">–
Provides information on new measures, attribution, and scoring for the
Cost performance category.<o:p></o:p></span></li>
</ul>
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<strong><span style="color: black; font-family: "Arial",sans-serif; font-size: 10.5pt;">For More
Information</span></strong><span style="color: black; font-family: "Arial",sans-serif; font-size: 10.5pt;"><o:p></o:p></span></div>
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<br />
<ul type="disc">
<li class="MsoNormal" style="color: black; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-list: l1 level1 lfo1; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial",sans-serif; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman";">Visit the CMS.gov </span><span style="color: windowtext;"><a href="https://urldefense.proofpoint.com/v2/url?u=https-3A__lnks.gd_l_eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDIsInVyaSI6ImJwMjpjbGljayIsImJ1bGxldGluX2lkIjoiMjAxOTEwMjQuMTE5NjU5NjEiLCJ1cmwiOiJodHRwczovL3d3dy5jbXMuZ292L091dHJlYWNoLWFuZC1FZHVjYXRpb24vTWVkaWNhcmUtTGVhcm5pbmctTmV0d29yay1NTE4vTUxOUHJvZHVjdHMvV2ViQmFzZWRUcmFpbmluZy5odG1sIn0.8muz-2DwOD4Q4GyFm01m-5F7d2fjDI-5F0lF6ue8ZY1Jd6MTg_br_70495452415-2Dl&d=DwMFAA&c=ay4DezFOFbDj-FQ_Ll6HHd73nukvvb42gL6BcQ6H_T0&r=vmDmCXhDlfc5ZYdNNWqnen8E7zA9gfAJPlXD-tt8VqI&m=Fe-tWKJYaQ3sPbV89Unnb3jVKBhhDkbq7gOELz1O3f8&s=7x26u9LK-oO1oWcSY9Lrpfqih3JrdHoc-aqJeWy9Y-E&e="><span style="color: #052bff; font-family: "Arial",sans-serif; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman";">MLN Web-Based Training webpage</span></a></span><span style="font-family: "Arial",sans-serif; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman";"> and </span><span style="color: windowtext;"><a href="https://urldefense.proofpoint.com/v2/url?u=https-3A__lnks.gd_l_eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDMsInVyaSI6ImJwMjpjbGljayIsImJ1bGxldGluX2lkIjoiMjAxOTEwMjQuMTE5NjU5NjEiLCJ1cmwiOiJodHRwczovL2xlYXJuZXIubWxubG1zLmNvbS9EZWZhdWx0LmFzcHgifQ.3UXxaeVEKUCX-5FbgrFMIjXDwnCTma3EYtk9FdmLUEDSY_br_70495452415-2Dl&d=DwMFAA&c=ay4DezFOFbDj-FQ_Ll6HHd73nukvvb42gL6BcQ6H_T0&r=vmDmCXhDlfc5ZYdNNWqnen8E7zA9gfAJPlXD-tt8VqI&m=Fe-tWKJYaQ3sPbV89Unnb3jVKBhhDkbq7gOELz1O3f8&s=j6n0_LljRzY7czlWuY0xRQKVy0xWALBYfTjwUU_hslA&e="><span style="color: #052bff; font-family: "Arial",sans-serif; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman";">log in to MLN</span></a></span><span style="font-family: "Arial",sans-serif; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman";"> to access the modules.<o:p></o:p></span></li>
</ul>
<ul type="disc">
<li class="MsoNormal" style="color: black; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-list: l0 level1 lfo2; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial",sans-serif; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman";">Visit the </span><span style="color: windowtext;"><a href="https://urldefense.proofpoint.com/v2/url?u=https-3A__lnks.gd_l_eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDQsInVyaSI6ImJwMjpjbGljayIsImJ1bGxldGluX2lkIjoiMjAxOTEwMjQuMTE5NjU5NjEiLCJ1cmwiOiJodHRwczovL3FwcC5jbXMuZ292L2Fib3V0L3Jlc291cmNlLWxpYnJhcnkifQ.QVBmMG-5FF-5FevwubpB5D89sQnnIXqTP2YmwENfWPKHFG8_br_70495452415-2Dl&d=DwMFAA&c=ay4DezFOFbDj-FQ_Ll6HHd73nukvvb42gL6BcQ6H_T0&r=vmDmCXhDlfc5ZYdNNWqnen8E7zA9gfAJPlXD-tt8VqI&m=Fe-tWKJYaQ3sPbV89Unnb3jVKBhhDkbq7gOELz1O3f8&s=4obnUim6Dt6xeDzmcr_24bzbDlB9soW0m_cJmvX09cY&e="><span style="color: #052bff; font-family: "Arial",sans-serif; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman";">QPP Resource Library</span></a></span><span style="font-family: "Arial",sans-serif; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman";"> to review new and existing QPP resources.<o:p></o:p></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-list: l0 level1 lfo2; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Arial",sans-serif; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman";">Contact the Quality Payment
Program at </span><span style="color: windowtext;"><a href="mailto:QPP@cms.hhs.gov"><span style="color: #052bff; font-family: "Arial",sans-serif; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman";">QPP@cms.hhs.gov</span></a></span><span style="font-family: "Arial",sans-serif; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman";"> or 1-866-288-8292 (TTY: 1-877-715-6222). To receive
assistance more quickly, consider calling during non-peak hours—before 10
AM and after 2 PM ET.<o:p></o:p></span></li>
</ul>
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<br />Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-2464913347731009629.post-55459856116624150472018-06-27T12:50:00.000-07:002018-06-27T12:50:21.788-07:00SNF Billing GuideRecently, we've noticed that there are a number of Skilled Nursing Facility claims/encounters rejected by CMS due to the following reasons:<br />
<br />
<ol>
<li>Skilled Nursing Facility Claims required Health Insurance Prospective Payment System (HIPPS) codes not present on the claim.</li>
<li>HIPPS Codes and Revenue Codes conflict </li>
<li>Hospital to Skilled Nursing Facility within 24 hours.</li>
</ol>
<br />
All of these issues can be remedied, by following the Centers for Medicare and Medicaid Services guidelines for billing of Skilled Nursing Facility guidance, including the correct use of HIPPS codes.<br />
<br />
<br />
Although CMS allows Medicare Advantage plans to provide services which may not meet the coverage criteria in Fee-for-service (FFS) Medicare, provision of services and submission of an encounter data are two distinct things. So, while coverage may be extended in some cases when FFS guidelines are not met, encounter data must meet FFS billing requirements in order to be processed. And CMS does require that all services must be submitted as encounter data, whether or not CMS covers them.<br />
<br />
In order to ensure your encounter data is processed correctly, you should follow the instructions contained in the <a href="https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/snfspellillnesschrt.pdf" target="_blank">CMS Skilled Nursing Facility (SNF) Billing Reference.</a> For complete instructions on HIPPS Codes, you should review the<a href="https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ProspMedicareFeeSvcPmtGen/HIPPSCodes.html" target="_blank"> HIPPS code page on the CMS website </a>as well.<br />
Finally, in order to ensure that your claim/encounter for a SNF transfer within 24 hours, be sure to use Condition Code 40 on the encounter.<br />
<br />
The importance of correct encounter data cannot be stressed enough. In order for CMS to have an accurate and complete picture of the services provided to our members, encounters must be processed to completion. By and large, that means they must meet the requirements of FFS medicare when they are sent to health plans. This ensures that they will be correctly processed, and that CMS can more accurately assess the care provided to MA members.<br />
<br />
If you have questions regarding CMS Encounter Data, contact Michelle Nguyen of our Encounter Data team at MNguyen3@scanhealthplan.com.<br />
<br />
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Stacey Hernandezhttp://www.blogger.com/profile/12799819464802934448noreply@blogger.com0tag:blogger.com,1999:blog-2464913347731009629.post-86151449841283433302018-05-08T15:23:00.000-07:002018-05-08T15:23:19.550-07:00Importance of Submitting Complete Encounter Data<br />
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As you know, CMS now uses a combination of RAPS (Risk Adjustment
Processing System) data and encounter data submitted thru EDPS (Encounter Data
Processing System) as inputs into the payment system for projecting RAFs (Risk
Adjustment Factors), which is a key input to payment model for MAPD (Medicare
Advantage Prescription Drug) health plans. CMS requires that all
encounter data be submitted by MAPD health plans, including services not
covered by CMS in Fee-For-Service (FFS) Medicare.<o:p></o:p></div>
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Due to the growth of payment strategies such as capitation
in MAPD, providers are no longer financially incentivized to provide complete
data as they were in the traditional claims billing process. This has
been a widely identified trend in MAPD professional data, but also occurs in
the inpatient setting which often contains more robust information then other
places of service. Missing encounter data and the growth of the gap in
these data (between MAPD and FFS) has a number of important ramifications for
MAPD:<o:p></o:p></div>
<div class="MsoListParagraph" style="text-indent: -.25in;">
</div>
<ul>
<li>·<span style="font-family: "Times New Roman", serif; font-size: 7pt; text-indent: -0.25in;">
</span><span style="text-indent: -0.25in;">It causes inaccuracies in payment because treated conditions are not
reported and therefore not loaded into the payment model</span></li>
<li>·<span style="font-family: "Times New Roman", serif; font-size: 7pt; text-indent: -0.25in;">
</span><span style="text-indent: -0.25in;">It suggests a distorted picture of members’ true disease burden as being
lower than the actual</span></li>
<li>·<span style="font-family: "Times New Roman", serif; font-size: 7pt; text-indent: -0.25in;">
</span><span style="text-indent: -0.25in;">It suggests incorrectly to CMS that MAPD members are receiving fewer
services than beneficiaries in traditional Medicare (FFS)</span></li>
</ul>
<o:p></o:p><br />
<div class="MsoListParagraph" style="text-indent: -.25in;">
<o:p></o:p></div>
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<o:p></o:p></div>
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Some possible drivers for this under-reporting are:<o:p></o:p></div>
<div class="MsoListParagraph" style="text-indent: -.25in;">
</div>
<ul>
<li>·<span style="font-family: "Times New Roman", serif; font-size: 7pt; text-indent: -0.25in;">
</span><span style="text-indent: -0.25in;">Failure to submit data from sub-capitated providers, including hospitals</span></li>
<li>·<span style="font-family: "Times New Roman", serif; font-size: 7pt; text-indent: -0.25in;">
</span><span style="text-indent: -0.25in;">The purposeful filtering of encounter data submitted to the plan with
the goal of providing only incremental HCC model data</span></li>
<li>·<span style="font-family: "Times New Roman", serif; font-size: 7pt; text-indent: -0.25in;">
</span><span style="text-indent: -0.25in;">Downstream data that medical groups processes as claims are not always extracted
and reported. This is especially true when the groups’ encounter data and
claims data are on different platforms.</span></li>
<li>·<span style="font-family: "Times New Roman", serif; font-size: 7pt; text-indent: -0.25in;">
</span><span style="text-indent: -0.25in;">Selective reporting from providers of only risk adjustable diagnoses in
MAPD and only providing a single E&M procedure code so that the encounter
will process</span></li>
<li>·<span style="font-family: "Times New Roman", serif; font-size: 7pt; text-indent: -0.25in;">
</span><span style="text-indent: -0.25in;">Submitting reporting from providers of only diagnoses “linked” to a
procedure code for traditional Medicare claims or only the minimum needed for
the claim to process</span></li>
</ul>
<br /><o:p></o:p><br />
<div class="MsoListParagraph" style="text-indent: -.25in;">
<o:p></o:p></div>
<div class="MsoListParagraph" style="text-indent: -.25in;">
<o:p></o:p></div>
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<o:p></o:p></div>
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<o:p></o:p></div>
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While there are no mechanisms in traditional Medicare at
present to submit additional diagnosis data (maximums are currently <=8
diagnoses for professional, <=25 diagnoses for institutional), it’s
important to submit all documented diagnoses and procedures for both programs.
In traditional Medicare where there are more diagnoses then 8, we would suggest
that the provider or biller first choose linked diagnoses followed by the
diagnoses that most accurately reflect the need for the visit and evaluations
conducted at that service. Similarly, reporting all CPT/HCPCS codes is
important since it is the only way that CMS can gain an accurate picture of
procedures performed with the goal of trying to understand and compare value
between the programs. <o:p></o:p></div>
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At present we believe that there are a number of systematic
biases that are impacting the accuracy of the view CMS has on the health status
of the entire Medicare population, biasing towards fewer CPT/HCPCS for MAPD and
fewer ICD codes for traditional FFS.<o:p></o:p></div>
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<br /></div>
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NOTE:<o:p></o:p></div>
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Remember, SCAN’s Encounter and Risk Adjustment provider team
is here to assist you. Please reach out to Michelle Nguyen at <a href="mailto:MNguyen3@scanhealthplan.com">MNguyen3@scanhealthplan.com</a> for
assistance.<o:p></o:p></div>
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<br />Stacey Hernandezhttp://www.blogger.com/profile/12799819464802934448noreply@blogger.com0tag:blogger.com,1999:blog-2464913347731009629.post-23318178131613064942018-03-29T12:41:00.000-07:002018-03-29T12:41:33.847-07:00Special Guest Posting by Coding Quality Specialist, Megha Patel, CCS, CPC- Official Coding Guideline ChangesGood afternoon, all. Today, we're lucky to have a special guest post, by one of SCAN's Coding Quality Specialists, Megha Patel, CCS, CPC. Megha has done a lot of hard work for us, compiling all the significant changes to the Official Guidelines for Coding and Reporting, beginning with the switch from ICD-9-CM to ICD-10-CM:<br />
<br />
<br />
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<b style="mso-bidi-font-weight: normal;"><u><span style="font-size: 15.0pt; line-height: 115%;">ICD -9 to ICD-10
Official Coding Guideline Updates<o:p></o:p></span></u></b></div>
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<!--[if !supportLists]--><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><!--[endif]--><b style="mso-bidi-font-weight: normal;"><u><span style="font-size: 12.0pt; line-height: 115%;">10/01/2015: <o:p></o:p></span></u></b></div>
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<span style="font-size: 12.0pt; line-height: 115%;">ICD-9 to ICD-10 updated October 1, 2015.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 115%;">CAD
with Angina: Use combination codes for CAD with Angina, A causal relationship
can be assumed in a patient with both Atherosclerosis and angina pectoris. It
is not necessary to code Angina Pectoris separately. <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l3 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 115%;">Sequelae
of CVA: Weakness due to previous CVA should be coded as Hemiplegia/Hemiparesis.
<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l3 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 115%;">Sequelae
of CVA: Hemiplegia/Hemiparesis/Monoplegia identify whether the dominant or non-dominant
side of affected.<span style="mso-spacerun: yes;"> </span>If provider didn’t
documented dominant or non-dominant, the default is to assume the right side is
the dominant side. If left side affected, the default is non-dominant. <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l3 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 115%;">DM
with Hyperglycemia: Uncontrolled DM, Inadequately Controlled, Out of
controlled, Poorly Controlled should be coded as Hyperglycemia. <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l3 level1 lfo2; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 115%;">Diabetes
Ketoacidosis: ICD-10 CM does not provide a specific code for Type II diabetic
Ketoacidosis. Assign code E13.10 Other Specified Diabetes with Ketoacidosis as
per Coding Clinic First Quarter of 2013.<o:p></o:p></span></div>
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<!--[if !supportLists]--><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><!--[endif]--><b style="mso-bidi-font-weight: normal;"><u><span style="font-size: 12.0pt; line-height: 115%;">03/18/2016:<o:p></o:p></span></u></b></div>
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<div class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level1 lfo3; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 115%;">DM
with Complications Assumed relationship. The guidelines published in the first
quarter 2016 issue of AHA Coding Clinic on pg. 11. According to this
clarification, the subterm “with” in the index should be interrupted as a link
between diabetes and any of those conditions indented under the word “with”. <o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="color: red; font-size: 12.0pt; line-height: 115%;">** </span></b><span style="font-size: 12.0pt; line-height: 115%;">The
linkage between diabetes and Osteomyelitis used to be assumed in ICD-9 but it
is not assumed in ICD -10 (<u>10/01/2015-10/01/2016</u> Not coded). There is no
assumed relationship till October 1, 2016.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l2 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><!--[endif]--><b style="mso-bidi-font-weight: normal;"><u><span style="font-size: 12.0pt; line-height: 115%;">10/01/2016:<o:p></o:p></span></u></b></div>
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<div class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level1 lfo3; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 115%;">Uncontrolled
DM: Uncontrolled DM is classified by type and whether it is hyperglycemia or
hypoglycemia. There is no default code for “uncontrolled DM”. Effective Oct. 1,
2016, uncontrolled diabetes can be referenced as Hyperglycemia or Hypoglycemia.
<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 115%;"><span style="mso-spacerun: yes;"> </span>Hypertension with CHF: Presumes a causal
relationship between hypertension and heart involvement.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l0 level1 lfo3; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 115%;">COPD
with Asthma: COPD with asthma only coded as J44.9. If type of asthma not
documented J45.909 should not be coded. <span style="mso-spacerun: yes;"> </span>“Unspecified” is not type of asthma. <o:p></o:p></span></div>
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<div class="MsoListParagraphCxSpFirst" style="mso-list: l2 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><b style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><!--[endif]--><b style="mso-bidi-font-weight: normal;"><u><span style="font-size: 12.0pt; line-height: 115%;">10/01/2017:<o:p></o:p></span></u></b></div>
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<div class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l1 level1 lfo4; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 115%;">Diabetic
Ketoacidosis: October 1, 2017 updated with new codes for Diabetes Ketoacidosis
(Type II). E11.10 Type II DM with Ketoacidosis w/o Coma and E11.11 Type II DM
with Ketoacidosis w/ Coma. <b style="mso-bidi-font-weight: normal;"><u><o:p></o:p></u></b></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l1 level1 lfo4; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 115%;">COPD,
Emphysema and Chronic Bronchitis all documented: Assign J449 only, because
J43.9 Emphysema has Exclude 1 note (Emphysema with chronic bronchitis). J44.9
has Include note Chronic Bronchitis with emphysema. (J439 is Emphysema without
Chronic Bronchitis) (J449 is Emphysema with Chronic Bronchitis).<b style="mso-bidi-font-weight: normal;"><u><o:p></o:p></u></b></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l1 level1 lfo4; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 115%;">COPD
with Emphysema: J43.9 Emphysema assigned as Emphysema is specific type of COPD.
<b style="mso-bidi-font-weight: normal;"><u><o:p></o:p></u></b></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l1 level1 lfo4; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 115%;">Emphysema
with an Acute Exacerbation of COPD: Assign J43.9. Both codes have Exclude 1
note to each other. J439 is without Chronic Bronchitis and J449 is with Chronic
Bronchitis. Emphysema is type of COPD so Acute Exacerbation of COPD is covers
in J43.9. <b style="mso-bidi-font-weight: normal;"><u><o:p></o:p></u></b></span></div>
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<br /></div>
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<br /></div>
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<span style="font-size: large;">Thanks, Megha--for doing all the heavy lifting!</span></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l1 level1 lfo4; text-indent: -.25in;">
Remember, you can always download the full text of the ICD-10-CM guidelines on our website, at http://hccuniversity.com/asset/154d663f-95bf-4a59-a1fd-a6e4eb7c8477</div>
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<br /></div>
Stacey Hernandezhttp://www.blogger.com/profile/12799819464802934448noreply@blogger.com0tag:blogger.com,1999:blog-2464913347731009629.post-13870825468323692962018-03-05T10:22:00.001-08:002018-03-05T10:22:27.129-08:00An Important Reminder From our Encounter Data Team<br />
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Hello SCAN Provider Partners,</span><o:p></o:p></div>
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<br /></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">The January CMS Encounter Data Sweep deadline
has been extended! This is the <b><span style="color: red;">FINAL</span></b><span style="color: red;"> </span>CMS sweep impacting 2016 DOS (2017 payment) and
requires the submission of encounters for DOS range<span style="color: #1f497d;">
</span>01/01/2016 </span><span style="font-family: Wingdings; font-size: 10.0pt;">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">12/31/2016<span style="color: #1f497d;">.</span> CMS currently plans a 75% RAPS and Fee for
Service and 25% EDS and Fee for Service blended risk score based on 2016 DOS. </span><span style="color: #1f497d;"><o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Additionally, <b><u><span style="color: red;">TODAY</span></u></b>
is the CMS Final Deadline Date for the March CMS Encounter Data Sweep, which requires
the submission of encounters for DOS range 01/01/2017 </span><span style="font-family: Wingdings; font-size: 10.0pt;">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">12/31/2017. CMS currently plans a 85%
RAPS and Fee for Service and 15% EDS and Fee for Service blended risk score
based on 2017 DOS.<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">SCAN has one date for you to manage towards
for the January 2018 sweep (2016 DOS):</span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l3 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b><span style="background: yellow; color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Deadline</span></b><span style="color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; color: red; mso-highlight: yellow;">April 27, 2018</span><span style="color: #1f497d;"> </span><span style="color: red;">– <i>RAPS only</i></span></b></span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l3 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">After this deadline,
SCAN will <b><i>NOT</i></b> process any<span style="color: #1f497d;"> </span>RAPS
files received for the January CMS sweep</span><o:p></o:p></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">*Note: 2016 DOS EDS
deadline has been extended to September 2018<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">SCAN has two dates for you to manage towards
for the March 2018 sweep:</span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l3 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b><span style="background: yellow; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Target Date</span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> for Provider Partners: EOB Friday, <b><span style="background: yellow; mso-highlight: yellow;">January 26, 2018</span><span style="color: #1f497d;"> </span><i><span style="color: red;">– closed</span></i><span style="color: red;"> </span></b></span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l3 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">This target date
ensures that SCAN has adequate time to complete processing prior to the health
plan cut-off date by CMS</span><o:p></o:p></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l3 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b><span style="background: yellow; color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Deadline</span></b><span style="color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; color: red; mso-highlight: yellow;">February 23, 2018</span><span style="color: red;"> <i>– closed</i></span></b></span><o:p></o:p></div>
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</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">After
this deadline, SCAN will <b><i>NOT</i></b> process any files received for the
March CMS sweep</span><o:p></o:p></div>
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<b><u><span style="background: lime; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: lime;">7 STEPS YOU CAN TAKE TO PREPARE:</span></u></b><o:p></o:p></div>
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<li class="MsoNormal" style="mso-list: l4 level1 lfo3; text-autospace: none;"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Review your SCAN monthly Encounter Submission Reports <o:p></o:p></span></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal" style="mso-list: l4 level2 lfo3; text-autospace: none;"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">March reports were uploaded to the SCAN Encounter Data
Portal on 3/2/2018. The next ESRs will be uploaded the first week of
April 2018.<o:p></o:p></span></li>
</ol>
</ol>
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<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Review
your SCAN Encounter HCC Reconciliation Reports <o:p></o:p></span></div>
<ol start="2" style="margin-top: 0in;" type="1">
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal" style="mso-list: l4 level2 lfo3; text-autospace: none;"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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 <i>SCAN Documents tab -> HCCs and Encounters.</i><o:p></o:p></span></li>
</ol>
</ol>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> <b> </b><o:p></o:p></span></div>
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<li class="MsoNormal" style="mso-list: l4 level1 lfo3; text-autospace: none;"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Review your SCAN All DX Reconciliation reports <o:p></o:p></span></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal" style="mso-list: l4 level2 lfo3; text-autospace: none;"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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 <i>SCAN Documents tab -> HCCs and Encounters.</i><o:p></o:p></span></li>
</ol>
</ol>
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<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">QUESTION</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: What is the All Diagnoses (DX)
Reconciliation report? <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">ANSWER</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: 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.<o:p></o:p></span></div>
<ol start="3" style="margin-top: 0in;" type="1">
<ol start="2" style="margin-top: 0in;" type="a">
<li class="MsoNormal" style="mso-list: l4 level2 lfo3; text-autospace: none;"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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.<o:p></o:p></span></li>
</ol>
</ol>
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<li class="MsoNormal" style="mso-list: l4 level1 lfo3; text-autospace: none;"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Review your SCAN PCN Reconciliation reports<o:p></o:p></span></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal" style="mso-list: l4 level2 lfo3; text-autospace: none;"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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 <i>SCAN Documents tab -> HCCs and Encounters.</i><o:p></o:p></span></li>
</ol>
</ol>
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<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">QUESTION</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: What is the Patient
Control Number (PCN) Reconciliation report? <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">ANSWER</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: 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<o:p></o:p></span></div>
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<li class="MsoNormal" style="mso-list: l4 level2 lfo3; text-autospace: none;"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">If you are already reconciling against the PCN report,
then continue to do so and provide an update on results as soon as
available.<o:p></o:p></span></li>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">*<i>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 May 4, 2018 for the January
Sweep (RAPS only) and March 2, 2018 for the March Sweep.<o:p></o:p></i></span></div>
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<b><span style="background: lime; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: lime;">Additional
Steps:</span></b><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
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<li class="MsoNormal" style="mso-list: l4 level1 lfo3; text-autospace: none;"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Work your clearinghouse rejections via OfficeAlly,
Ability Network, or Change Healthcare <o:p></o:p></span></li>
</ol>
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<li class="MsoNormal" style="mso-list: l4 level1 lfo3; text-autospace: none;"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Upload all ICE alternative submission files to SCAN via
the Encounter Data Portal (</span><span style="font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"><a href="http://providerportal.scanhealthplan.com/"><span style="font-family: "Arial","sans-serif";">providerportal.scanhealthplan.com</span></a></span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">) using the File Transmission link <o:p></o:p></span></li>
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<li class="MsoNormal" style="mso-list: l4 level2 lfo3; text-autospace: none;"><b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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. </span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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.<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l4 level2 lfo3; text-autospace: none;"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Send these files sooner than later; <i><u>please do
not to wait until April 27, 2018 to upload your 2016 DOS files for the
January Sweep (RAPS only). Additionally, please do not wait until
February 23, 2018 to upload your 2017 DOS files for the March Sweep.</u></i><o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l4 level2 lfo3; text-autospace: none;"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">ICE files should only be used to submit additional DX
codes or deletes of DX codes.<o:p></o:p></span></li>
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</ol>
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<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">SCAN expects to
receive all original encounter data records via your normal clearinghouse
workflow<span style="color: #1f497d;">.</span><o:p></o:p></span></b></div>
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<li class="MsoNormal" style="mso-list: l4 level1 lfo3; text-autospace: none;"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Follow up on additional cleanup requests (contact your
respective HCI representative with your direct questions) <o:p></o:p></span></li>
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<li class="MsoNormal" style="mso-list: l4 level2 lfo3; text-autospace: none;"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Provider Name Mismatch (PNM) rejection reports<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l4 level2 lfo3; text-autospace: none;"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Rendering Provider/Entity (RPX) rejection reports<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l4 level2 lfo3; text-autospace: none;"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">EDS Full Encounter Data rejection reports<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l4 level2 lfo3; text-autospace: none;"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Invalid DX rejection reports<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l4 level2 lfo3; text-autospace: none;"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">ICE File Pend reports<o:p></o:p></span></li>
</ol>
</ol>
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<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">POS
21, 22, and 23 reports<o:p></o:p></span></div>
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<b><u><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">What are the Timelines?</span></u></b><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
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<li class="MsoNormal" style="mso-list: l5 level1 lfo5; text-autospace: none;"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Last day to submit all 01/01/2016 -> 12/31/2016 DOS<span style="color: #1f497d;"> </span>encounters<span style="color: #1f497d;"> </span>for
RAPS to your Clearinghouse: <b><i><u><span style="background: yellow; mso-highlight: yellow;">04/27/2018</span></u></i></b></span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l5 level1 lfo5; text-autospace: none;"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Last day for ICE file submissions of
additions/deletions of DX codes for 01/01/2016<span style="color: #1f497d;">
</span>-> 12/31/2016 to SCAN: <b><i><u><span style="background: yellow; mso-highlight: yellow;">04/27/2018</span></u></i></b></span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l5 level1 lfo5; text-autospace: none;"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">January<span style="color: #1f497d;"> </span>CMS Sweep
RAPS deadline for SCAN: 05/04/2018</span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
<li class="MsoNormal" style="color: #1f497d; mso-list: l5 level1 lfo5; text-autospace: none;"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Submit all
01/01/2017 -> 12/31/2017 DOS encounters to your Clearinghouse: <b><i><u><span style="background: yellow; mso-highlight: yellow;">02/23/2018</span></u></i></b></span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l5 level1 lfo5; text-autospace: none;"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Last day for ICE file submissions of
additions/deletions of DX codes for 01/01/2017 -> 12/31/2017 to SCAN: <b><i><u><span style="background: yellow; mso-highlight: yellow;">02/23/2018</span></u></i></b></span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l5 level1 lfo5; text-autospace: none;"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">March<span style="color: #1f497d;"> </span>CMS Sweep
deadline for SCAN: 03/02/2018</span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
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<i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">* Remember: SCAN has two dates for provider
partners to manage towards for the January and March Sweep</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">:<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l3 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b><span style="background: yellow; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">January Sweep SCAN Target Date</span></b><b><span style="color: #1f497d; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; mso-highlight: yellow;">December
29, 2017</span><i><span style="color: red;">- closed</span></i></b></span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l3 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">This target date ensures
that SCAN has adequate time to complete processing prior to the health plan
cut-off date by CMS</span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l3 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b><span style="background: yellow; color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">January Sweep SCAN Deadline (RAPS only)</span></b><span style="color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; color: red; mso-highlight: yellow;">April 27, 2018</span></b></span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l3 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">After this deadline,
SCAN will <b><i>NOT</i> </b>process any files received for the January CMS
sweep</span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b><span style="background: yellow; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">March Sweep SCAN Target Date</span></b><b><span style="color: #1f497d; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; mso-highlight: yellow;">January
26, 2018</span><i><span style="color: red;">- closed</span></i></b></span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l3 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">This target date
ensures that SCAN has adequate time to complete processing prior to the health
plan cut-off date by CMS</span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l3 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b><span style="background: yellow; color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">March Sweep SCAN Deadline</span></b><span style="color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; color: red; mso-highlight: yellow;">February 23, 2018</span><i><span style="color: red;">- closed</span></i></b></span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l3 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">After this deadline,
SCAN will <b><i>NOT</i> </b>process any files received for the March CMS sweep</span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Please be prepared for continued
communication from SCAN. We look forward to supporting and working with you
during this upcoming sweep period!</span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-autospace: none;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">If you have any questions or concerns, please
feel free to contact me directly or reach out to SCAN’s HCI Representative:<o:p></o:p></span></div>
<div class="MsoListParagraph" style="mso-list: l0 level1 lfo6; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Michelle Nguyen: </span><a href="mailto:MNguyen3@scanhealthplan.com"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">MNguyen3@scanhealthplan.com</span></a><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif";">Best regards,<o:p></o:p></span></div>
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<b><span style="color: #002060;">Christina Cabiltes<o:p></o:p></span></b></div>
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<span style="color: #404040; font-size: 9.0pt;">Supervisor, HCI
Projects<o:p></o:p></span></div>
<br />Stacey Hernandezhttp://www.blogger.com/profile/12799819464802934448noreply@blogger.com0tag:blogger.com,1999:blog-2464913347731009629.post-32471548218894237802018-01-29T15:11:00.001-08:002018-01-29T15:11:31.156-08:00RAPS Submission Deadline Extension Memo<div class="MsoNormal">
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The memo below was shared with our provider partners today explaining the CMS extension for filing RAPS for Payment Year 2017.a</div>
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<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1T1Ou6wTzIgu1yy_QxA9M2IDluLDdkHvI3quY_FkBdKA5HRHLe6oxDoJ1OYsfPKcIytEvX1oYsNVhiJYAQAE3xyrxDPgE9HiB8itzl8SxCLj7w3qK79DGHN47hEgRlDdZoD_V7IZMnQon/s1600/PY2017+RAPS+Deadline+Extension+01.26.2018.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em; text-align: left;"><img border="0" data-original-height="1056" data-original-width="816" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1T1Ou6wTzIgu1yy_QxA9M2IDluLDdkHvI3quY_FkBdKA5HRHLe6oxDoJ1OYsfPKcIytEvX1oYsNVhiJYAQAE3xyrxDPgE9HiB8itzl8SxCLj7w3qK79DGHN47hEgRlDdZoD_V7IZMnQon/s640/PY2017+RAPS+Deadline+Extension+01.26.2018.jpg" width="494" /></a></div>
Stacey Hernandezhttp://www.blogger.com/profile/12799819464802934448noreply@blogger.com0tag:blogger.com,1999:blog-2464913347731009629.post-56865667583479614582018-01-29T09:53:00.002-08:002018-01-29T09:53:32.543-08:00Important Reminder from Our Encounter Data Department<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Hello SCAN Provider Partners,</span><o:p></o:p></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">The January CMS Encounter Data Sweep is
coming to a close. <b><u><span style="color: red;">TODAY</span></u></b><span style="color: red;"> </span>is the Final Deadline Date to submit the remainder of
your 2016 DOS Encounter Data!<span style="color: #1f497d;"> </span>This is the <b><span style="color: red;">FINAL</span></b><span style="color: red;"> </span>CMS sweep
impacting 2016 DOS (2017 payment) and requires the submission of encounters for
DOS range<span style="color: #1f497d;"> </span>01/01/2016 </span><span style="font-family: Wingdings; font-size: 10.0pt;">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">12/31/2016<span style="color: #1f497d;">.</span>
CMS currently plans a 75% RAPS and Fee for Service and 25% EDS and Fee for
Service blended risk score based on 2016 DOS. <span style="color: #1f497d;"><o:p></o:p></span></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Additionally, we are now <b><u><span style="color: red;">4</span></u></b> 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 </span><span style="font-family: Wingdings; font-size: 10.0pt;">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">12/31/2017.
CMS currently plans a 85% RAPS and Fee for Service and 15% EDS and Fee for
Service blended risk score based on 2017 DOS.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">SCAN has two dates for you to manage towards
for the January 2018 sweep:</span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Target Date</span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> for Provider Partners: EOB Friday, <b><span style="background: yellow; mso-highlight: yellow;">December 29, 2017</span><span style="color: #1f497d;"> </span><i><span style="color: red;">- closed</span></i></b></span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">This target date
ensures that SCAN has adequate time to complete processing prior to the health
plan cut-off date by CMS</span><o:p></o:p></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Deadline</span></b><span style="color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; color: red; mso-highlight: yellow;">January 26, 2018</span></b></span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">After this deadline,
SCAN will <b><i>NOT</i></b> process any files received for the January CMS
sweep</span><o:p></o:p></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">SCAN has two dates for you to manage towards
for the March 2018 sweep:</span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Target Date</span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> for Provider Partners: EOB Friday, <b><span style="background: yellow; mso-highlight: yellow;">January 26, 2018</span></b></span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">This target date
ensures that SCAN has adequate time to complete processing prior to the health
plan cut-off date by CMS</span><o:p></o:p></div>
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<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Deadline</span></b><span style="color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; color: red; mso-highlight: yellow;">February 23, 2018</span></b></span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">After this deadline,
SCAN will <b><i>NOT</i></b> process any files received for the March CMS sweep</span><o:p></o:p></div>
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<b><u><span style="background: lime; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: lime;">7 STEPS YOU CAN TAKE TO PREPARE:</span></u></b><o:p></o:p></div>
<ol start="1" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Review your SCAN monthly Encounter Submission Reports <o:p></o:p></span></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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.<o:p></o:p></span></li>
</ol>
</ol>
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<br /></div>
<div class="MsoListParagraph" style="mso-list: l3 level1 lfo2; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: Arial;">2.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Review
your SCAN Encounter HCC Reconciliation Reports <o:p></o:p></span></div>
<ol start="2" style="margin-top: 0in;" type="1">
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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 <i>SCAN Documents tab -> HCCs and Encounters.</i><o:p></o:p></span></li>
</ol>
</ol>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> <b> </b><o:p></o:p></span></div>
<ol start="3" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Review your SCAN All DX Reconciliation reports <o:p></o:p></span></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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 <i>SCAN Documents tab -> HCCs and Encounters.</i><o:p></o:p></span></li>
</ol>
</ol>
<div class="MsoNormal" style="margin-left: 1.5in; mso-list: l3 level3 lfo2; text-autospace: none; text-indent: -9.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">QUESTION</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: What is the All Diagnoses (DX)
Reconciliation report? <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.5in; mso-list: l3 level3 lfo2; text-autospace: none; text-indent: -9.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">ANSWER</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: 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.<o:p></o:p></span></div>
<ol start="3" style="margin-top: 0in;" type="1">
<ol start="2" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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.<o:p></o:p></span></li>
</ol>
</ol>
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<br /></div>
<ol start="4" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Review your SCAN PCN Reconciliation reports<o:p></o:p></span></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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 <i>SCAN Documents tab -> HCCs and Encounters.</i><o:p></o:p></span></li>
</ol>
</ol>
<div class="MsoListParagraph" style="margin-left: 1.5in; mso-list: l1 level1 lfo3; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">QUESTION</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: What is the Patient
Control Number (PCN) Reconciliation report? <o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 1.5in; mso-list: l1 level1 lfo3; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">ANSWER</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: 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<o:p></o:p></span></div>
<ol start="4" style="margin-top: 0in;" type="1">
<ol start="2" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">If you are already reconciling against the PCN report,
then continue to do so and provide an update on results as soon as available.<o:p></o:p></span></li>
</ol>
</ol>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">*<i>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.<o:p></o:p></i></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="background: lime; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: lime;">Additional
Steps:</span></b><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<ol start="5" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Work your clearinghouse rejections via OfficeAlly,
Ability Network, or Change Healthcare <o:p></o:p></span></li>
</ol>
<div class="MsoNormal">
<br /></div>
<ol start="6" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Upload all ICE alternative submission files to SCAN via
the Encounter Data Portal (</span><span style="font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"><a href="http://providerportal.scanhealthplan.com/"><span style="font-family: "Arial","sans-serif";">providerportal.scanhealthplan.com</span></a></span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">) using the File Transmission link <o:p></o:p></span></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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. </span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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.<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Send these files sooner than later; <i><u>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.</u></i><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">ICE files should only be used to submit additional DX
codes or deletes of DX codes.<o:p></o:p></span></li>
</ol>
</ol>
<div class="MsoNormal" style="margin-left: 1.5in; mso-list: l3 level3 lfo2; text-autospace: none; text-indent: -9.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">SCAN expects to
receive all original encounter data records via your normal clearinghouse
workflow<span style="color: #1f497d;">.</span><o:p></o:p></span></b></div>
<div class="MsoListParagraph" style="margin-left: 1.0in; text-autospace: none;">
<br /></div>
<ol start="7" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Follow up on additional cleanup requests (contact your
respective HCI representative with your direct questions) <o:p></o:p></span></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Provider Name Mismatch (PNM) rejection reports<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Rendering Provider/Entity (RPX) rejection reports<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">EDS Full Encounter Data rejection reports<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Invalid DX rejection reports<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">ICE File Pend reports<o:p></o:p></span></li>
</ol>
</ol>
<div class="MsoListParagraph" style="margin-left: 1.0in; mso-list: l3 level2 lfo2; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: Arial;">f.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">POS
21 reports<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><u><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">What are the Timelines?</span></u></b><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<ol start="1" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Last day to submit all 01/01/2016 -> 12/31/2016 DOS
encounters to your Clearinghouse: <b><i><u><span style="background: yellow; mso-highlight: yellow;">01/26/2018</span></u></i></b></span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Last day for ICE file submissions of
additions/deletions of DX codes for 01/01/2016<span style="color: #1f497d;">
</span>-> 12/31/2016 to SCAN: <b><i><u><span style="background: yellow; mso-highlight: yellow;">01/26/2018</span></u></i></b></span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">January<span style="color: #1f497d;"> </span>CMS Sweep
deadline for SCAN: 01/31/2018</span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
<li class="MsoNormal" style="color: #1f497d; mso-list: l4 level1 lfo4; text-autospace: none;"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Submit all
01/01/2017 -> 12/31/2017 DOS encounters to your Clearinghouse: <b><i><u><span style="background: yellow; mso-highlight: yellow;">02/23/2018</span></u></i></b></span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Last day for ICE file submissions of
additions/deletions of DX codes for 01/01/2017 -> 12/31/2017 to SCAN: <b><i><u><span style="background: yellow; mso-highlight: yellow;">02/23/2018</span></u></i></b></span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">March<span style="color: #1f497d;"> </span>CMS Sweep
deadline for SCAN: 03/02/2018</span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
</ol>
<div class="MsoNormal" style="margin-left: .25in; text-autospace: none;">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">* Remember: SCAN has two dates for provider
partners to manage towards for the January and March Sweep</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">:<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">January Sweep SCAN Target Date</span></b><b><span style="color: #1f497d; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; mso-highlight: yellow;">December
29, 2017</span><i><span style="color: red;">- closed</span></i></b></span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">This target date
ensures that SCAN has adequate time to complete processing prior to the health
plan cut-off date by CMS</span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 1.0in; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">January Sweep SCAN Deadline</span></b><span style="color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; color: red; mso-highlight: yellow;">January 26, 2018</span></b></span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">After this deadline,
SCAN will <b><i>NOT</i> </b>process any files received for the January CMS
sweep</span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">March Sweep SCAN Target Date</span></b><b><span style="color: #1f497d; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; mso-highlight: yellow;">January
26, 2018</span></b></span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">This target date
ensures that SCAN has adequate time to complete processing prior to the health
plan cut-off date by CMS</span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 1.0in; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">March Sweep SCAN Deadline</span></b><span style="color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; color: red; mso-highlight: yellow;">February 23, 2018</span></b></span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">After this deadline,
SCAN will <b><i>NOT</i> </b>process any files received for the March CMS sweep</span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Please be prepared for continued
communication from SCAN. We look forward to supporting and working with you
during this upcoming sweep period!</span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">If you have any questions or concerns, please
feel free to contact me directly or reach out to SCAN’s HCI Representative:<o:p></o:p></span></div>
<div class="MsoListParagraph" style="mso-list: l0 level1 lfo5; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Michelle Nguyen: </span><a href="mailto:MNguyen3@scanhealthplan.com"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">MNguyen3@scanhealthplan.com</span></a><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<div class="MsoListParagraph">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif";">Best regards,<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="color: #002060;">Christina Cabiltes<o:p></o:p></span></b></div>
<br />
<div class="MsoNormal">
<span style="color: #404040; font-size: 9.0pt;">Supervisor, HCI
Projects<o:p></o:p></span></div>
Stacey Hernandezhttp://www.blogger.com/profile/12799819464802934448noreply@blogger.com0tag:blogger.com,1999:blog-2464913347731009629.post-45910380337136003132018-01-16T08:38:00.001-08:002018-01-16T08:38:35.662-08:00Urgent Reminder from our Encounter Data Team<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Hello SCAN Provider Partners,</span><o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">The January CMS Encounter Data Sweep is
approaching. This is the <b><span style="color: red;">FINAL</span></b><span style="color: red;"> </span>CMS sweep impacting 2016 DOS (2017 payment) and
requires the submission of encounters for DOS range<span style="color: #1f497d;">
</span>01/01/2016 </span><span style="font-family: Wingdings; font-size: 10.0pt;">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">12/31/2016<span style="color: #1f497d;">.</span> 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’s Target Date for submission of 2016 DOS has passed, but there is still
time to submit the remainder of your 2016 DOS Encounter Data! We are <b><u><span style="color: red;">2</span></u></b><span style="color: red;"> </span>weeks away
from SCAN’s Final Deadline Date! <span style="color: #1f497d;"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Additionally, we are now <b><u><span style="color: red;">2</span></u></b> 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 </span><span style="font-family: Wingdings; font-size: 10.0pt;">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">12/31/2017. CMS
currently plans a 85% RAPS and Fee for Service and 15% EDS and Fee for Service
blended risk score based on 2017 DOS.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">SCAN has two dates for you to manage towards
for the January 2018 sweep:</span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Target Date</span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> for Provider Partners: EOB Friday, <b><span style="background: yellow; mso-highlight: yellow;">December 29, 2017</span><span style="color: #1f497d;"> </span><i><span style="color: red;">- closed</span></i></b></span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">This target date
ensures that SCAN has adequate time to complete processing prior to the health
plan cut-off date by CMS</span><o:p></o:p></div>
<div class="MsoListParagraph" style="margin-left: 1.0in; text-autospace: none;">
<br /></div>
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<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Deadline</span></b><span style="color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; color: red; mso-highlight: yellow;">January 26, 2018</span></b></span><o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">After this deadline,
SCAN will <b><i>NOT</i></b> process any files received for the January CMS
sweep</span><o:p></o:p></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">SCAN has two dates for you to manage towards
for the March 2018 sweep:</span><o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Target Date</span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> for Provider Partners: EOB Friday, <b><span style="background: yellow; mso-highlight: yellow;">January 26, 2018</span></b></span><o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">This target date
ensures that SCAN has adequate time to complete processing prior to the health
plan cut-off date by CMS</span><o:p></o:p></div>
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<br /></div>
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<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Deadline</span></b><span style="color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; color: red; mso-highlight: yellow;">February 23, 2018</span></b></span><o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">After this deadline,
SCAN will <b><i>NOT</i></b> process any files received for the March CMS sweep</span><o:p></o:p></div>
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<b><u><span style="background: lime; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: lime;">7 STEPS YOU CAN TAKE TO PREPARE:</span></u></b><o:p></o:p></div>
<ol start="1" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Review your SCAN monthly Encounter Submission Reports <o:p></o:p></span></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">December 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.<o:p></o:p></span></li>
</ol>
</ol>
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<br /></div>
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<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: Arial;">2.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Review
your SCAN Encounter HCC Reconciliation Reports <o:p></o:p></span></div>
<ol start="2" style="margin-top: 0in;" type="1">
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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 <i>SCAN Documents tab -> HCCs and Encounters.</i><o:p></o:p></span></li>
</ol>
</ol>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> <b> </b><o:p></o:p></span></div>
<ol start="3" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Review your SCAN All DX Reconciliation reports <o:p></o:p></span></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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 <i>SCAN Documents tab -> HCCs and Encounters.</i><o:p></o:p></span></li>
</ol>
</ol>
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<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">QUESTION</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: What is the All Diagnoses (DX)
Reconciliation report? <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.5in; mso-list: l3 level3 lfo2; text-autospace: none; text-indent: -9.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">ANSWER</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: 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.<o:p></o:p></span></div>
<ol start="3" style="margin-top: 0in;" type="1">
<ol start="2" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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.<o:p></o:p></span></li>
</ol>
</ol>
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<br /></div>
<ol start="4" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Review your SCAN PCN Reconciliation reports<o:p></o:p></span></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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 <i>SCAN Documents tab -> HCCs and Encounters.</i><o:p></o:p></span></li>
</ol>
</ol>
<div class="MsoListParagraph" style="margin-left: 1.5in; mso-list: l1 level1 lfo3; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">QUESTION</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: What is the Patient
Control Number (PCN) Reconciliation report? <o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 1.5in; mso-list: l1 level1 lfo3; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">ANSWER</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: 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<o:p></o:p></span></div>
<ol start="4" style="margin-top: 0in;" type="1">
<ol start="2" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">If you are already reconciling against the PCN report,
then continue to do so and provide an update on results as soon as
available.<o:p></o:p></span></li>
</ol>
</ol>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">*<i>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.<o:p></o:p></i></span></div>
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<b><span style="background: lime; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: lime;">Additional
Steps:</span></b><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<ol start="5" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Work your clearinghouse rejections via OfficeAlly,
Ability Network, or Change Healthcare <o:p></o:p></span></li>
</ol>
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<ol start="6" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Upload all ICE alternative submission files to SCAN via
the Encounter Data Portal (</span><span style="font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"><a href="http://providerportal.scanhealthplan.com/"><span style="font-family: "Arial","sans-serif";">providerportal.scanhealthplan.com</span></a></span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">) using the File Transmission link <o:p></o:p></span></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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. </span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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.<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Send these files sooner than later; <i><u>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.</u></i><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">ICE files should only be used to submit additional DX
codes or deletes of DX codes.<o:p></o:p></span></li>
</ol>
</ol>
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<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">SCAN expects to
receive all original encounter data records via your normal clearinghouse
workflow<span style="color: #1f497d;">.</span><o:p></o:p></span></b></div>
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<ol start="7" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Follow up on additional cleanup requests (contact your
respective HCI representative with your direct questions) <o:p></o:p></span></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Provider Name Mismatch (PNM) rejection reports<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Rendering Provider/Entity (RPX) rejection reports<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">EDS Full Encounter Data rejection reports<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Invalid DX rejection reports<o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">ICE File Pend reports<o:p></o:p></span></li>
</ol>
</ol>
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<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: Arial;">f.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">POS
21 reports<o:p></o:p></span></div>
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<b><u><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">What are the Timelines?</span></u></b><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<ol start="1" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Last day to submit all 01/01/2016 -> 12/31/2016 DOS
encounters to your Clearinghouse: <b><i><u><span style="background: yellow; mso-highlight: yellow;">01/26/2018</span></u></i></b></span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Last day for ICE file submissions of
additions/deletions of DX codes for 01/01/2016<span style="color: #1f497d;">
</span>-> 12/31/2016 to SCAN: <b><i><u><span style="background: yellow; mso-highlight: yellow;">01/26/2018</span></u></i></b></span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">January<span style="color: #1f497d;"> </span>CMS Sweep
deadline for SCAN: 01/31/2018</span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
<li class="MsoNormal" style="color: #1f497d; mso-list: l4 level1 lfo4; text-autospace: none;"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Submit all
01/01/2017 -> 12/31/2017 DOS encounters to your Clearinghouse: <b><i><u><span style="background: yellow; mso-highlight: yellow;">02/23/2018</span></u></i></b></span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Last day for ICE file submissions of
additions/deletions of DX codes for 01/01/2017 -> 12/31/2017 to SCAN: <b><i><u><span style="background: yellow; mso-highlight: yellow;">02/23/2018</span></u></i></b></span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">March<span style="color: #1f497d;"> </span>CMS Sweep
deadline for SCAN: 03/02/2018</span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
</ol>
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<i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">* Remember: SCAN has two dates for provider
partners to manage towards for the January and March Sweep</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">:<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">January Sweep SCAN Target Date</span></b><b><span style="color: #1f497d; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; mso-highlight: yellow;">December
29, 2017</span><i><span style="color: red;">- closed</span></i></b></span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">This target date
ensures that SCAN has adequate time to complete processing prior to the health
plan cut-off date by CMS</span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">January Sweep SCAN Deadline</span></b><span style="color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; color: red; mso-highlight: yellow;">January 26, 2018</span></b></span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">After this deadline,
SCAN will <b><i>NOT</i> </b>process any files received for the January CMS
sweep</span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">March Sweep SCAN Target Date</span></b><b><span style="color: #1f497d; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; mso-highlight: yellow;">January
26, 2018</span></b></span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">This target date
ensures that SCAN has adequate time to complete processing prior to the health
plan cut-off date by CMS</span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">March Sweep SCAN Deadline</span></b><span style="color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; color: red; mso-highlight: yellow;">February 23, 2018</span></b></span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">After this deadline,
SCAN will <b><i>NOT</i> </b>process any files received for the March CMS sweep</span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Please be prepared for continued
communication from SCAN. We look forward to supporting and working with you
during this upcoming sweep period!</span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">If you have any questions or concerns, please
feel free to contact me directly or reach out to SCAN’s HCI Representative:<o:p></o:p></span></div>
<div class="MsoListParagraph" style="mso-list: l0 level1 lfo5; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Michelle Nguyen: </span><a href="mailto:MNguyen3@scanhealthplan.com"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">MNguyen3@scanhealthplan.com</span></a><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif";">Best regards,<o:p></o:p></span></div>
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<br /></div>
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<b><span style="color: #002060;">Christina Cabiltes<o:p></o:p></span></b></div>
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<span style="color: #404040; font-size: 9.0pt;">Supervisor, HCI
Projects, CCabiltes@scanhealthplan.com<o:p></o:p></span></div>
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<span style="color: #404040; font-size: 9.0pt;"><br /></span></div>
Stacey Hernandezhttp://www.blogger.com/profile/12799819464802934448noreply@blogger.com0tag:blogger.com,1999:blog-2464913347731009629.post-82543394869903569772018-01-02T08:35:00.001-08:002018-01-02T08:35:47.810-08:00Urgent Notice from our Encounter Data Team- January And March 2018 SweepsBelow is a notice sent to our provider partners regarding the upcoming Encounter Data Sweeps:<br />
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Hello SCAN Provider Partners,</span><o:p></o:p></div>
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<br /></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">The January CMS Encounter Data Sweep is
approaching. <b><i><u>TODAY</u> </i></b>is SCAN’s Target Date for submission of
2016 DOS! This is the <b><span style="color: red;">FINAL</span></b><span style="color: red;"> </span>CMS sweep impacting 2016 DOS (2017 payment) and
requires the submission of encounters for DOS range<span style="color: #1f497d;">
</span>01/01/2016 </span><span style="font-family: Wingdings; font-size: 10.0pt;">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">12/31/2016<span style="color: #1f497d;">.</span> CMS currently plans a 75% RAPS and Fee for
Service and 25% EDS and Fee for Service blended risk score based on 2016 DOS.<span style="color: #1f497d;"><o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Additionally, we are now <b><u><span style="color: red;">4</span></u></b> 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 </span><span style="font-family: Wingdings; font-size: 10.0pt;">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">12/31/2017. CMS
currently plans a 85% RAPS and Fee for Service and 15% EDS and Fee for Service
blended risk score based on 2017 DOS.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">SCAN has two dates for you to manage towards
for the January 2018 sweep:</span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Target Date</span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> for Provider Partners: EOB Friday, <b><span style="background: yellow; mso-highlight: yellow;">December 29, 2017</span></b></span><o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">This target date
ensures that SCAN has adequate time to complete processing prior to the health
plan cut-off date by CMS</span><o:p></o:p></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Deadline</span></b><span style="color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; color: red; mso-highlight: yellow;">January 26, 2018</span></b></span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">After this deadline,
SCAN will <b><i>NOT</i></b> process any files received for the January CMS
sweep</span><o:p></o:p></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">SCAN has two dates for you to manage towards
for the March 2018 sweep:</span><o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Target Date</span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> for Provider Partners: EOB Friday, <b><span style="background: yellow; mso-highlight: yellow;">January 26, 2018</span></b></span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">This target date
ensures that SCAN has adequate time to complete processing prior to the health
plan cut-off date by CMS</span><o:p></o:p></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Deadline</span></b><span style="color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; color: red; mso-highlight: yellow;">February 23, 2018</span></b></span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">After this deadline,
SCAN will <b><i>NOT</i></b> process any files received for the March CMS sweep</span><o:p></o:p></div>
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<b><u><span style="background: lime; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: lime;">7 STEPS YOU CAN TAKE TO PREPARE:</span></u></b><o:p></o:p></div>
<ol start="1" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Review your SCAN monthly Encounter Submission Reports</span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">
<o:p></o:p></span></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">December reports were uploaded to the SCAN Encounter
Data Portal on 12/08/2017. The next ESRs will be uploaded the first week
of January 2018.</span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
</ol>
</ol>
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<br /></div>
<div class="MsoListParagraph" style="mso-list: l3 level1 lfo2; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;">2.<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Review your SCAN
Encounter HCC Reconciliation Reports </span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<ol start="2" style="margin-top: 0in;" type="1">
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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 </span><i><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">SCAN Documents tab -> HCCs
and Encounters.</span></i><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
</ol>
</ol>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> <b> </b></span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<ol start="3" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Review your SCAN All DX Reconciliation reports</span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">
<o:p></o:p></span></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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 </span><i><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">SCAN Documents tab -> HCCs
and Encounters.</span></i><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
</ol>
</ol>
<div class="MsoNormal" style="margin-left: 1.5in; mso-list: l3 level3 lfo2; text-autospace: none; text-indent: -9.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">QUESTION</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: What is the All
Diagnoses (DX) Reconciliation report? </span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.5in; mso-list: l3 level3 lfo2; text-autospace: none; text-indent: -9.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">ANSWER</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: A report containing
all diagnosis codes received from your group for dates of service 01/01/2016
-> 12/31/2016</span><span style="font-family: "Arial","sans-serif";"> and </span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">01/01/2017 ->
12/31/2017.</span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<ol start="3" style="margin-top: 0in;" type="1">
<ol start="2" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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.</span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
</ol>
</ol>
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<br /></div>
<ol start="4" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Review your SCAN PCN Reconciliation report</span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">s<o:p></o:p></span></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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 </span><i><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">SCAN Documents tab -> HCCs
and Encounters.</span></i><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
</ol>
</ol>
<div class="MsoListParagraph" style="margin-left: 1.5in; mso-list: l1 level1 lfo3; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">QUESTION</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: What is the Patient Control Number (PCN)
Reconciliation report? </span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 1.5in; mso-list: l1 level1 lfo3; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">ANSWER</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: A report containing a list of all the PCNs
received from your group for dates of service 01/01/2016 -> 12/31/2016</span><span style="font-family: "Arial","sans-serif";"> and </span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">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</span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<ol start="4" style="margin-top: 0in;" type="1">
<ol start="2" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">If you are already reconciling against the PCN report,
then continue to do so and provide an update on results as soon as
available.</span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
</ol>
</ol>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">*<i>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.</i></span><i><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></i></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="background: lime; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: lime;">Additional
Steps:</span></b><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<ol start="5" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Work your clearinghouse rejections via OfficeAlly,
Ability Network, or Change Healthcare </span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
</ol>
<div class="MsoNormal">
<br /></div>
<ol start="6" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Upload all ICE alternative submission files to SCAN via
the Encounter Data Portal (</span><a href="http://providerportal.scanhealthplan.com/"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">providerportal.scanhealthplan.com</span></a><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">) using the File Transmission link</span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">
<o:p></o:p></span></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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. </span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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.</span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Send these files sooner than later; <i><u>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.</u></i></span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">ICE files should only be used to submit additional DX
codes or deletes of DX codes.</span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
</ol>
</ol>
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<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">SCAN expects to receive all original encounter data
records via your normal clearinghouse workflow.</span></b><b><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></b></div>
<div class="MsoListParagraph" style="margin-left: 1.0in; text-autospace: none;">
<br /></div>
<ol start="7" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Follow up on additional cleanup requests (contact your
respective HCI representative with your direct questions)</span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";">
<o:p></o:p></span></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Provider Name Mismatch (PNM) rejection reports</span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Rendering Provider/Entity (RPX) rejection reports</span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">EDS Full Encounter Data rejection reports</span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Invalid DX rejection reports</span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">ICE File Pend reports</span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
</ol>
</ol>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><u><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">What are the Timelines?</span></u></b><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<ol start="1" style="margin-top: 0in;" type="1">
<li class="MsoNormal" style="color: #1f497d; mso-list: l4 level1 lfo4; text-autospace: none;"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Submit all
01/01/2016 -> 12/31/2016 DOS encounters to your Clearinghouse: <b><i><u><span style="background: yellow; mso-highlight: yellow;">12/29/2017</span></u></i></b></span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Last day for ICE file submissions of
additions/deletions of DX codes for 01/01/2016<span style="color: #1f497d;">
</span>-> 12/31/2016 to SCAN: <b><i><u><span style="background: yellow; mso-highlight: yellow;">12/29/2017</span></u></i></b></span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">January<span style="color: #1f497d;"> </span>CMS Sweep
deadline for SCAN: 01/31/2018</span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
<li class="MsoNormal" style="color: #1f497d; mso-list: l4 level1 lfo4; text-autospace: none;"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Submit all
01/01/2017 -> 12/31/2017 DOS encounters to your Clearinghouse: <b><i><u><span style="background: yellow; mso-highlight: yellow;">01/26/2018</span></u></i></b></span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Last day for ICE file submissions of
additions/deletions of DX codes for 01/01/2017 -> 12/31/2017 to SCAN: <b><i><u><span style="background: yellow; mso-highlight: yellow;">02/23/2018</span></u></i></b></span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">March<span style="color: #1f497d;"> </span>CMS Sweep
deadline for SCAN: 03/02/2018</span><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></li>
</ol>
<div class="MsoNormal" style="margin-left: .25in; text-autospace: none;">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">* Remember: SCAN has two dates for provider
partners to manage towards for the January and March Sweep</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">:<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">January Sweep SCAN Target Date</span></b><b><span style="color: #1f497d; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; mso-highlight: yellow;">December
29, 2017</span></b></span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">This target date
ensures that SCAN has adequate time to complete processing prior to the health
plan cut-off date by CMS</span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 1.0in; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">January Sweep SCAN Deadline</span></b><span style="color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; color: red; mso-highlight: yellow;">January 26, 2018</span></b></span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">After this deadline,
SCAN will <b><i>NOT</i> </b>process any files received for the January CMS
sweep</span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">March Sweep SCAN Target Date</span></b><b><span style="color: #1f497d; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; mso-highlight: yellow;">January
26, 2018</span></b></span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">This target date
ensures that SCAN has adequate time to complete processing prior to the health
plan cut-off date by CMS</span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 1.0in; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">March Sweep SCAN Deadline</span></b><span style="color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; color: red; mso-highlight: yellow;">February 23, 2018</span></b></span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">After this deadline,
SCAN will <b><i>NOT</i> </b>process any files received for the March CMS sweep</span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Please be prepared for continued
communication from SCAN. We look forward to supporting and working with you
during this upcoming sweep period!</span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">If you have any questions or concerns, please
feel free to contact me directly or reach out to SCAN’s HCI Representative:<o:p></o:p></span></div>
<div class="MsoListParagraph" style="mso-list: l0 level1 lfo5; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Michelle Nguyen: </span><a href="mailto:MNguyen3@scanhealthplan.com"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">MNguyen3@scanhealthplan.com</span></a><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<div class="MsoListParagraph">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif";">Best regards,<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<br />
<div class="MsoNormal">
<b><span style="color: #002060;">Christina Cabiltes<o:p></o:p></span></b></div>
Stacey Hernandezhttp://www.blogger.com/profile/12799819464802934448noreply@blogger.com0tag:blogger.com,1999:blog-2464913347731009629.post-25908491073446977292017-12-04T09:07:00.001-08:002017-12-04T09:07:52.687-08:00An Important Message From Our Encounter Data Team About the January and March Sweeps<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Hello SCAN Provider Partners,</span><o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">The January CMS Encounter Data Sweep is
approaching. We are <b><u><span style="color: red;">4</span></u></b><span style="color: red;"> </span>weeks away from SCAN’s Target Date! This is the <b><span style="color: red;">FINAL</span></b><span style="color: red;"> </span>CMS sweep
impacting 2016 DOS (2017 payment) and requires the submission of encounters for
DOS range<span style="color: #1f497d;"> </span>01/01/2016 </span><span style="font-family: Wingdings; font-size: 10.0pt;">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">12/31/2016<span style="color: #1f497d;">.</span>
CMS currently plans a 75% RAPS and Fee for Service and 25% EDS and Fee for
Service blended risk score based on 2016 DOS.<span style="color: #1f497d;"><o:p></o:p></span></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Additionally, we are now <b><u><span style="color: red;">8</span></u></b> 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 </span><span style="font-family: Wingdings; font-size: 10.0pt;">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">12/31/2017. CMS
currently plans a 85% RAPS and Fee for Service and 15% EDS and Fee for Service
blended risk score based on 2017 DOS.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">SCAN has two dates for you to manage towards
for the January 2018 sweep:</span><o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Target Date</span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> for Provider Partners: EOB Friday, <b><span style="background: yellow; mso-highlight: yellow;">December 29, 2017</span></b></span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">This target date
ensures that SCAN has adequate time to complete processing prior to the health
plan cut-off date by CMS</span><o:p></o:p></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Deadline</span></b><span style="color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; color: red; mso-highlight: yellow;">January 26, 2018</span></b></span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">After this deadline,
SCAN will <b><i>NOT</i></b> process any files received for the January CMS
sweep</span><o:p></o:p></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">SCAN has two dates for you to manage towards
for the March 2018 sweep:</span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Target Date</span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> for Provider Partners: EOB Friday, <b><span style="background: yellow; mso-highlight: yellow;">January 26, 2018</span></b></span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">This target date
ensures that SCAN has adequate time to complete processing prior to the health
plan cut-off date by CMS</span><o:p></o:p></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Deadline</span></b><span style="color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; color: red; mso-highlight: yellow;">February 23, 2018</span></b></span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">After this deadline,
SCAN will <b><i>NOT</i></b> process any files received for the March CMS sweep</span><o:p></o:p></div>
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<div class="Default">
<b><u><span style="background: lime; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: lime;">7 STEPS YOU CAN TAKE TO PREPARE:</span></u></b><o:p></o:p></div>
<ol start="1" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Review your SCAN monthly Encounter Submission Reports</span> <o:p></o:p></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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.</span><o:p></o:p></li>
</ol>
</ol>
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<br /></div>
<div class="MsoListParagraph" style="mso-list: l3 level1 lfo2; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]-->2.<span style="font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Review
your SCAN Encounter HCC Reconciliation Reports </span><o:p></o:p></div>
<ol start="2" style="margin-top: 0in;" type="1">
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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 </span><i>SCAN
Documents tab -> HCCs and Encounters.</i><o:p></o:p></li>
</ol>
</ol>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> <b> </b></span><o:p></o:p></div>
<ol start="3" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Review your SCAN All DX Reconciliation reports</span> <o:p></o:p></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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 </span><i>SCAN
Documents tab -> HCCs and Encounters.</i><o:p></o:p></li>
</ol>
</ol>
<div class="MsoNormal" style="margin-left: 1.5in; mso-list: l3 level3 lfo2; text-autospace: none; text-indent: -9.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">QUESTION</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: What is the All
Diagnoses (DX) Reconciliation report? </span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.5in; mso-list: l3 level3 lfo2; text-autospace: none; text-indent: -9.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">ANSWER</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: A report containing
all diagnosis codes received from your group for dates of service 01/01/2016 </span><span style="font-family: Wingdings; font-size: 10.0pt;">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> 12/31/2016</span> or <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">01/01/2017 </span><span style="font-family: Wingdings; font-size: 10.0pt;">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> 12/31/2017.</span><o:p></o:p></div>
<ol start="3" style="margin-top: 0in;" type="1">
<ol start="2" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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.</span><o:p></o:p></li>
</ol>
</ol>
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<br /></div>
<ol start="4" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Review your SCAN PCN Reconciliation report</span>s<o:p></o:p></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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 </span><i>SCAN
Documents tab -> HCCs and Encounters.</i><o:p></o:p></li>
</ol>
</ol>
<div class="MsoListParagraph" style="margin-left: 1.5in; mso-list: l1 level1 lfo3; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">QUESTION</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: What is the Patient Control Number (PCN)
Reconciliation report? </span><o:p></o:p></div>
<div class="MsoListParagraph" style="margin-left: 1.5in; mso-list: l1 level1 lfo3; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">ANSWER</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: A report containing a list of all the PCNs
received from your group for dates of service 01/01/2016 </span><span style="font-family: Wingdings; font-size: 10.0pt;">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> 12/31/2016</span> or <span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">01/01/2017 </span><span style="font-family: Wingdings; font-size: 10.0pt;">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> 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</span><o:p></o:p></div>
<ol start="4" style="margin-top: 0in;" type="1">
<ol start="2" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">If you are already reconciling against the PCN report,
then continue to do so and provide an update on results as soon as
available.</span><o:p></o:p></li>
</ol>
</ol>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">*<i>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.</i></span><i><o:p></o:p></i></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="background: lime; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: lime;">Additional
Steps:</span></b><o:p></o:p></div>
<ol start="5" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Work your clearinghouse rejections via OfficeAlly,
Ability Network, or Change Healthcare </span><o:p></o:p></li>
</ol>
<div class="MsoNormal">
<br /></div>
<ol start="6" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Upload all ICE alternative submission files to SCAN via
the Encounter Data Portal (</span><a href="http://providerportal.scanhealthplan.com/"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">providerportal.scanhealthplan.com</span></a><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">) using the File Transmission link</span> <o:p></o:p></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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. </span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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.</span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Send these files sooner than later; <i><u>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<sup>th</sup>
to upload your 2017 DOS files for the March Sweep.</u></i></span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">ICE files should only be used to submit additional DX codes
or deletes of DX codes.</span><o:p></o:p></li>
</ol>
</ol>
<div class="MsoNormal" style="margin-left: 1.5in; mso-list: l3 level3 lfo2; text-autospace: none; text-indent: -9.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">SCAN expects to receive all original encounter data
records via your normal clearinghouse workflow.</span><o:p></o:p></b></div>
<div class="MsoListParagraph" style="margin-left: 1.0in; text-autospace: none;">
<br /></div>
<ol start="7" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Follow up on additional cleanup requests (contact your
respective HCI representative with your direct questions)</span> <o:p></o:p></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Provider Name Mismatch (PNM) rejection reports</span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Rendering Provider/Entity (RPX) rejection reports</span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">EDS Full Encounter Data rejection reports</span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Invalid DX rejection reports</span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">ICE File Pend reports</span><o:p></o:p></li>
</ol>
</ol>
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<div class="MsoNormal">
<b><u><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">What are the Timelines?</span></u></b><o:p></o:p></div>
<ol start="1" style="margin-top: 0in;" type="1">
<li class="MsoNormal" style="color: #1f497d; mso-list: l4 level1 lfo4; text-autospace: none;"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Submit all
01/01/2016 </span><span style="color: windowtext; font-family: Wingdings; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">à</span><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"> 12/31/2016 DOS encounters to your
Clearinghouse: <b><i><u><span style="background: yellow; mso-highlight: yellow;">12/29/2017</span></u></i></b></span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Last day for ICE file submissions of
additions/deletions of DX codes for 01/01/2016 </span><span style="font-family: Wingdings; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"> 12/31/2016 to SCAN: <b><i><u><span style="background: yellow; mso-highlight: yellow;">12/29/2017</span></u></i></b></span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">January<span style="color: #1f497d;"> </span>CMS Sweep
deadline for SCAN: 01/31/2018</span><o:p></o:p></li>
<li class="MsoNormal" style="color: #1f497d; mso-list: l4 level1 lfo4; text-autospace: none;"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Submit all
01/01/2017 </span><span style="color: windowtext; font-family: Wingdings; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">à</span><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"> 12/31/2017 DOS encounters to your
Clearinghouse: <b><i><u><span style="background: yellow; mso-highlight: yellow;">01/26/2018</span></u></i></b></span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Last day for ICE file submissions of
additions/deletions of DX codes for 01/01/2017 </span><span style="font-family: Wingdings; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"> 12/31/2017 to SCAN: <b><i><u><span style="background: yellow; mso-highlight: yellow;">02/23/2018</span></u></i></b></span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">March<span style="color: #1f497d;"> </span>CMS Sweep
deadline for SCAN: 03/02/2018</span><o:p></o:p></li>
</ol>
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<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">* Remember: SCAN has two dates for provider
partners to manage towards for the January and March Sweep</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">:<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">January Sweep SCAN Target Date</span></b><b><span style="color: #1f497d; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; mso-highlight: yellow;">December
29, 2017</span></b></span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">This target date
ensures that SCAN has adequate time to complete processing prior to the health
plan cut-off date by CMS</span><o:p></o:p></div>
<div class="MsoListParagraph" style="margin-left: 1.0in; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">January Sweep SCAN Deadline</span></b><span style="color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; color: red; mso-highlight: yellow;">January 26, 2018</span></b></span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">After this deadline,
SCAN will <b><i>NOT</i> </b>process any files received for the January CMS
sweep</span><o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">March Sweep SCAN Target Date</span></b><b><span style="color: #1f497d; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; mso-highlight: yellow;">January
26, 2018</span></b></span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">This target date
ensures that SCAN has adequate time to complete processing prior to the health
plan cut-off date by CMS</span><o:p></o:p></div>
<div class="MsoListParagraph" style="margin-left: 1.0in; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">March Sweep SCAN Deadline</span></b><span style="color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; color: red; mso-highlight: yellow;">February 23, 2018</span></b></span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">After this deadline,
SCAN will <b><i>NOT</i> </b>process any files received for the March CMS sweep</span><o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Please be prepared for continued
communication from SCAN. We look forward to supporting and working with you
during this upcoming sweep period!</span><o:p></o:p></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><o:p></o:p></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">If you have any questions or concerns, please
feel free to contact me directly or reach out to SCAN’s HCI Representative:<o:p></o:p></span></div>
<div class="MsoListParagraph" style="mso-list: l0 level1 lfo5; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Michelle Nguyen: </span><a href="mailto:MNguyen3@scanhealthplan.com"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">MNguyen3@scanhealthplan.com</span></a><o:p></o:p></div>
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<br /></div>
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Best regards,<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="color: #002060;">Christina Cabiltes<o:p></o:p></span></b></div>
<br />
<div class="MsoNormal">
<span style="color: #404040; font-size: 9.0pt;">Supervisor, HCI
Projects<o:p></o:p></span></div>
Stacey Hernandezhttp://www.blogger.com/profile/12799819464802934448noreply@blogger.com0tag:blogger.com,1999:blog-2464913347731009629.post-20913038119994412752017-11-22T11:59:00.000-08:002017-11-22T11:59:04.399-08:00A Special Message From Our Encounter Data Team About Data Submission<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Hello SCAN Provider Partners,</span><o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">The January CMS Encounter Data Sweep is
approaching. We are <b><u><span style="color: red;">5</span></u></b><span style="color: red;"> </span>weeks away from SCAN’s Target Date! This is the <b><span style="color: red;">FINAL</span></b><span style="color: red;"> </span>CMS sweep
impacting 2016 DOS (2017 payment) and requires the submission of encounters for
DOS range<span style="color: #1f497d;"> </span>01/01/2016 </span><span style="font-family: Wingdings; font-size: 10.0pt;">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> 12/31/2016<span style="color: #1f497d;">.</span>
CMS currently plans a 75% RAPS and Fee for Service and 25% EDS and Fee for
Service blended risk score based on 2016 DOS.</span><span style="color: #1f497d;"><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">SCAN has two dates for you to manage towards:</span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Target Date</span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> for Provider Partners: EOB Friday, <b><span style="background: yellow; mso-highlight: yellow;">December 29, 2017</span></b></span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">This target date
ensures that SCAN has adequate time to complete processing prior to the health
plan cut-off date by CMS</span><o:p></o:p></div>
<div class="MsoListParagraph" style="margin-left: 1.0in; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Deadline</span></b><span style="color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; color: red; mso-highlight: yellow;">January 26, 2018</span></b></span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">After this deadline,
SCAN will <b><i>NOT</i></b> process any files received for the January CMS
sweep</span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; text-autospace: none;">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="Default">
<b><u><span style="background: lime; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: lime;">7 STEPS YOU CAN TAKE TO PREPARE:</span></u></b><o:p></o:p></div>
<ol start="1" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Review your SCAN monthly Encounter Submission Reports</span> <o:p></o:p></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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.</span><o:p></o:p></li>
</ol>
</ol>
<div class="MsoListParagraph" style="margin-left: 1.0in; text-autospace: none;">
<br /></div>
<div class="MsoListParagraph" style="mso-list: l3 level1 lfo2; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]-->2.<span style="font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Review
your SCAN Encounter HCC Reconciliation Reports </span><o:p></o:p></div>
<ol start="2" style="margin-top: 0in;" type="1">
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">This report is available to you monthly. If you would
like to utilize this report for the January Sweep, please access the EDP </span><i>SCAN Documents tab
-> HCCs and Encounters.</i><o:p></o:p></li>
</ol>
</ol>
<div class="MsoListParagraph" style="margin-left: 1.0in; mso-list: l3 level2 lfo2; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]-->b.<span style="font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Reports with dates
specific to the January CMS sweep dates 01/01/2016 </span><span style="font-family: Wingdings; font-size: 10.0pt;">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> 12/31/2016 will be uploaded before
end of week 11/13/17.</span><o:p></o:p></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> <b> </b></span><o:p></o:p></div>
<ol start="3" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Review your SCAN All DX Reconciliation reports</span> <o:p></o:p></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">This report is available to you monthly. If you would
like to utilize this report for the January Sweep, please access the EDP </span><i>SCAN Documents tab
-> HCCs and Encounters.</i><o:p></o:p></li>
</ol>
</ol>
<div class="MsoNormal" style="margin-left: 1.5in; mso-list: l3 level3 lfo2; text-autospace: none; text-indent: -9.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">QUESTION</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: What is the All
Diagnoses (DX) Reconciliation report? </span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.5in; mso-list: l3 level3 lfo2; text-autospace: none; text-indent: -9.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">ANSWER</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: A report containing
all diagnosis codes received from your group for dates of service 01/01/2016 </span><span style="font-family: Wingdings; font-size: 10.0pt;">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> 12/31/2016</span>.<o:p></o:p></div>
<ol start="3" style="margin-top: 0in;" type="1">
<ol start="2" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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.</span><o:p></o:p></li>
</ol>
</ol>
<div class="MsoListParagraph" style="margin-left: 1.0in; text-autospace: none;">
<br /></div>
<ol start="4" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Review your SCAN PCN Reconciliation report</span>s<o:p></o:p></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">This report is available to you monthly. If you would
like to utilize this report for the January Sweep, please access the EDP </span><i>SCAN Documents tab
-> HCCs and Encounters.</i><o:p></o:p></li>
</ol>
</ol>
<div class="MsoListParagraph" style="margin-left: 1.5in; mso-list: l1 level1 lfo3; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">QUESTION</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: What is the Patient Control Number (PCN)
Reconciliation report? </span><o:p></o:p></div>
<div class="MsoListParagraph" style="margin-left: 1.5in; mso-list: l1 level1 lfo3; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">ANSWER</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: A report containing a list of all the PCNs
received from your group for dates of service 01/01/2016 </span><span style="font-family: Wingdings; font-size: 10.0pt;">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> 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</span><o:p></o:p></div>
<ol start="4" style="margin-top: 0in;" type="1">
<ol start="2" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">If you are already reconciling against the PCN report,
then continue to do so and provide an update on results as soon as
available.</span><o:p></o:p></li>
</ol>
</ol>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">*<i>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.</i></span><i><o:p></o:p></i></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="background: lime; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: lime;">Additional
Steps:</span></b><o:p></o:p></div>
<ol start="5" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Work your clearinghouse rejections via OfficeAlly,
Ability Network, or Change Healthcare </span><o:p></o:p></li>
</ol>
<div class="MsoNormal">
<br /></div>
<ol start="6" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Upload all ICE alternative submission files to SCAN via
the Encounter Data Portal (</span><a href="http://providerportal.scanhealthplan.com/"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">providerportal.scanhealthplan.com</span></a><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">) using the File Transmission link</span> <o:p></o:p></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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. </span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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.</span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Send these files sooner than later; <i><u>please do
not to wait until December 29, 2017 to upload your files.</u></i></span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">ICE files should only be used to submit additional DX
codes or deletes of DX codes.</span><o:p></o:p></li>
</ol>
</ol>
<div class="MsoNormal" style="margin-left: 1.5in; mso-list: l3 level3 lfo2; text-autospace: none; text-indent: -9.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">SCAN expects to receive all original encounter data
records via your normal clearinghouse workflow.</span><o:p></o:p></b></div>
<div class="MsoListParagraph" style="margin-left: 1.0in; text-autospace: none;">
<br /></div>
<ol start="7" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Follow up on additional cleanup requests (contact your
respective HCI representative with your direct questions)</span> <o:p></o:p></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Provider Name Mismatch (PNM) rejection reports</span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Rendering Provider/Entity (RPX) rejection reports</span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">EDS Full Encounter Data rejection reports</span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Invalid DX rejection reports</span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">ICE File Pend reports</span><o:p></o:p></li>
</ol>
</ol>
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<br /></div>
<div class="MsoNormal">
<b><u><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">What are the Timelines?</span></u></b><o:p></o:p></div>
<ol start="1" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Submit all 01/01/2016 </span><span style="font-family: Wingdings; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"> 12/31/2016 DOS encounters to your Clearinghouse: <b><i><u><span style="background: yellow; mso-highlight: yellow;">12/29/2017</span></u></i></b></span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Last day for ICE file submissions of
additions/deletions of DX codes for 01/01/2016 </span><span style="font-family: Wingdings; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"> 12/31/2016 to SCAN: <b><i><u><span style="background: yellow; mso-highlight: yellow;">12/29/2017</span></u></i></b></span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">CMS Sweep deadline for SCAN: 01/31/2018</span><o:p></o:p></li>
</ol>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">* Remember: SCAN has two dates for provider
partners to manage towards</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">:<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Target Date</span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> for Provider Partners: EOB Friday, <b><span style="background: yellow; mso-highlight: yellow;">December 29, 2017</span></b></span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">This target date
ensures that SCAN has adequate time to complete processing prior to the health
plan cut-off date by CMS</span><o:p></o:p></div>
<div class="MsoListParagraph" style="margin-left: 1.0in; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Deadline</span></b><span style="color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; color: red; mso-highlight: yellow;">January 26, 2018</span></b></span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo1; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">After this deadline,
SCAN will <b><i>NOT</i> </b>process any files received for the January CMS
sweep</span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: .25in; text-autospace: none;">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Please be prepared for continued
communication from SCAN. We look forward to supporting and working with you
during this upcoming sweep period!</span><o:p></o:p></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><o:p></o:p></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">If you have any questions or concerns, please
feel free to contact me directly or reach out to SCAN’s HCI Representative:<o:p></o:p></span></div>
<div class="MsoListParagraph" style="mso-list: l0 level1 lfo5; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Michelle Nguyen: </span><a href="mailto:MNguyen3@scanhealthplan.com"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">MNguyen3@scanhealthplan.com</span></a><o:p></o:p></div>
<div class="MsoListParagraph">
<br /></div>
<div class="MsoNormal">
Best regards,<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="color: #002060;">Christina Cabiltes<o:p></o:p></span></b></div>
<br />
<div class="MsoNormal">
<span style="color: #404040; font-size: 9.0pt;">Supervisor, HCI
Projects<o:p></o:p></span></div>
Stacey Hernandezhttp://www.blogger.com/profile/12799819464802934448noreply@blogger.com0tag:blogger.com,1999:blog-2464913347731009629.post-48876026548923746402017-11-16T11:28:00.000-08:002017-11-16T11:28:37.907-08:00AHRQ and HealthIT.Gov Post EMR Information<div class="MsoNormal">
The Agency for Healthcare Research and Quality (AHRQ) has
posted an <a href="https://psnet.ahrq.gov/primers/primer/43?utm_source=ahrq&utm_medium=en20&utm_term=&utm_content=20&utm_campaign=ahrq_en11_14_2017">Electronic
Health Record (EHR) primer for physicians and hospitals</a>. This
primer provides guidance for providers in the use of EMRs. The AHRQ’s
mission: <o:p></o:p></div>
<div class="MsoNormal">
<b>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</b>. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The AHRQ primer references the Safety Assurance Factors for
EHR Resilience (SAFER) guides, developed by <a href="https://www.healthit.gov/">HealthIT.gov</a>,
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. <o:p></o:p></div>
<div class="MsoNormal">
The SAFER guides provide an additional resource for
providers seeking information on EHRs. The following SAFER guides are available:<o:p></o:p></div>
<div class="MsoListParagraph" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><a href="https://www.healthit.gov/safer/sites/safer/files/guides/safer_high_priority_practices.pdf">High
Priority Practice</a><o:p></o:p></div>
<div class="MsoListParagraph" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><a href="https://www.healthit.gov/safer/sites/safer/files/guides/safer_contingency_planning.pdf">Contingency
Planning</a><o:p></o:p></div>
<div class="MsoListParagraph" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><a href="https://www.healthit.gov/safer/sites/safer/files/guides/safer_system_interfaces.pdf">System
Interfaces</a><o:p></o:p></div>
<div class="MsoListParagraph" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><a href="https://www.healthit.gov/safer/sites/safer/files/guides/safer_cpoe.pdf">Computerized
Provider Order Entry with Decision Support</a><o:p></o:p></div>
<div class="MsoListParagraph" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><a href="https://www.healthit.gov/safer/sites/safer/files/guides/safer_clinician_communication.pdf">Clinician
Communication</a><o:p></o:p></div>
<div class="MsoListParagraph" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><a href="https://www.healthit.gov/safer/sites/safer/files/guides/safer_organizational_responsibilities.pdf">Organizational
Responsibilities</a><o:p></o:p></div>
<div class="MsoListParagraph" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><a href="https://www.healthit.gov/safer/sites/safer/files/guides/safer_system_configuration.pdf">System
Configuration</a><o:p></o:p></div>
<div class="MsoListParagraph" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><a href="https://www.healthit.gov/safer/sites/safer/files/guides/safer_patient_identification.pdf">Patient
Identification</a><o:p></o:p></div>
<div class="MsoListParagraph" style="mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><a href="https://www.healthit.gov/sites/default/files/safer_test_results_reporting.pdf">Test
Results Reporting and Follow Up</a><o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Finally, AHRQ has developed free CME (1 CME unit for
American Board of Internal Medicine) and <span lang="EN">Medical Knowledge/Patient Safety credit (up to 45 MOC points).
There is a related CME program, <a href="https://psnet.ahrq.gov/webmm/case/398/The-Hazards-of-Distraction-Ticking-All-the-EHR-Boxes">The
Hazards of Distraction: Ticking All the EHR Boxes</a> available on the AHRQ
site (registration required).<o:p></o:p></span></div>
<span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><br />
We hope this information is helpful.</span>Stacey Hernandezhttp://www.blogger.com/profile/12799819464802934448noreply@blogger.com0tag:blogger.com,1999:blog-2464913347731009629.post-75014482018796537042017-08-07T12:02:00.001-07:002017-08-07T12:02:29.515-07:00Encounter Data UpdatesIn 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:<div>
<h1>
Encounter Data Processing<o:p></o:p></h1>
<h2>
Duplicate Logic<o:p></o:p></h2>
<div class="MsoNormal">
Last Updated: 8/7/2017 222 KB<o:p></o:p></div>
<div class="MsoNormal">
One page guide to assist encounter data staff submit
compliant encounters for CMS processing, and avoid duplicate line/encounter
rejects.<o:p></o:p></div>
<h2>
Swing Bed SNF Conditions Not Met<o:p></o:p></h2>
<div class="MsoNormal">
Last Updated: 8/7/2017 183 KB<o:p></o:p></div>
<div class="MsoNormal">
One page guide to assist encounter data staff submit
compliant SNF swing bed encounters for CMS processing.<o:p></o:p></div>
<h2>
Occurrence Code 55 and DOD Required<o:p></o:p></h2>
<div class="MsoNormal">
Last Updated: 8/7/2017 184 KB<o:p></o:p></div>
<div class="MsoNormal">
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.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
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---------------------------------------------------------------</div>
<div class="MsoNormal">
<span style="color: #8e7cc3; font-size: x-large;"><b><br /></b></span></div>
<div class="MsoNormal">
<span style="color: #8e7cc3; font-size: x-large;"><b>UPDATE On Sweep Dates</b></span></div>
<div class="MsoNormal">
<span style="color: #8e7cc3; font-size: x-large;"><b>*IMPORTANT* -- SCAN Dates for Upcoming September 2017 Encounter Data CMS Sweep</b></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Hello SCAN Provider Partners,</span><o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">The September CMS Encounter Data Sweep is
approaching. We are <b><u><span style="color: red;">1</span></u></b><span style="color: red;"> </span>weeks away from SCAN’s Target Date! This is the <b><span style="color: red;">INITIAL</span></b><span style="color: red;"> </span>CMS sweep
impacting 2017 DOS (2018 payment) and requires the submission of encounters for
DOS range:</span><o:p></o:p></div>
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">07/01/2016 </span><span style="font-family: Wingdings; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"> 06/30/2017</span><o:p></o:p></li>
</ul>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">SCAN has two dates for you to manage towards:</span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo2; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Target Date</span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> for Provider Partners: EOB Friday, <b><span style="background: yellow; mso-highlight: yellow;">August 11, 2017</span></b></span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo2; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">This target date
ensures that SCAN has adequate time to complete processing prior to the health
plan cut-off date by CMS</span><o:p></o:p></div>
<div class="MsoListParagraph" style="margin-left: 1.0in; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo2; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Deadline</span></b><span style="color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; color: red; mso-highlight: yellow;">September 1, 2017</span></b></span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo2; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">After this deadline,
SCAN will <b><i>NOT</i></b> process any files received for the September CMS
sweep</span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; text-autospace: none;">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="Default">
<b><u><span style="background: lime; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: lime;">7 STEPS YOU CAN TAKE TO PREPARE:</span></u></b><o:p></o:p></div>
<ol start="1" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Review your SCAN monthly Encounter Submission Reports</span> <o:p></o:p></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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.</span><o:p></o:p></li>
</ol>
</ol>
<div class="MsoListParagraph" style="margin-left: 1.0in; text-autospace: none;">
<br /></div>
<div class="MsoListParagraph" style="mso-list: l3 level1 lfo3; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]-->2.<span style="font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Review
your SCAN Encounter HCC Reconciliation Reports </span><o:p></o:p></div>
<ol start="2" style="margin-top: 0in;" type="1">
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">This report is available to you monthly. If you would
like to utilize this report for the September Sweep, please access the
EDP </span><i>SCAN
Documents tab -> HCCs and Encounters.</i><o:p></o:p></li>
</ol>
</ol>
<div class="MsoListParagraph" style="margin-left: 1.0in; mso-list: l3 level2 lfo3; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]-->b.<span style="font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Reports with dates
specific to the September CMS sweep dates 07/01/2016 </span><span style="font-family: Wingdings; font-size: 10.0pt;">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> 06/30/2017 will be uploaded before
end of week 07/14/17.</span><o:p></o:p></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> <b> </b></span><o:p></o:p></div>
<ol start="3" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Review your SCAN All DX Reconciliation Reports</span> <o:p></o:p></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">This report is available to you monthly. If you would
like to utilize this report for the September Sweep, please access the
EDP </span><i>SCAN
Documents tab -> HCCs and Encounters.</i><o:p></o:p></li>
</ol>
</ol>
<div class="MsoNormal" style="margin-left: 1.5in; mso-list: l3 level3 lfo3; text-autospace: none; text-indent: -9.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">QUESTION</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: What is the All
Diagnoses (DX) Reconciliation report? </span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.5in; mso-list: l3 level3 lfo3; text-autospace: none; text-indent: -9.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">ANSWER</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: A report containing
all diagnosis codes received from your group for dates of service 07/01/2016 </span><span style="font-family: Wingdings; font-size: 10.0pt;">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> 06/30/2017</span>.<o:p></o:p></div>
<ol start="3" style="margin-top: 0in;" type="1">
<ol start="2" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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.</span><o:p></o:p></li>
</ol>
</ol>
<div class="MsoListParagraph" style="margin-left: 1.0in; text-autospace: none;">
<br /></div>
<ol start="4" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Review your SCAN PCN Reconciliation Report</span>s<o:p></o:p></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">This report is available to you monthly. If you would
like to utilize this report for the September Sweep, please access the
EDP </span><i>SCAN
Documents tab -> HCCs and Encounters.</i><o:p></o:p></li>
</ol>
</ol>
<div class="MsoListParagraph" style="margin-left: 1.5in; mso-list: l1 level1 lfo4; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">QUESTION</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: What is the Patient Control Number (PCN)
Reconciliation report? </span><o:p></o:p></div>
<div class="MsoListParagraph" style="margin-left: 1.5in; mso-list: l1 level1 lfo4; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">ANSWER</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: A report containing a list of all the PCNs
received from your group for dates of service 07/01/2016 </span><span style="font-family: Wingdings; font-size: 10.0pt;">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> 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</span><o:p></o:p></div>
<ol start="4" style="margin-top: 0in;" type="1">
<ol start="2" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">If you are already reconciling against the PCN report,
then continue to do so and provide an update on results as soon as
available.</span><o:p></o:p></li>
</ol>
</ol>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">*<i>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.</i></span><i><o:p></o:p></i></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="background: lime; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: lime;">Additional
Steps:</span></b><o:p></o:p></div>
<ol start="5" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Work your clearinghouse rejections via OfficeAlly,
Ability Network, or Change Healthcare </span><o:p></o:p></li>
</ol>
<div class="MsoNormal">
<br /></div>
<ol start="6" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Upload all ICE alternative submission files to SCAN via
the Encounter Data Portal (</span><a href="http://providerportal.scanhealthplan.com/"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">providerportal.scanhealthplan.com</span></a><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">) using the File Transmission link</span> <o:p></o:p></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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. </span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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.</span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Send these files sooner than later; <i><u>please do
not to wait until September 1, 2017 to upload your files.</u></i></span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">ICE files should only be used to submit additional DX
codes or deletes of DX codes.</span><o:p></o:p></li>
</ol>
</ol>
<div class="MsoNormal" style="margin-left: 1.5in; mso-list: l3 level3 lfo3; text-autospace: none; text-indent: -9.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">SCAN expects to receive all original encounter data
records via your normal clearinghouse workflow.</span><o:p></o:p></b></div>
<div class="MsoListParagraph" style="margin-left: 1.0in; text-autospace: none;">
<br /></div>
<ol start="7" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Follow up on additional cleanup requests (contact your
respective encounter data representative with your direct questions)</span> <o:p></o:p></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Provider Name Mismatch (PNM) rejection reports</span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Rendering Provider/Entity (RPX) rejection reports</span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">EDS Full Encounter Data rejection reports</span><o:p></o:p></li>
</ol>
</ol>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><u><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">What are the Timelines?</span></u></b><o:p></o:p></div>
<ol start="1" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Submit all 07/01/2016 </span><span style="font-family: Wingdings; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"> 06/30/2017 DOS encounters to your Clearinghouse: <b><i><u><span style="background: yellow; mso-highlight: yellow;">08/11/2017</span></u></i></b></span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Last day for ICE file submissions of
additions/deletions of DX codes for 07/01/2016 </span><span style="font-family: Wingdings; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"> 06/30/2017 to SCAN: <b><i><u><span style="background: yellow; mso-highlight: yellow;">08/11/2017</span></u></i></b></span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">CMS Sweep deadline for SCAN: 09/08/2017</span><o:p></o:p></li>
</ol>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">* Remember: SCAN has two dates for provider
partners to manage towards</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">:<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo2; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Target Date</span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> for Provider Partners: EOB Friday, <b><span style="background: yellow; mso-highlight: yellow;">August 11, 2017</span></b></span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo2; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">This target date
ensures that SCAN has adequate time to complete processing prior to the health
plan cut-off date by CMS</span><o:p></o:p></div>
<div class="MsoListParagraph" style="margin-left: 1.0in; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo2; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Deadline</span></b><span style="color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; color: red; mso-highlight: yellow;">September 1, 2017</span></b></span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo2; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">After this deadline,
SCAN will <b><i>NOT</i> </b>process any files received for the September CMS
sweep</span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: .25in; text-autospace: none;">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Please be prepared for continued
communication from SCAN. We look forward to supporting and working with you
during this upcoming sweep period!</span><o:p></o:p></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><o:p></o:p></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">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:p></o:p></span></div>
<div class="MsoListParagraph" style="mso-list: l0 level1 lfo6; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Michelle Nguyen: </span><a href="mailto:MNguyen3@scanhealthplan.com">MNguyen3@scanhealthplan.com</a><o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Best regards,<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="color: #002060;">Christina Cabiltes<o:p></o:p></span></b></div>
<div class="MsoNormal">
</div>
<div class="MsoNormal">
<span style="color: #404040; font-size: 9.0pt;">Supervisor, HCI
Projects<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="color: #8e7cc3; font-size: x-large;"><b><br /></b></span></div>
</div>
Stacey Hernandezhttp://www.blogger.com/profile/12799819464802934448noreply@blogger.com0tag:blogger.com,1999:blog-2464913347731009629.post-20133148316323632782017-07-25T10:51:00.001-07:002017-07-25T10:51:13.970-07:00Updated Reminder from our Encounter Team<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Hello SCAN Provider Partners,</span><o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">The September CMS Encounter Data Sweep is
approaching. We are <b><u><span style="color: red;">3</span></u></b><span style="color: red;"> </span>weeks away from SCAN’s Target Date! This is the <b><span style="color: red;">INITIAL</span></b><span style="color: red;"> </span>CMS sweep
impacting 2017 DOS (2018 payment) and requires the submission of encounters for
DOS range:</span><o:p></o:p></div>
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<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">07/01/2016 </span><span style="font-family: Wingdings; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"> 06/30/2017</span><o:p></o:p></li>
</ul>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">SCAN has two dates for you to manage towards:</span><o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Target Date</span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> for Provider Partners: EOB Friday, <b><span style="background: yellow; mso-highlight: yellow;">August 11, 2017</span></b></span><o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">This target date
ensures that SCAN has adequate time to complete processing prior to the health
plan cut-off date by CMS</span><o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Deadline</span></b><span style="color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; color: red; mso-highlight: yellow;">September 1, 2017</span></b></span><o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">After this deadline,
SCAN will <b><i>NOT</i></b> process any files received for the September CMS
sweep</span><o:p></o:p></div>
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<b><u><span style="background: lime; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: lime;">7 STEPS YOU CAN TAKE TO PREPARE:</span></u></b><o:p></o:p></div>
<ol start="1" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Review your SCAN monthly Encounter Submission Reports</span> <o:p></o:p></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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.</span><o:p></o:p></li>
</ol>
</ol>
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<!--[if !supportLists]-->2.<span style="font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Review
your SCAN Encounter HCC Reconciliation Reports </span><o:p></o:p></div>
<ol start="2" style="margin-top: 0in;" type="1">
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">This report is available to you monthly. If you would
like to utilize this report for the September Sweep, please access the
EDP </span><i>SCAN
Documents tab -> HCCs and Encounters.</i><o:p></o:p></li>
</ol>
</ol>
<div class="MsoListParagraph" style="margin-left: 1.0in; mso-list: l3 level2 lfo3; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]-->b.<span style="font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Reports with dates
specific to the September CMS sweep dates 07/01/2016 </span><span style="font-family: Wingdings; font-size: 10.0pt;">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> 06/30/2017 will be uploaded before
end of week 07/14/17.</span><o:p></o:p></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> <b> </b></span><o:p></o:p></div>
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<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Review your SCAN All DX Reconciliation Reports</span> <o:p></o:p></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">This report is available to you monthly. If you would
like to utilize this report for the September Sweep, please access the
EDP </span><i>SCAN
Documents tab -> HCCs and Encounters.</i><o:p></o:p></li>
</ol>
</ol>
<div class="MsoNormal" style="margin-left: 1.5in; mso-list: l3 level3 lfo3; text-autospace: none; text-indent: -9.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">QUESTION</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: What is the All
Diagnoses (DX) Reconciliation report? </span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.5in; mso-list: l3 level3 lfo3; text-autospace: none; text-indent: -9.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">ANSWER</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: A report containing
all diagnosis codes received from your group for dates of service 07/01/2016 </span><span style="font-family: Wingdings; font-size: 10.0pt;">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> 06/30/2017</span>.<o:p></o:p></div>
<ol start="3" style="margin-top: 0in;" type="1">
<ol start="2" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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.</span><o:p></o:p></li>
</ol>
</ol>
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<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Review your SCAN PCN Reconciliation Report</span>s<o:p></o:p></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">This report is available to you monthly. If you would
like to utilize this report for the September Sweep, please access the
EDP </span><i>SCAN
Documents tab -> HCCs and Encounters.</i><o:p></o:p></li>
</ol>
</ol>
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<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">QUESTION</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: What is the Patient Control Number (PCN)
Reconciliation report? </span><o:p></o:p></div>
<div class="MsoListParagraph" style="margin-left: 1.5in; mso-list: l1 level1 lfo4; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">ANSWER</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: A report containing a list of all the PCNs
received from your group for dates of service 07/01/2016 </span><span style="font-family: Wingdings; font-size: 10.0pt;">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> 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</span><o:p></o:p></div>
<ol start="4" style="margin-top: 0in;" type="1">
<ol start="2" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">If you are already reconciling against the PCN report,
then continue to do so and provide an update on results as soon as
available.</span><o:p></o:p></li>
</ol>
</ol>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">*<i>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.</i></span><i><o:p></o:p></i></div>
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<b><span style="background: lime; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: lime;">Additional
Steps:</span></b><o:p></o:p></div>
<ol start="5" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Work your clearinghouse rejections via OfficeAlly,
Ability Network, or Change Healthcare </span><o:p></o:p></li>
</ol>
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<ol start="6" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Upload all ICE alternative submission files to SCAN via
the Encounter Data Portal (</span><a href="http://providerportal.scanhealthplan.com/"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">providerportal.scanhealthplan.com</span></a><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">) using the File Transmission link</span> <o:p></o:p></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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. </span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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.</span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Send these files sooner than later; <i><u>please do not
to wait until September 1, 2017 to upload your files.</u></i></span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">ICE files should only be used to submit additional DX
codes or deletes of DX codes.</span><o:p></o:p></li>
</ol>
</ol>
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<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">SCAN expects to receive all original encounter data
records via your normal clearinghouse workflow.</span><o:p></o:p></b></div>
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<br /></div>
<ol start="7" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Follow up on additional cleanup requests (contact your
respective encounter data representative with your direct questions)</span> <o:p></o:p></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Provider Name Mismatch (PNM) rejection reports</span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Rendering Provider/Entity (RPX) rejection reports</span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">EDS Full Encounter Data rejection reports</span><o:p></o:p></li>
</ol>
</ol>
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<b><u><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">What are the Timelines?</span></u></b><o:p></o:p></div>
<ol start="1" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Submit all 07/01/2016 </span><span style="font-family: Wingdings; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"> 06/30/2017 DOS encounters to your Clearinghouse: <b><i><u><span style="background: yellow; mso-highlight: yellow;">08/11/2017</span></u></i></b></span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Last day for ICE file submissions of
additions/deletions of DX codes for 07/01/2016 </span><span style="font-family: Wingdings; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"> 06/30/2017 to SCAN: <b><i><u><span style="background: yellow; mso-highlight: yellow;">08/11/2017</span></u></i></b></span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">CMS Sweep deadline for SCAN: 09/08/2017</span><o:p></o:p></li>
</ol>
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<i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">* Remember: SCAN has two dates for provider
partners to manage towards</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">:<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo2; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Target Date</span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> for Provider Partners: EOB Friday, <b><span style="background: yellow; mso-highlight: yellow;">August 11, 2017</span></b></span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo2; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">This target date
ensures that SCAN has adequate time to complete processing prior to the health
plan cut-off date by CMS</span><o:p></o:p></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo2; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Deadline</span></b><span style="color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; color: red; mso-highlight: yellow;">September 1, 2017</span></b></span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo2; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">After this deadline,
SCAN will <b><i>NOT</i> </b>process any files received for the September CMS
sweep</span><o:p></o:p></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Please be prepared for continued
communication from SCAN. We look forward to supporting and working with you
during this upcoming sweep period!</span><o:p></o:p></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><o:p></o:p></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">If you have any questions or concerns, please
feel free to contact me directly or reach out to SCAN’s Encounter Data
Specialist:<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Steve Vo: </span><a href="mailto:svo@scanhealthplan.com"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">svo@scanhealthplan.com</span></a><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><o:p></o:p></div>
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<br /></div>
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Best regards,<o:p></o:p></div>
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<br /></div>
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<b><span style="color: #002060;">Christina Cabiltes<o:p></o:p></span></b></div>
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<span style="color: #404040; font-size: 9.0pt;">Supervisor, HCI
Projects<o:p></o:p></span></div>
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<br /></div>
Stacey Hernandezhttp://www.blogger.com/profile/12799819464802934448noreply@blogger.com0tag:blogger.com,1999:blog-2464913347731009629.post-38344605027986828892017-07-17T11:30:00.000-07:002017-07-17T11:30:58.141-07:00 *IMPORTANT* -- SCAN Dates for Upcoming September 2017 Encounter Data CMS Sweep<div class="MsoNormal">
<span style="font-family: Arial, sans-serif; font-size: large;"><b><u>Special Notice to SCAN Providers</u></b></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"><br /></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Hello SCAN Provider Partners,</span><o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">The September CMS Encounter Data Sweep is
approaching. We are <b><u><span style="color: red;">4</span></u></b><span style="color: red;"> </span>weeks away from SCAN’s Target Date! This is the <b><span style="color: red;">INITIAL</span></b><span style="color: red;"> </span>CMS sweep
impacting 2017 DOS (2018 payment) and requires the submission of encounters for
DOS range:</span><o:p></o:p></div>
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">07/01/2016 </span><span style="font-family: Wingdings; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"> 06/30/2017</span><o:p></o:p></li>
</ul>
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<br /></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">SCAN has two dates for you to manage towards:</span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo2; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Target Date</span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> for Provider Partners: EOB Friday, <b><span style="background: yellow; mso-highlight: yellow;">August 11, 2017</span></b></span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo2; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">This target date
ensures that SCAN has adequate time to complete processing prior to the health
plan cut-off date by CMS</span><o:p></o:p></div>
<div class="MsoListParagraph" style="margin-left: 1.0in; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo2; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Deadline</span></b><span style="color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; color: red; mso-highlight: yellow;">September 1, 2017</span></b></span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo2; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">After this deadline,
SCAN will <b><i>NOT</i></b> process any files received for the September CMS
sweep</span><o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
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<div class="Default">
<b><u><span style="background: lime; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: lime;">7 STEPS YOU CAN TAKE TO PREPARE:</span></u></b><o:p></o:p></div>
<ol start="1" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Review your SCAN monthly Encounter Submission Reports</span> <o:p></o:p></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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.</span><o:p></o:p></li>
</ol>
</ol>
<div class="MsoListParagraph" style="margin-left: 1.0in; text-autospace: none;">
<br /></div>
<div class="MsoListParagraph" style="mso-list: l3 level1 lfo3; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]-->2.<span style="font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Review
your SCAN Encounter HCC Reconciliation Reports </span><o:p></o:p></div>
<ol start="2" style="margin-top: 0in;" type="1">
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">This report is available to you monthly. If you would
like to utilize this report for the September Sweep, please access the
EDP </span><i>SCAN
Documents tab -> HCCs and Encounters.</i><o:p></o:p></li>
</ol>
</ol>
<div class="MsoListParagraph" style="margin-left: 1.0in; mso-list: l3 level2 lfo3; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]-->b.<span style="font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Reports with dates
specific to the September CMS sweep dates 07/01/2016 </span><span style="font-family: Wingdings; font-size: 10.0pt;">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> 06/30/2017 will be uploaded before
end of week 07/14/17.</span><o:p></o:p></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> <b> </b></span><o:p></o:p></div>
<ol start="3" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Review your SCAN All DX Reconciliation Reports</span> <o:p></o:p></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">This report is available to you monthly. If you would
like to utilize this report for the September Sweep, please access the
EDP </span><i>SCAN
Documents tab -> HCCs and Encounters.</i><o:p></o:p></li>
</ol>
</ol>
<div class="MsoNormal" style="margin-left: 1.5in; mso-list: l3 level3 lfo3; text-autospace: none; text-indent: -9.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">QUESTION</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: What is the All
Diagnoses (DX) Reconciliation report? </span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.5in; mso-list: l3 level3 lfo3; text-autospace: none; text-indent: -9.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">ANSWER</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: A report containing
all diagnosis codes received from your group for dates of service 07/01/2016 </span><span style="font-family: Wingdings; font-size: 10.0pt;">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> 06/30/2017</span>.<o:p></o:p></div>
<ol start="3" style="margin-top: 0in;" type="1">
<ol start="2" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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.</span><o:p></o:p></li>
</ol>
</ol>
<div class="MsoListParagraph" style="margin-left: 1.0in; text-autospace: none;">
<br /></div>
<ol start="4" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Review your SCAN PCN Reconciliation Report</span>s<o:p></o:p></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">This report is available to you monthly. If you would
like to utilize this report for the September Sweep, please access the
EDP </span><i>SCAN
Documents tab -> HCCs and Encounters.</i><o:p></o:p></li>
</ol>
</ol>
<div class="MsoListParagraph" style="margin-left: 1.5in; mso-list: l1 level1 lfo4; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">QUESTION</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: What is the Patient Control Number (PCN)
Reconciliation report? </span><o:p></o:p></div>
<div class="MsoListParagraph" style="margin-left: 1.5in; mso-list: l1 level1 lfo4; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">ANSWER</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">: A report containing a list of all the PCNs
received from your group for dates of service 07/01/2016 </span><span style="font-family: Wingdings; font-size: 10.0pt;">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> 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</span><o:p></o:p></div>
<ol start="4" style="margin-top: 0in;" type="1">
<ol start="2" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">If you are already reconciling against the PCN report,
then continue to do so and provide an update on results as soon as
available.</span><o:p></o:p></li>
</ol>
</ol>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">*<i>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.</i></span><i><o:p></o:p></i></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="background: lime; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: lime;">Additional
Steps:</span></b><o:p></o:p></div>
<ol start="5" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Work your clearinghouse rejections via OfficeAlly,
Ability Network, or Change Healthcare </span><o:p></o:p></li>
</ol>
<div class="MsoNormal">
<br /></div>
<ol start="6" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Upload all ICE alternative submission files to SCAN via
the Encounter Data Portal (</span><a href="http://providerportal.scanhealthplan.com/"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">providerportal.scanhealthplan.com</span></a><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">) using the File Transmission link</span> <o:p></o:p></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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. </span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">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.</span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Send these files sooner than later; <i><u>please do
not to wait until September 1, 2017 to upload your files.</u></i></span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">ICE files should only be used to submit additional DX
codes or deletes of DX codes.</span><o:p></o:p></li>
</ol>
</ol>
<div class="MsoNormal" style="margin-left: 1.5in; mso-list: l3 level3 lfo3; text-autospace: none; text-indent: -9.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;">§<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">
</span></span><!--[endif]--><b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">SCAN expects to receive all original encounter data
records via your normal clearinghouse workflow.</span><o:p></o:p></b></div>
<div class="MsoListParagraph" style="margin-left: 1.0in; text-autospace: none;">
<br /></div>
<ol start="7" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Follow up on additional cleanup requests (contact your
respective encounter data representative with your direct questions)</span> <o:p></o:p></li>
<ol start="1" style="margin-top: 0in;" type="a">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Provider Name Mismatch (PNM) rejection reports</span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Rendering Provider/Entity (RPX) rejection reports</span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">EDS Full Encounter Data rejection reports</span><o:p></o:p></li>
</ol>
</ol>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><u><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">What are the Timelines?</span></u></b><o:p></o:p></div>
<ol start="1" style="margin-top: 0in;" type="1">
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Submit all 07/01/2016 </span><span style="font-family: Wingdings; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"> 06/30/2017 DOS encounters to your Clearinghouse: <b><i><u><span style="background: yellow; mso-highlight: yellow;">08/11/2017</span></u></i></b></span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">Last day for ICE file submissions of
additions/deletions of DX codes for 07/01/2016 </span><span style="font-family: Wingdings; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">à</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";"> 06/30/2017 to SCAN: <b><i><u><span style="background: yellow; mso-highlight: yellow;">08/11/2017</span></u></i></b></span><o:p></o:p></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">CMS Sweep deadline for SCAN: 09/08/2017</span><o:p></o:p></li>
</ol>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">* Remember: SCAN has two dates for provider
partners to manage towards</span></i><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">:<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo2; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Target Date</span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> for Provider Partners: EOB Friday, <b><span style="background: yellow; mso-highlight: yellow;">August 11, 2017</span></b></span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo2; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">This target date
ensures that SCAN has adequate time to complete processing prior to the health
plan cut-off date by CMS</span><o:p></o:p></div>
<div class="MsoListParagraph" style="margin-left: 1.0in; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="margin-left: .5in; mso-list: l2 level1 lfo2; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: yellow; color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-highlight: yellow;">SCAN Deadline</span></b><span style="color: red; font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">for Provider
Partners: EOB Friday, <b><span style="background: yellow; color: red; mso-highlight: yellow;">September 1, 2017</span></b></span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 1.0in; mso-list: l2 level2 lfo2; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 9.0pt;">After this deadline,
SCAN will <b><i>NOT</i> </b>process any files received for the September CMS
sweep</span><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: .25in; text-autospace: none;">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Please be prepared for continued
communication from SCAN. We look forward to supporting and working with you
during this upcoming sweep period!</span><o:p></o:p></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><o:p></o:p></div>
<div class="MsoNormal">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">If you have any questions or concerns, please
feel free to contact me directly or reach out to SCAN’s Encounter Data
Specialist:<o:p></o:p></span></div>
<div class="MsoListParagraph" style="mso-list: l0 level1 lfo6; text-autospace: none; text-indent: -.25in;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";">o<span style="font-family: "Times New Roman"; font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Steve Vo: </span><a href="mailto:svo@scanhealthplan.com"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">svo@scanhealthplan.com</span></a><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> </span><o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Best regards,<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="color: #002060;">Christina Cabiltes<o:p></o:p></span></b></div>
<br />
<div class="MsoNormal">
<span style="color: #404040; font-size: 9.0pt;">Supervisor, HCI
Projects<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="color: #404040;"><span style="font-size: 12px;">CCabiltes@scanhealthplan.com</span></span></div>
Stacey Hernandezhttp://www.blogger.com/profile/12799819464802934448noreply@blogger.com0tag:blogger.com,1999:blog-2464913347731009629.post-12172663699062235272017-04-17T07:23:00.000-07:002017-04-17T07:23:06.504-07:00Free Continuing Education From the CDCThe Centers for Disease control is offering free CEUs to the following: <span style="background-color: white; box-sizing: border-box; font-family: "open sans" , "arial" , "helvetica" , sans-serif; font-size: 14px;"><span style="box-sizing: border-box; font-weight: 700;"><span style="box-sizing: border-box; font-family: "arial" , sans-serif; font-size: 12pt;"> </span></span><span style="box-sizing: border-box; font-weight: 700;"><span style="box-sizing: border-box; font-family: "arial" , sans-serif; font-size: 12pt;">Physicians, Physician Assistants, Nurse Practitioners, Registered Nurses, Health Educators, Pharmacists, Pharmacy Technicians, Medical Residents, Epidemiologists, Laboratorians, and Administrators.</span></span></span><br />
<span style="background-color: white; box-sizing: border-box; font-family: "open sans" , "arial" , "helvetica" , sans-serif; font-size: 14px;"><span style="box-sizing: border-box; font-weight: 700;"><span style="box-sizing: border-box; font-family: "arial" , sans-serif; font-size: 12pt;"><br /></span></span></span>
<span style="background-color: white; box-sizing: border-box; font-family: "open sans" , "arial" , "helvetica" , sans-serif; font-size: 14px;"><span style="box-sizing: border-box; font-weight: 700;"><span style="box-sizing: border-box; font-family: "arial" , sans-serif; font-size: 12pt;">The topic of the webinar is:</span></span></span><br />
<div align="center">
<table border="0" cellpadding="0" cellspacing="3" class="MsoNormalTable" style="mso-cellspacing: 2.2pt; mso-padding-alt: 2.25pt 2.25pt 2.25pt 2.25pt; mso-yfti-tbllook: 1184; width: 574px;">
<tbody>
<tr>
<td style="padding: 2.25pt 2.25pt 2.25pt 2.25pt;" valign="top"><strong><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Webinar:
</span></strong></td>
<td style="padding: 2.25pt 2.25pt 2.25pt 2.25pt;" valign="top"><strong><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Lessons
from an Outbreak Investigation: Improving Medication Preparation, Use, and
Other Infection Control Practices in Outpatient Oncology Clinics </span></strong></td>
</tr>
<tr>
<td style="padding: 2.25pt 2.25pt 2.25pt 2.25pt;" valign="top"><strong><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Date:
</span></strong></td>
<td style="padding: 2.25pt 2.25pt 2.25pt 2.25pt;"><div class="MsoNormal">
<strong><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Tuesday, April 18, 2017
Time: 2:00–3:00 p.m. EDT
</span></strong><o:p></o:p></div>
</td>
</tr>
<tr>
<td style="padding: 2.25pt 2.25pt 2.25pt 2.25pt;" valign="top"><strong><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">Sign
up: </span></strong></td>
<td style="padding: 2.25pt 2.25pt 2.25pt 2.25pt;"><div class="MsoNormal">
<strong><span style="font-family: "arial" , "sans-serif"; font-size: 10.0pt;">View webinar invitation and
pre-register (at no cost) <a href="https://urldefense.proofpoint.com/v2/url?u=http-3A__links.govdelivery.com-3A80_track-3Ftype-3Dclick-26enid-3DZWFzPTEmbWFpbGluZ2lkPTIwMTcwNDE3LjcyMzcyMjQxJm1lc3NhZ2VpZD1NREItUFJELUJVTC0yMDE3MDQxNy43MjM3MjI0MSZkYXRhYmFzZWlkPTEwMDEmc2VyaWFsPTE3MTMzMjkzJmVtYWlsaWQ9c2hlcm5hbmRlekBzY2FuaGVhbHRocGxhbi5jb20mdXNlcmlkPXNoZXJuYW5kZXpAc2NhbmhlYWx0aHBsYW4uY29tJmZsPSZleHRyYT1NdWx0aXZhcmlhdGVJZD0mJiY-3D-26-26-26101-26-26-26https-3A__cc.readytalk.com_registration_-23_-3Fmeeting-3Db369tqxy40ug-26campaign-3Dvgid4l9rykei&d=DwMFAA&c=ay4DezFOFbDj-FQ_Ll6HHd73nukvvb42gL6BcQ6H_T0&r=vmDmCXhDlfc5ZYdNNWqnen8E7zA9gfAJPlXD-tt8VqI&m=RVLt7yvCA3OXjJVmuf-isIolYu05615ZqXUbSBcMShE&s=kMQpijkNF5Z3229evjD9DNF2Ho25X0rDKFSTxF0Mlfg&e=">HERE</a></span></strong><br />
<strong><br /></strong>
<strong><br /></strong>
<strong><br /></strong>
<b>Please share this valuable information with your physician, pharmacist and other colleagues.</b></div>
</td>
</tr>
</tbody></table>
</div>
Stacey Hernandezhttp://www.blogger.com/profile/12799819464802934448noreply@blogger.com0tag:blogger.com,1999:blog-2464913347731009629.post-69062058037269469432016-09-13T08:09:00.000-07:002016-09-13T08:09:39.010-07:00Changes to Diabetes Coding Rules Create ChallengesIn Q1 2016, Coding Clinic published a question and answer about "Diabetes with Associated Conditions". <br />
<br />
On the surface, this new rule seems great--here's an excerpt from AHA's Coding Clinic:<br />
<br />
<span class="Apple-tab-span" style="white-space: pre;"> </span><br />
Question:<br />
<br />
"The ICD-10-CM Alphabetic Index entry for 'Diabetes with' includes listings for conditions associated with diabetes...Does the provider need to document a relationship between the two conditions or should the coder assume a causal relationship?"<br />
<br />
Answer:<br />
<br />
"... the term "with" means "associated with" or "due to," when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List,... The classification assumes a cause-and-effect relationship between diabetes and certain diseases of the kidneys, nerves, and circulatory system....<br />
<br />
It is not required that two conditions be listed together in the health record. However, the provider needs to document the linkage, except for situations where the classification assumes an association ...When the provider establishes a linkage or relationship between the two conditions, they should be coded as such. .... The fact that a patient has two conditions that commonly occur together does not necessarily mean they are related...."<br />
<br />
All of this sounds like it should make things easier for both physicians and coders. However, the opposite can be true.<br />
<br />
As coders, it's our job to educate physicians on coding rules. But I think this Coding Clinic ruling, and other similar ones, as potential minefields. Physicians, by the very nature of their jobs, have to keep current with a large amount of very complex information. Educating physicians on a rule like this has the potential to backfire.<br />
<br />
The physician is unlikely to go to the ICD-10 and check the code title, then to the Alphabetic Index, and continue on to search for instructional notes in the Tabular list to determine if the term "with" is present. That may lead them to assume that the rule applies in cases where it doesn't. <br />
<br />
There is no harm in documenting the association between two diseases, but there can be tremendous harm (in an audit situation) in failing to document that association if the rule does not apply.<br />
<br />
So, how can we best educate our physicians? I think that explaining that there are some limited cases where a causal relationship is assumed is a good approach. But with that explanation, physicians must also be told that the majority of the time, a causal relationship is NOT assumed, and that trying to remember which is which is difficult for coders who do this all day long. The safest approach is to state the causal relationship, which ensures that coders can code what the physician actually means. Give them examples--and make sure those examples demonstrate how this can be done without significantly increasing their workload. By simply adding a few words, the physician can convey their clinical judgement that one disease cause another--for example "CKD 4 2<sup>o </sup>DM2" clearly shows the physician's diagnosis that type 2 diabetes mellitus caused the patient's stage 4 kidney disease. And it means that doctors don't have one more thing to remember.<br />
<br />
While telling our physicians about these rules in detail may seem like a good idea, it can increase the likelihood of errors.<br />
<br />
<br />
What coding and educational challenges do you face? Do you have ideas for helping providers navigate documentation issues? Be sure to leave us a comment, or send ideas you would like to share to coding@scanhealthplan.com.<br />
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<o:p></o:p></div>
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<sup><o:p></o:p></sup></div>
Stacey Hernandezhttp://www.blogger.com/profile/12799819464802934448noreply@blogger.com0tag:blogger.com,1999:blog-2464913347731009629.post-59075259089194323282016-07-19T08:12:00.001-07:002016-07-19T08:27:32.776-07:00Encounter Data Filtering Logic UpdatesAs you probably know, CMS has provided guidance regarding the filtering of encounter data for risk adjustment purposes. This doesn't mean that either Medical Groups or Health Plans should not submit certain encounters- CMS requires that ALL encounter data must be submitted to them.<br />
<div>
<br />
Currently, encounter data represents 25% of the calculation of risk scores. CMS plans to increase the weighting of encounter data-based risk scores over the next couple of years by moving to a risk score incorporating 50% of the encounter data/FFS-based risk score in 2018, a risk score incorporating 75% of the encounter data/FFS-based risk score for 2019, and a risk score of 100% encounter data/FFS-based risk score in 2020,</div>
<div>
<br /></div>
<div>
The logic that they use to determine what encounters are included is laid out in this <a href="http://www.hccuniversity.com/documents/hcc/ICD-10/Final%20Industry%20Memo%20Medicare%20Filtering%20Logic%2012%2022%2015.pdf" target="_blank">2015 memo from CMS to health plans.</a> At the same time, CMS released a list of <a href="https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/2014-Medicare-CPT-HCPCS-Codes.zip" target="_blank">procedure codes</a> that would be used for filtering professional and outpatient hospital encounters. </div>
<div>
<br /></div>
<div>
Recently, CMS released the list of <a href="https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/2015-Medicare-CPT-HCPCS-Codes.zip" target="_blank">2015 codes</a> and <a href="https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/2016-Medicare-CPT-HCPC-List.zip" target="_blank">preliminary 2016 codes</a> to be used for encounter data filtering.</div>
<div>
<br /></div>
<div>
When determining which encounters may be used in calculating risk scores, health plans and provider groups should refer to these documents, as well as reports received from CMS and health plans. As CMS moves forward with using only encounter data for risk score calculation it will become more important than ever that your encounter data be accepted by the health plan and ultimately by CMS. We will continue to provide you as much information as possible on <a href="http://www.hccuniversity.com/hcc-university/full-encounter-dataicd-10/" target="_blank">our Encounter Data/ICD-10 Page</a>. CMS is currently hosting teleconferences with health plans, to keep them informed about changes to encounter data processing. We'll post webinar slides <a href="http://www.hccuniversity.com/documents/hcc/ICD-10/full-encounter-data/data-submission/EDRA_Slides_062316_5CR_062916.pdf" target="_blank">like these, on duplicate record and demographic data fields processing</a>, so you can stay up to date as well.</div>
<div>
<br /></div>
<div>
What other tools would be helpful to you? Remember, if you have suggestions for HCC University, or the blog, you can contact us at coding@scanhealthplan.com.</div>
Stacey Hernandezhttp://www.blogger.com/profile/12799819464802934448noreply@blogger.com0tag:blogger.com,1999:blog-2464913347731009629.post-85331861269888612242016-07-14T08:53:00.000-07:002016-07-14T08:53:39.544-07:00Coding Clinic Clarifies Diabetes and Complications, Ketoacidosis, and Anti-MAG PolyneuropathyApparently the Q1 2016 "clarification" of diabetes with associated conditions confused many people. In Q2, 2016, Coding Clinic furthers their clarification by stating:<br />
<br />
"The subterm "with" in the Index should be interpreted as a link between diabetes and any of those conditions indented under the word "with." The physician documentation does not need to provide a link ..... These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated.... For conditions not specifically linked by these relational terms in the classification, provider documentation must link the conditions in order to code them as related."<br />
<br />
Coders will have to look to the Index and/or the code description for the term "with" in order to make the determination whether or not the physician must specifically link the diabetes to the complication.<br />
<br />
<br />
Coding Clinic also addressed Ketoacidosis in Diabetes. They noted that physicians should be queried if they do not specify the type (i.e. Type 1 or Type 2) of diabetes. In most cases, when a physician does not state the type of diabetes, the default is Type 2, due to coding rules. However, ketoacidosis occurs most frequently in Type 1 diabetes. Therefore, when the physician fails to state what type of diabetes the patient has, the physician is to be queried. This presents problems when coders are reviewing a chart note that is months old, since addenda or late entries should generally be made within a 'reasonable' time frame. It's especially important to inform physicians that they must state the type of diabetes when documenting ketoacidosis, to avoid coding problems later.<br />
<br />
Finally, Coding Clinic was asked what the correct code assignment for Anti-MAG (anti-myelin-associated glycoprotein) polyneuropathy is. Coding Clinic instructed that code G62.89, Other specified polyneuropathies, should be used. <br />
<br />
Most of the other Coding Clinic entries for Q2 were related to procedural coding. <br />
<br />
Given the ongoing confusion about diabetic complications, I think that we can expect more Coding Clinic comments on diabetes in the future. <br />
<br />
Although Coding Clinic has provided a lot of instruction about the documentation requirements for diabetic complications, physicians don't usually access the Index when documenting in a medical record. Short descriptions in EMRs don't always provide enough information for physicians to know whether or not linkage exists in the description or index. Given these limitations, it cannot hurt for physicians to include the causal relationship in their documentation when present.<br />
<br />
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<br />Stacey Hernandezhttp://www.blogger.com/profile/12799819464802934448noreply@blogger.com0tag:blogger.com,1999:blog-2464913347731009629.post-66055995858060788742016-06-30T10:04:00.000-07:002016-06-30T10:04:31.725-07:00Really Common Coding Errors--and how to fix them!<br />
<div>
<br /></div>
Sometimes, it seems like we see the same list of "common coding errors" over and over. Mine probably won't be that different, except that I thought something was missing from those lists--the SOLUTION! So here's my list of common coding and documentation errors--and how to fix them.<br />
<br />
<b>Problem</b>: The record doesn't contain a legible signature and/or credential<br />
<b>Solution:</b> If you hand write your charts, make sure your name and credential are on your progress note letterhead. If there's more than one person in the practice, have a check box (be sure to check it!) next to each name/credential.<br />
<b><br /></b>
<b>Problem: </b> The status of a disease is unclear, due to use of "history of"<br />
<b>Solution: </b> Be sure to re-state any disease being assessed/treated on this date of service in the present tense, in your assessment. Be sure to include the patient's current status. For example, you might note "diabetes well controlled on diet, ck HbA1C 1 week prior to next visit. f/u 3 mos.<br />
<b><br /></b>
<b>Problem: </b>The documentation doesn't match the ICD-10-CM diagnosis code chosen.<br />
<b>Solution: </b>This one comes in many flavors. Some of the most common are things like "h/o CVA 2-20-13, no neurologic deficits" and the diagnosis code is for an acute CVA. Another common issue is with amputations--the patient lost an arm in an accident 10 years ago, and the ICD10 code chosen is for a traumatic amputation. The last section of the ICD-10 is <b>Factors influencing health status and contact with health services (Z00-Z99),</b> and this section contains codes representing statuses like amputations and history of many illnesses.<br />
<br />
<b>Problem: </b>The status of a patient's cancer isn't clear.<br />
<b>Solution: </b>If the patient is still undergoing <i style="font-weight: bold;">treatment</i>, then it is considered an active malignancy. The ICD-10-CM, Chapter 2 m. "When a primary malignancy has been excised but further treatment,<br />
such as an additional surgery for the malignancy, radiation therapy or chemotherapy is directed to<br />
that site, the primary malignancy code should be used until treatment is completed.<br />
<br />
When a primary malignancy has been previously excised or eradicated from its site, there is no<br />
further treatment (of the malignancy) directed to that site, and there is no evidence of any<br />
existing primary malignancy, a code from category Z85, Personal history of malignant<br />
neoplasm, should be used to indicate the former site of the malignancy."<br />
<div>
<br /></div>
So, if the patient is undergoing <b><i>routine</i></b> <i style="font-weight: bold;">surveillance only</i>, it should be documented and coded as a "history of" the cancer. <br />
<b><br /></b>
P<b>roblem: </b>The documentation is not sufficient to support a diabetic complication.<br />
<b>Solution: </b>Be sure to document the history, physical exam and treatment directed at the complication. <br />
<b>Problem:</b> Chronic conditions are not documented in the medical record at least annually.<br />
<b>Solution: </b> This one happens a lot--and we often see signs (for example, medications ordered) that the disease exists. But unless you're documenting the disease, it's current status, and anything you've advised the patient, it can't be coded.<br />
<br />
<b>Problem: </b>Electronic medical record is not signed.<br />
<b>Solution: </b>Assign someone the task of following up on all records that have not been properly closed by authentication every week. Be sure that all staff are aware that they must close records by authentication immediately following the visit.<br />
<br />
<b>Problem: </b>Diseases are coded without proper supporting documentation. <br />
Solution: According to the Official Guidelines for Coding and Reporting, Section IV. Diagnostic Coding and Reporting Guidelines for Outpatient Services, J.: "Code all documented conditions that coexist at the time of the encounter/visit, and require or affect patient care treatment or management." If there's no documentation that they required (and received) treatment or management, or had an impact on your treatment of another condition, they should not be reported.<br />
<br />
<b>Problem:</b> The diagnosis code chosen was more specific than the documentation.<br />
<b>Solution: </b>Be sure you thoroughly document all illnesses, including their complications. Always document the patient's response (or lack of response) to treatment.<br />
<br style="background-color: white; color: #292929; font-family: Helvetica, Arial, Geneva, sans-serif; font-size: 12px; line-height: 18px;" />
<b>Problem</b>: The diagnosis code chosen was not at the highest level of specificity documented. <br />
<b>Solution:</b> This is the opposite of the problem above--you've documented the patient's condition and complications well--but chosen a code that doesn't reflect those complications. If the patient has multiple complications of a disease, each one should be coded separately. Stacey Hernandezhttp://www.blogger.com/profile/12799819464802934448noreply@blogger.com0tag:blogger.com,1999:blog-2464913347731009629.post-59873024182469811592016-06-10T07:00:00.000-07:002016-07-19T08:14:53.643-07:00Coding Clinic Q1 2016 Addresses Diabetic ComplicationsIn the Q1 2016, AHA Coding Clinic addresses a number of issues--two of which are hot topics for coders in risk adjustment.<br />
<br />
Most of the questions we get in the Coding Inbox (coding@scanhealthplan.com) deal with "Diabetes and ______________", and whether or not the ICD-10CM assumes a causal relationship. Usually, this is because the physician has not made a link in the medical record, and the coder is unsure whether or not they can code the diabetic complication.<br />
<br />
In ICD-9, the question also came up a lot--and most often, the answer was NO.<br />
<br />
Coding Clinic took this subject on once again, for ICD-10CM.. In <b style="font-style: italic;">Section I. Conventions, general coding guidelines and chapter specific guidelines </b>of the Official Guidelines for Coding and Reporting, the ICD-10 describes how the word "with" is to be interpreted:<br />
<br />
<br />
<br />
15. “With”<br />
<br />
The word “with” should be interpreted to mean “associated with” or “due to”<br />
when it appears in a <b>code title, the Alphabetic Index, or an instructional note in the Tabular </b><br />
<b>List.</b><br />
<br />
In a code title, the association might look like this:<br />
<br />
E11.31 Type 2 diabetes mellitus <b>with</b> unspecified diabetic retinopathy<br />
<br />
This tells you that there is an association between the two diseases.<br />
_____________________________________________________________<br />
<br />
The word “with” in the Alphabetic Index is sequenced immediately following the main term, not in<br />
alphabetical order.<br />
<div>
</div>
In part, the Alphabetic Index under "Diabetes" looks like this:<br />
<br />
Diabetes, diabetic (mellitus) (sugar) E11.9<br />
- with<br />
- - amyotrophy E11.44,- - arthropathy NEC E11.618<br />
- - autonomic (poly)neuropathy E11.43<br />
- - cataract E11.36<br />
- - Charcot's joints E11.610<br />
- - chronic kidney disease E11.22<br />
- - circulatory complication NEC E11.59<br />
- - complication E11.8<br />
- - - specified NEC E11.69<br />
- - dermatitis E11.620<br />
- - foot ulcer E11.621<br />
- - gangrene E11.52<br />
- - gastroparesis E11.43<br />
- - glomerulonephrosis, intracapillary E11.21<br />
- - glomerulosclerosis, intercapillary E11.21<br />
- - hyperglycemia E11.65<br />
- - hyperosmolarity E11.00<br />
- - - with coma E11.01<br />
- - hypoglycemia E11.649<br />
- - - with coma E11.641<br />
- - kidney complications NEC E11.29<br />
- - Kimmelsteil-Wilson disease E11.21<br />
- - loss of protective sensation (LOPS) —see Diabetes, by type, with neuropathy<br />
- - mononeuropathy E11.41<br />
- - myasthenia E11.44<br />
- - necrobiosis lipoidica E11.620<br />
- - nephropathy E11.21<br />
- - neuralgia E11.42<br />
- - neurologic complication NEC E11.49<br />
- - neuropathic arthropathy E11.610<br />
- - neuropathy E11.40<br />
- - ophthalmic complication NEC E11.39<br />
- - oral complication NEC E11.638<br />
- - periodontal disease E11.630<br />
- - peripheral angiopathy E11.51<br />
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With this new Coding Clinic clarification, when the physician documents and another disease, you need to check the Alphabetic Index first, to see if the problem/complication is listed there, and then as always, go to the code itself. If the condition is qualified by the term diabetes with ____, the you can code the complication. The doctor does not have to state the complication--it is assumed. If you don't find that causal relationship is supported, then the two diseases are coded as unrelated.<br />
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This clarification should help make coding more accurately reflect what the physician is trying to convey to the coder. As always, we as coders have to be careful to ensure that we double check the ICD-10CM to be sure we're coding it right.</div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-2464913347731009629.post-11260851213342050392016-06-09T14:46:00.001-07:002016-06-09T14:46:15.591-07:00Coding Clinic Q1 2016 Addresses Heart Failure Coding<br />
Hi everyone! It's been a while since I've posted anything--I had an unexpected "vacation" from work.<br />
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While I was away, the AHA's Coding Clinic was busy clarifying ICD-10 coding for us. There were many situations clarified in Q1 of 2016, but a couple of them warrant blog posts.<br />
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Heart failure coding has been a challenge for quite some time--with coders and physicians going bck and forth. The physicians telling us that the patient has heart failure, the coders telling the physcians that it doesn't say that in the chart!<br />
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Earlier Coding Clinic guidance (Q1 2014) indicated that the coder could not assume diastolic heart failure, systolic heart failure or combined diastolic/systolic heart failure when the physician documented heart failure with reduced ejection fraction (HFrEF) or heart failure with preserved ejection fraction (HFpEF). Thanks to input from the American College of Cardiology, these contemporary terms for heart failure have been now been accepted by Coding Clinic.<br />
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Going forward, when the provider has documented HFpEF, HFrEF, or other
similar terms noted above, the coder may interpret these as "diastolic
heart failure" or "systolic heart failure," respectively, or a
combination of both if the provider has documented it, and assign the appropriate ICD-10-CM codes based on these definitions.<br />
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Just as an FYI--we've posted new information to HCC University. The 2016 Risk Score Calculator is online, there's an updated document with all of the ICD-10 codes by HCC and the updated Companion Guides for encounter data submission. Stay tuned for exciting HCC U news in the very near future!<br />
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Finally, remember, when you have coding questions, you can contact us at Coding@scanhealthplan.com.<br />
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Stacey Hernandezhttp://www.blogger.com/profile/12799819464802934448noreply@blogger.com0tag:blogger.com,1999:blog-2464913347731009629.post-9967588805205468022016-01-05T14:34:00.001-08:002016-01-05T14:34:40.963-08:00Coding "Cardiac Dysfunction" in ICD-10I was recently asked how to code "diastolic dysfunction" in ICD-9. The inquirer asked if it should be coded as "heart failure, NOS based on something she had read.<br />
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In 2009, Q1, Coding Clinic noted that you could not assume heart failure in a patient with diastolic dysfunction, and that it should be coded as 429.9, heart disease, unspecified. <br />
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The term dysfunction is very non-specific, and runs the gamut from very mild, to extremely severe. There may be minimal dysfunction present, or life threatening dysfunction. As with a lot of documentation, there's simply not enough information there to select a specific diagnosis code. Therefore, the best you can do is choose a non-specific code, that is not more severe than the documentation.<br />
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In ICD-10, "heart dysfunction" is indexed to I51.89--Other ill-defined heart diseases. This seems like it follows similar logic, and it makes sense--ill defined documentation corresponding to an ill defined heart disease.<br />
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<br />Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-2464913347731009629.post-64351638750706814482015-12-31T09:04:00.000-08:002016-01-05T12:04:33.809-08:00Code Numbers in Lieu of a Diagnosis-- Dangers in the EMROne of the most frequent questions I get asked is "isn't selecting the diagnosis (code) in the EMR good enough documentation?" The answer is no, and a recent Coding Clinic broaches this subject. I will expand a little on their thoughts.<br />
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Basically, Coding Clinic Q4 2015 received a question if physicians could use a code number in lieu of a diagnosis. Their answer was a resounding no--but they went a little further.<br />
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Coding Clinic told the inquirer that it was not appropriate for providers select a code number from a list of codes in place of a written diagnostic
statement.<br />
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Their rationale is that the ICD-10 is a statistical classification, not a
diagnosis. Further, they indicated that many clinical diagnoses may be included in an ICD-10 code, and it may be important to document these diagnoses. They went on to say that it was the provider's responsibility to provide clear documentation of a diagnosis.<br />
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The abbreviated ICD-10 descriptions are often so shortened they make no sense--and can't be called a diagnosis. One reason that writing a code in lieu of a diagnosis is inappropriate is that the code chosen may simply be wrong--without a narrative description (of sufficient specificity), there's no way to even know if it's right. Coding is done from a narrative, not from a number.<br />
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This issue was very common in ICD-9. Think back to all of the "Diabetes with _____________manifestations". These codes were chosen all the time, and could not be supported--there was no way to know what the "manifestation" was, without further description by the physician. A manifestation isn't a disease description--it's a whole array of possible diseases. Without further documentation by the physician, it's not possible to know what that disease is. In ICD-10, with its added complexity, this issue will arise over and over again. It is the clinician's responsibility to ensure that their documentation makes sense, and includes sufficient information to validate that the code chosen is correct. The act of choosing a code is not enough.<br />
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EMRs are great time savers. But they are not a substitute for adequate documentation by the physician to determine if the selected code is correct.<br />
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Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-2464913347731009629.post-44830027107449240582015-12-22T08:44:00.000-08:002015-12-22T11:02:19.853-08:00So, I recently read a funny blog....About Coding of all things. It's called <a href="http://codercoach.blogspot.com/" target="_blank">Coder Coach</a>. And the author does a code for the day, with a focus on humor. I'm not as funny as she is, so I'm not even going to try. But I think that I will try to be more diligent about posting--and I think I'll <i>try</i> to do a code a day (or week...or something). <br />
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Let's face it--ICD-10 has been a royal pain of an implementation. So, by focusing on a new code with some regularity, I might be able to lend a hand. No time like the present!<br />
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We'll start off, not with a code, but with at category. This category may be the most <i style="font-weight: bold;">misused</i> category of codes I've ever seen.<br />
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I've been coding for more years than I like to admit. Let's say north of 30. While I've seen instances where these codes (and their predecessors in ICD-9) could have been used correctly, I've never actually seen them used correctly. They are: Neoplasms of Uncertain Behavior. In ICD-10 they are found in the section Neoplasms of Uncertain Behavior, Polycythemia Vera and Myelodysplastic Disorders (D37-D48).<br />
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When I see a code for neoplasm of uncertain behavior submitted, no matter the body area, it's always because:<br />
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<li>The physician hasn't biopsied the lesion yet, and so he/she is uncertain of the histology; or</li>
<li>The physician has biopsied the lesion, but hasn't yet received the pathology report</li>
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Neither of these is the correct usage of the code. The beginning of the code section explains the correct use of the codes, but unfortunately, one of the downsides of Electronic Health Records (EHRs) is that none of these instructions are visible to most users. Here's the instruction, straight from the ICD-10:</div>
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<b>Note: Categories D37-D44, and D48 classify by site neoplasms of uncertain behavior, i.e., histologic confirmation whether the neoplasm is malignant or benign cannot be made.</b></div>
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As you might guess, the instances where you can correctly use these codes are relatively rare. So, unless the pathologist cannot tell you whether to neoplasm is benign or malignant, these codes should not be used. </div>
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This code category points out the importance of the coding instructions and guidelines. As noted, these are generally lost in an EHR--that's not to say EHRs are bad, simply that they have their limitations. So, what's a coder (or the physician who is coding) to do? I strongly recommend that coders AND physicians read the sections of the Coding Guidelines that apply to them. That means any specialty specific guidelines, and the entire Outpatient coding section. You should also review the section of the code book that includes common codes you use. And, when faced with the new and unusual (like these), take a quick glance at the book to see if there are special instructions like we found here. </div>
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Now, if you have an EHR, you don't have to buy the code book to do that. Every year, we post a full text copy of the ICD-10 on <a href="http://hccuniversity.com/hcc-university/full-encounter-dataicd-10/" target="_blank">HCC University</a>.</div>
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I'm going to do my best to keep posting these coding tips. If I fall behind, feel free to email me at Coding@scanhealthplan.com to remind me. I sometimes suffer from mild memory loss, NOS (R41.3)</div>
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