Import Audit Requests to AudaPro Using a Flat File

Transcription

1 Import Audit Requests to AudaPro Using a Flat File

2 Document History Publication Date: September 17, 2013 Document Edition: 1.3 Contact Information HealthPort 120 Bluegrass Valley Parkway Alpharetta, GA AudaPro Support Phone Number: Copyright and Trademarks Copyright 2013 HealthPort. All rights reserved. Document History and Copyright

3 Importing Audit Request Data from a Flat File ABOUT THIS GUIDE HealthPort s AudaPro audit tracking application can be configured to receive claim and remit information in a flat file. When an AudaPro user enters a new audit request, the application displays possible matches from this imported information, significantly reducing the need for manual data entry. See the following sections for detailed information on this process: Overview on page 4 Delimiters on page 5 Supported AudaPro Fields For Data Import on page 7 Data Files for Multiple Facilities on page 18 Maximum File Size on page 19 File Transmission Rate on page 19 Importing Audit Request Data from a Flat File 3

4 OVERVIEW HealthPort creates a lookup database from the claim data in your flat file. AudaPro queries this database when you create a new audit request; if a match is found, AudaPro imports the data into the new request. 4 Overview

5 DELIMITERS Supported Delimiters AudaPro allows these delimiter characters: Comma, Pipe No other delimiters are accepted. Single Delimiter Only You cannot create a single file that uses both comma and pipe delimiter characters. Changing Delimiters You cannot use different delimiter characters within the same file. If you need to change delimiters for your data files, notify your HealthPort representative so that the configuration settings can be changed. Delimiters for Files with Data from Multiple Sites HealthPort can accept a single flat file with information from more than one site, but ONLY if the file uses a single delimiter type. Importing Audit Request Data from a Flat File 5

6 Avoid Delimiters in Data Strings Make sure your delimiter is ONLY used to separate columns and is not present in the data itself. This problem occurs most often when commas are used as the delimiter and you intend to populate one or more Custom Fields with the data from the flat file. Let s look at an example. Here we see part of a data file for a hospital that intends to populate three AudaPro Custom Fields with information related to its Risk Assessment process: Because the Assessed By data included a comma to separate the first and last names, however, this is how AudaPro sees the information: The mismatch caused by the extra delimiter character causes the entire data import process to fail. 6 Delimiters

7 SUPPORTED AUDAPRO FIELDS FOR DATA IMPORT Data from a CDF file can be imported to the following fields in AudaPro. Column # AudaPro Field Found on Tab Allowed Characters 1 AudaPro Site # **** (HP assigned number) Request Information 5 2 Patient Account # Request Information 30 max. 3 Admit Date/Service From Request Information MM/DD/YYYY 4 Discharge Date Request Information MM/DD/YYYY 5 Original Discharge Disposition (Billed Discharge Disposition) Billing & Coding 30 max. 6 Billed DRG Code Billing & Coding 30 max. 7 ICD-9 Diagnosis Code(s) Billed - Admitting Billing & Coding 9 max. 8 ICD-9 Diagnosis Code(s) Billed - E Code Billing & Coding 9 max. 9 Original APC * Billing & Coding 3 max. 10 ICD-9 Diagnosis Code(s) Billed - Principal Billing & Coding 9 max. 11 ICD-9 Procedure Code(s) Billed - Principal Billing & Coding 9 max. 12 ICD-9 Procedure Date - Principal Billing & Coding MM/DD/YYYY 13 Date of Birth (Patient Date of Birth) Request Information MM/DD/YYYY 14 Facility NPI Basic Information 50 max. 15 HIC # Request Information 30 max. 16 MRN Request Information 30 max. 17 Patient First Name Basic Information 30 max. 18 Patient Last Name Basic Information 30 max. 19 Tax ID Basic Information 30 max. Importing Audit Request Data from a Flat File 7

8 Column # AudaPro Field Found on Tab Allowed Characters 20 Physician 21 Physician NPI Audit Information (RAC Information) Audit Information (RAC Information) 30 max. 30 max. 22 Payer Name Reconciliation 30 max. 23 Claim # Basic Information 30 max. 24 Initial Paid Date of Claim Reconciliation MM/DD/YYYY 25 Original Payment Reconciliation 15 max. 26 Coder/MDS Coordinator Audit Information (RAC Information) 30 max. Repetitive Field Section. See page 10 for more information. To populate multiple rows on the Billing & Coding tab, add more Repetitive Field sections, each separated with beginline and endline. Your file can contain as many as 25 distinct Repetitive Field sections. 27 beginline NA NA 28 Revenue Code Billing & Coding 4 max. 29 Original Billed Units Of Service Billing & Coding 4 max. 30 CPT/HCPCS Procedure Codes Billed Billing & Coding 5 max. 31 Charge Amount Billing & Coding 15 max. 32 CPT/HCPCS Procedure Code Modifier (1st) Billed Billing & Coding 2 characters. 33 CPT/HCPCS Procedure Code Modifier (2nd) Billed Billing & Coding 2 characters 34 ICD-9 Diagnosis Code(s) Billed - Other Billing & Coding 9 max. 35 ICD-9 Procedure Code(s) Billed - Other Billing & Coding 9 max. 36 ICD-9 Procedure Date - Other Billing & Coding 10, date formatted with slash characters: 01/01/ endline NA NA 8 Supported AudaPro Fields For Data Import

9 Column # AudaPro Field Found on Tab Allowed Characters Custom Field data MUST follow the Repetitive Field section(s). See page 15 for more information. 38 Custom Field 1 (Optional) 39 Custom Field 2 (Optional) 40 Custom Field 3 (Optional) 41 Custom Field 4 (Optional) 42 Custom Field 5 (Optional) 43 Custom Field 6 (Optional) 44 Custom Field 7 (Optional) Any Per Custom Field settings Importing Audit Request Data from a Flat File 9

10 Repetitive Fields The Data Import process can populate several repetitive rows of data entry fields on the Billing & Coding tab. See pages 11 through 14 for detailed instructions. 10 Supported AudaPro Fields For Data Import

11 Repetitive Field Location in Flat File As shown on page 8, the data for the repetitive Billing & Coding tab fields must come AFTER Column #26, the last column of the Standard Field section. As explained in Maximum Number of Repetitive Field Columns on page 12, the Repetitive Field section can actually include as many as 25 sub-sections, each populating a row on the Billing & Coding tab. Each of these subsections must: begin with beginline end with endline contain delimiter characters for the nine repetitive data entry fields Importing Audit Request Data from a Flat File 11

12 Repetitive Field Section Identification Each repetitive section must begin with beginline and finish with endline. AudaPro Fields in the Repetitive Field Section Revenue Code Original Billed Units Of Service CPT/HCPCS Procedure Codes Billed Charge Amount CPT/HCPCS Procedure Code Modifier (1st) Billed CPT/HCPCS Procedure Code Modifier (2nd) Billed ICD-9 Diagnosis Code(s) Billed - Other ICD-9 Procedure Code(s) Billed - Other ICD-9 Procedure Date - Other No Data for a Repetitive Billing & Coding Field? Within a Repetitive Line section, you can provide data for some or all of the repetitive fields; insert an extra delimiter for any of those fields for which there is no data, as explained in No Data for a Field? on page 17. Maximum Number of Repetitive Field Columns A single row of data in the CDF file, representing one claim or account, could conceivably include 275 Repetitive Field columns after Column #26: Each Repetitive Field section consists of 11 columns (beginline, 9 data entry field columns, and endline). You can populate as many as 25 lines on the Billing & Coding tab. 11 x 25 = 275 possible Repetitive columns after Column #26 and before any Custom Field values. 12 Supported AudaPro Fields For Data Import

13 Filling Multiple Rows of Data Entry Fields on the Billing & Coding Tab This picture shows how each Repetitive Field section for a single claim or account in your CDF file populates a new row on the Billing & Coding tab. In this example, Patient John Doe s data includes two Repetitive Field sections. The first Repetitive Field section populates the first row of data entry fields on the Billing & Coding tab. The second Repetitive Field section populates the second row of data entry fields on the Billing & Coding tab. If John Doe s data had included more Repetitive Field sections, AudaPro would have continued to populate the Billing & Coding tab rows in sequence. Importing Audit Request Data from a Flat File 13

14 Repetitive Field Example Each beginline / endline section in a single row of data in your CDF file populates one row of fields on the Billing & Coding tab. In the example below, there are two beginline / endline sections. There are no blank fields in the example. The data highlighted in yellow was used to populate the first row of fields on the Billing & Coding tab. The data highlighted in green was used to populate the second row of fields. If there had been more beginline / endline sections in the CDF file, those values would have populated additional rows on the Billing & Coding tab. 14 Supported AudaPro Fields For Data Import

15 Custom Fields Any Custom AudaPro fields that are already configured for a client s facility can be populated with data imported through a flat file. Seven Custom Field Maximum Your file can include data for a maximum of seven Custom Fields. Existing Custom Fields Only Any Custom Fields that will be mapped to data in the flat file must already exist in your AudaPro system before you submit the flat file. Location of Custom Field Data in Flat File Custom Field MUST be listed at the END of the flat file, after the Repetitive Field data (if any). Importing Audit Request Data from a Flat File 15

16 Patient Identifier Data Your CDF file must contain at least one field, but there is no practical purpose to providing so little information. Unless the file provides enough information for AudaPro to identify probable matches and cut down on the manual data entry needed, there is no point to using the CDF import procedure. We recommend that the data file provide values for at least three patient identifier fields, such as: Patient First Name Patient Last Name HIC # Account # Claim # MRN 16 Supported AudaPro Fields For Data Import

17 No Data for a Field? If your file will not contain data for a field, insert an extra delimiter to occupy that place in the file. For example, if your file does not include Physician NPI data, you would format it as: The extra comma acts as a placeholder for the Physician NPI field, between the Physician and Payer fields. Importing Audit Request Data from a Flat File 17

18 DATA FILES FOR MULTIPLE FACILITIES HealthPort can accept a single flat file that includes data for more than one facility, as long as the file follows these rules: Every row of data MUST include a valid HealthPort Site ID # in the first column. The file MUST use the same delimiter for all data. The columns in the file MUST be in the same order for all facilities. There is no way to dynamically map disordered data to AudaPro s fields. If every facility does not have data for each column, make sure that the empty columns are populated by a delimiter. For example, if Hospital ABC can provide the Physician NPI, but Hospital XYZ does not capture this information, the flat file must include a delimiter for XYZ as a placeholder for the Physician NPI data. 18 Data Files for Multiple Facilities

19 MAXIMUM FILE SIZE Any one data file cannot contain more than 30,000 records. Files larger than 30,000 records can cause a failure of the upload/import procedure. FILE TRANSMISSION RATE Submit no more than 100 files per hour to avoid possible throughput problems. Uploaded Files 100 / hour The number of files transmitted will typically peak early in the process, when you are submitting historical information to build the lookup database. After the database has been created, you should transmit new files on a regular schedule. Importing Audit Request Data from a Flat File 19