| # | Name | Location | Type | Details | Index | Description |
|---|---|---|---|---|---|---|
| .01 | entry id(+) | 0;1 | NUMERIC | B | This is a unique number assigned to this entry. The first 3 characters of the number are the station number. | |
| .02 | patient | 0;2 | POINTER | 2 | C | Enter the patient that this Claims Tracking entry is for. This is the patient whose admission, outpatient visit, prescription refill, prosthetic device or other encounter for medical care or services is being tracked. |
| .03 | visit | 0;3 | POINTER | 9000010 | AVSIT | This is the visit for the patient that is being tracked in this entry. This field is a place holder for when visit tracking is implemented. It will point to the visit that is being tracked. |
| .04 | outpatient encounter | 0;4 | POINTER | 409.68 | ASCE | This is the outpatient encounter that is being tracked. If this is entered and the provider and/or diagnosis for the encounter are entered then the inforamation will be extracted from the encounter file. |
| .05 | admission | 0;5 | POINTER | 405 | AD | This is the admission that is being tracked. When an entry is added for inpatient care for any date the software will find the current admission for that date and use the current admission from the patient movement file. |
| .06 | episode date | 0;6 | DATE-TIME | D | This is the date of the episode of care or services that is being tracked. For admissions, it is the admission date. For outpatient visits it is the visit date. For prescription refills it is the refill date. For prosthetic items it is the date that the prosthetic item was issued. The data in this field is entered by the Claims tracking event tracker routines. | |
| .07 | admission type | 0;7 | SET OF CODES | 1:SCHEDULED 2:URGENT 3:EMERGENT 4:UNSCHEDULED 5:COURT ORDERED | Enter whether this admission was a scheduled admission, a direct admission from the outpatient area, or whether this was an urgent or emergent admission. The type of admission will impact whether pre-certification reviews should be done and the impact on reimbursements. | |
| .08 | prescription | 0;8 | POINTER | 52 | If the entry that is being tracked is a prescription refill then this field should point to the entry in the prescription file. | |
| .09 | prosthetic item | 0;9 | POINTER | 660 | APRO | If this tracking entry is for a prothetic item, this is the pointer to the prosthetic item file. |
| .1 | refill date | 0;10 | NUMERIC | This is a free text pointer to the REFILL multiple (subfile #52.1) in the PRESCRIPTION file (#52). The top-level pointer for the prescription entry in the PRESCRIPTION file (#52) can be found in the PRESCRIPTION field (#.08) of the CLAIMS TRACKING file (#356). The refill date is found at the first '^' piece of the REFILL multiple of the PRESCRIPTION file. Original Fills will be added as of July 2001. The Refill Date for these will be '0'. | ||
| .11 | initial bill number | 0;11 | POINTER | 399 | E | This is the bill number in the BILL/CLAIMS file for the initial bill number for this entry. It is the bill to the third party for this claim. |
| .12 | other type of bill | 0;12 | SET OF CODES | 1:TORT FEASOR 2:FEDERAL OWCP 3:WORKMAN'S COMP 4:OTHER | AC | If this claims tracking entry can be billed as other than an insurance claim or a patient bill enter the type of claim. If a patient has ever had a claim type other than insurance then special warnings may be given in the billing and claims tracking package. |
| .14 | second opinion required | 0;14 | BOOLEAN | 1:YES 0:NO | If this patient insurance policy requires a second opinion enter 'YES'. If a second opinion is not required then enter 'NO'. | |
| .15 | second opinion obtained | 0;15 | BOOLEAN | 1:YES 0:NO | If a second opinion was required by this patients' insurance policy, enter 'YES' if it was obtained or 'NO' if it was not obtained. If a second opinion was obtained but did not meet the insurance companies criteria for any reason, enter 'NO'. This field will be used to help determine the estimated reimbursement from the insurance carrier. If a second opinion was not obtained certain denials and penalties may be assessed. | |
| .17 | earliest auto bill date | 0;17 | DATE-TIME | ABD | This is the earliest date that this visit can be automatically billed. The automatic billing software will use this date when searching for events to bill. All events with an Earliest Auto Bill Date on or before the run date of the automatic biller will be considered for inclusion on a bill. This field may be set in one of two ways. If AUTOMATE BILLING is on for the Event Type then this field will be automatically set when apparently billable events are added to the claims tracking module. This field can also be directly set by a user, AUTOMATE BILLING does not need to be on for the Event Type. When the automated biller runs it will attempt to add the event to a bill. This date should be deleted if the event turns out not to be suitable for a reimbursable insurance bill. This field will automatically be deleted if the event is added to a bill or a reason not-billable is entered. | |
| .18 | event type | 0;18 | POINTER | 356.6 | EVNT | This is the type of event that is being tracked. This field is automatically stored when an entry is created. Scheduled admissions are tracked to allow for precertification reviews. When an admission occurs within 7 days of a scheduled admission the scheduled admission will be updated to an inpatient care event type automatically. Choose an event type of Scheduled Admission only for future scheduled admissions and choose an event type of admission for past admissions. If you are using the scheduled admissions portion of the MAS package then scheduled admissions will automatically be added to claims tracking 7 days before the scheduled admission and automatically converted to an event type of admission after the patient has been admitted. For admissions you will be able to specify the type of admission in another field. |
| .19 | reason not billable | 0;19 | POINTER | 356.8 | AR | This is the primary reason this episode of care should not be billed to an insurance company. If a reason not billable is entered, then this episode will no longer appear on reports as billable and will not be used by the automated biller as a billable event. |
| .2 | inactive | 0;20 | SET OF CODES | 0:INACTIVE 1:ACTIVE | An entry is automatically inactived if the parent event that is being tracked is either deleted or edited so that it no longer is a valid tracking entry. Inactivating an entry has the same affect as deleting an entry except that the activity is left as a history. | |
| .21 | estimated ins. payment (pri) | 0;21 | NUMERIC | This is the estimated amount that the primary insurance carrier is expected to pay on this claim. | ||
| .22 | estimated ins. payment (sec) | 0;22 | NUMERIC | This the the estimated amount that the secondary insurance carrier is expected to pay on this claim. | ||
| .23 | estimated ins. payment (ter) | 0;23 | NUMERIC | This is the estimated amount that the tertiary insurance carrier is expected to pay on this claim. | ||
| .24 | tracked as insurance claim? | 0;24 | BOOLEAN | 1:YES 0:NO | AI | Enter 'YES' if the patient is insured for this event. Enter 'No' if the patient is not insured for this event. If this event is not tracked as an insurance claim, the field REASON NOT BILLABLE will automatically have entered "NOT INSURED" if it is not otherwise entered. |
| .25 | tracked as random sample? | 0;25 | BOOLEAN | 1:YES 0:NO | Enter if this is to be tracked as a Random Sample for UR purposes. The Claims tracking module is designed to flag one admission per week each from the 3 major bedsections, Medicine, Surgery, and Psychiatry, as a random sample that is to have utilization review follow-up. If there is not sufficient activity in your facility for the automated tracker to set up the minimum random sample, then you may manually add entires to be tracked for UR purposes. | |
| .26 | tracked as special condition | 0;26 | SET OF CODES | 1:TURP 2:COPD 3:CVD 0:NONE | If you are tracking special conditions for follow up by UR then indicate that this is a special condition UR case and UR will be required and the information about this case will appear on special condition reports. The choices are: TURP -- Transurethral Prostatectomy COPD -- Chronic Obstructive Pulmonary Disease CVD -- Cerebrovascular Disease | |
| .27 | tracked as a local addition? | 0;27 | BOOLEAN | 1:YES 0:NO | If this is being track as a local addition for UR purposes then enter 'YES'. | |
| .28 | estimated mt charges | 0;28 | NUMERIC | Enter the estimated amount of Means Test copayment charges that are to be paid by the patient for this case. | ||
| .29 | estimated total charges | 0;29 | NUMERIC | Enter the estimated total charges from this case. This is the estimated total amount due the government. The total estimated charges minus the estimated payments from all sources will be the amount not anticipated to be reimbursed from this case. Comparing estimated receipt versus the actual amount received will help determine if all payers have sufficiently re-imbursed the government. | ||
| .3 | admitting reason (icd) | 0;30 | POINTER | 356.9 | This is the ICD diagnosis code for the admitting diagnosis. | |
| .31 | special consent roi | 0;31 | SET OF CODES | 1:NOT REQUIRED 2:OBTAINED 3:REQUIRED 4:REFUSED | Enter whether or not a special consent release of information form for this patient for this episode of care is required, obtained, or not necessary. If ROI is required but not obtained, certain clinical information may not be released to Insurance carriers. This will affect contacts with insurance companies and bill preparation. Generally a special consent is required if the patient has or was treated for Drug and Alcohol, HIV, and sickle cell anemia. | |
| .32 | scheduled admission | 0;32 | POINTER | 41.1 | ASCH | If this claims tracking entry is for a scheduled admission, this is the scheduled admission. This field points to the entry in the Scheduled Admissions file that is being tracked. When this scheduled admission is acutally admitted, it will be converted to an inpatient admission tracking record automatically. |
| 1.01 | date entered | 1;1 | DATE-TIME | Enter the date that this entry was created. This will usually be the date that the automated tracker created this entry on. | ||
| 1.02 | entered by | 1;2 | POINTER | 200 | Enter the name of the user who first created this entry. This is most important if this entry was not created by the automated tracker. | |
| 1.03 | date last edited | 1;3 | DATE-TIME | Enter the date that this claim was last edited. | ||
| 1.04 | last edited by | 1;4 | POINTER | 200 | Enter the user who last edited this claim tracking entry. | |
| 1.05 | hospital reviews assigned to | 1;5 | POINTER | 200 | Enter the UR person that this case is assigned to if it is assigned to an individual for hospital Reviews. Cases may be assigned for an individual to follow for the length of their admission. If viewing pending work by who it is assigned to then this field is used to sort the pending work. | |
| 1.06 | ins. reviews assigned to | 1;6 | POINTER | 200 | Enter the Insurance UR person that this case is assigned to if it is assigned to an individual for Insurance UR. Cases may be assigned for an individual to follow for the length of their admission. If viewing pending work by who it is assigned to then this field is used to sort the pending work. | |
| 1.07 | follow-up type | 1;7 | SET OF CODES | 1:NONE 2:ADMISSION NOTIFICATION 3:ADMISSION AND DISCHARGE NOTIFICATION 4:PRE-CERTIFICATION 5:PRE-CERT AND CONT. STAY 6:PRE-CERT AND DISCH. 7:PRE-CERT, CONT. STAY AND DISCH. | Enter type of follow that the insurance company requires for this visit. This information will be used by the reports to determine if the case requires pre-cert or not, or pre-cert and continued stay. | |
| 1.08 | additional comment | 1;8 | FREE TEXT | Enter any brief comment about this episode that may explain why a case is not billable. | ||
| 1.09 | acute care discharge date | 1;9 | DATE-TIME | ADIS | This date is filled by ACUTE CARE DISCHARGE DATE of the HOSPITAL REVIEW File (#356.1) when a discharge is entered. Used by UTILIZATION MANAGEMENT ROLLUP in association with the ADIS cross-reference. | |
| 1.1 | ecme number | 1;10 | FREE TEXT | AE | This is the ECME NUMBER associated with the e-Pharmacy Claim. This field may only be set for e-pharmacy prescriptions and refills. | |
| 1.11 | ecme reject | 1;11 | SET OF CODES | 0:NO 1:REJECTED 2:CLOSED | This field is a flag to mark ECME claims rejected by the Payer. The field is only meaningful if the field 1.1 "ECME NUMBER" is defined. | |
| 2.01 | non billable coder | 2;1 | POINTER | 200 | This field is populated automatically with the logged on user if REASON NOT BILLABLE is non-blank and ADDITIONAL COMMENTS was edited. | |
| 2.02 | last reviewed by | 2;2 | POINTER | 200 | This field is populated automatically with the logged on user reviewing this episode of care. | |
| 2.03 | billable coder | 2;3 | POINTER | 200 | This field is populated automatically with the logged on user if REASON NOT BILLABLE is blank and BILLABLE FINDINGS TYPEs were changed or added. | |
| 2.04 | code valid billable date | 2;4 | DATE-TIME | This date/time is automatically populated if BILLABLE FINDING TYPEs are added or edited and the episode is billable. | ||
| 2.05 | code valid non billable date | 2;5 | DATE-TIME | This date/time field is updated automatically if REASON NOT BILLABLE is blank and ADDITIONAL COMMENTS is edited. | ||
| 3 | billable findings type | 3;0 | MULTIPLE | 356.03 |