Produced by Araxis Merge on 6/20/2018 10:13:01 AM Central Daylight Time. See www.araxis.com for information about Merge. This report uses XHTML and CSS2, and is best viewed with a modern standards-compliant browser. For optimum results when printing this report, use landscape orientation and enable printing of background images and colours in your browser.
# | Location | File | Last Modified |
---|---|---|---|
1 | CCRS.zip\CCRS\CCRS-BUSRULES-v1.5.3.zip\CCRS-BUSRULES-v1.5.3-436e6fff1115001d614ccd45b469ad60a9bdb27b\docs | demo plan for sprint 6 - 20180108.xls | Tue Apr 10 06:18:41 2018 UTC |
2 | CCRS.zip\CCRS\CCRS-BUSRULES-v1.5.3.zip\CCRS-BUSRULES-v1.5.3-436e6fff1115001d614ccd45b469ad60a9bdb27b\docs | demo plan for sprint 6 - 20180108.xls | Fri Jun 15 15:16:35 2018 UTC |
Description | Between Files 1 and 2 |
|
---|---|---|
Text Blocks | Lines | |
Unchanged | 1 | 210 |
Changed | 0 | 0 |
Inserted | 0 | 0 |
Removed | 1 | 483 |
Whitespace | |
---|---|
Character case | Differences in character case are significant |
Line endings | Differences in line endings (CR and LF characters) are ignored |
CR/LF characters | Not shown in the comparison detail |
No regular expressions were active.
1 | SHEET: Sce narios | ||
2 | |||
3 | BATCH, EDI _837I_2018 0105, , De mo Plan fo r Sprint 6 | ||
4 | File Name, EDI_837I_ 20180104.D AT, , Scen ario 1 – E DI file CC N1_837I_20 180104.DAT contains 4 Institut ional Invo ices proce ssed as Ba tch EDI_83 7I_2018010 4. | ||
5 | claim_id, CCN1-837I- 0001, , · Invo ice ID CCN 1-837I-000 1 is for I nstitution al Outpati ent and ha s 8 lines | ||
6 | referral_n umber, VA0 000000017, , Referra l Number e xists | ||
7 | service_li ne_number, 1, , o LX-1 – dec ision = RE JECTED | ||
8 | service_da te, blank, , § Reas on - line is missing service d ate | ||
9 | service_li ne_number, 2, , o LX-2 – dec ision = DE NIED | ||
10 | start_date - service _date, 201 80104 - 20 170701, , § Reason - line fai led timely filing ru le (start_ date – ser vice_date > 180 days ) | ||
11 | service_li ne_number, 3, , o LX-3 – dec ision = DE NIED | ||
12 | service_da te, 2017-1 2-01 (Refe rralDate=2 017-12-23) , , § Rea son - line failed se rvice date rule (ref erral numb er is in t he ccra.re ferral tab le but dat e of servi ce is befo re the Ref erral Date ) | ||
13 | service_li ne_number, 4, , o LX-4 – dec ision = DE NIED | ||
14 | service_da te, 2017-1 2-29 (Refe rralExpira tionDate=2 017-12-28) , , § Rea son - line failed se rvice date rule (ref erral numb er is in t he ccra.re ferral tab le but the service d ate is aft erReferral Expiration Date) | ||
15 | service_li ne_number, 5, , o LX-5 – dec ision = PE NDING_REVI EW | ||
16 | charge_amo unt, $30,0 01, , o Reason – l ine passed all valid ation and business r ules edits but the c harge amou nt exceeds Claim Amo unt Thresh old (charg e amount > $30,000) | ||
17 | service_li ne_number, 6, , o LX-6 – dec ision = AP PROVED | ||
18 | f_institut ional_medi cal_claims _details, required f ields for reimbursem ent are po pulated, , § Reason – line pa sses all v alidation and busine ss rule ed its and is approved for reimbu rsement | ||
19 | service_li ne_number, 7, , o LX-7 – dec ision = AP PROVED | ||
20 | f_institut ional_medi cal_claims _details, required f ields for reimbursem ent are po pulated, , § Reason – line pa sses all v alidation and busine ss rule ed its and is approved for reimbu rsement | ||
21 | service_li ne_number, 8, , o LX-8 – dec ision = SE NT_FOR_PAY MENT | ||
22 | f_institut ional_medi cal_claims _details, required f ields for reimbursem ent are po pulated, , § CCRS q ueries all lines wit h decision = APPROVE D and gene rates a re port for I PPS. The decision c hanges fro m APPROVED to SENT_F OR_PAYMENT . | ||
23 | |||
24 | claim_id, CCN1-837I- 0002, , · Invo ice ID CCN 1-837I-000 2 is Insti tutional I npatient a nd has 6 l ines | ||
25 | referral_n umber, VA0 000000077, , Referra l Number e xists | ||
26 | service_li ne_number, 1, , o LX-1 – dec ision = RE JECTED | ||
27 | revenue_co de, blank, , § Reas on - line is missing revenue c ode | ||
28 | service_li ne_number, 2, , o LX-2 – dec ision = DE NIED | ||
29 | start_date - admissi on_date, 2 018-01-04 - 2017-08- 01, , § R eason - li ne failed timely fil ing rule ( start_date – admissi on_date > 180 days) | ||
30 | service_li ne_number, 3, , o LX-3 – dec ision = DE NIED | ||
31 | service_da te, 2017-1 2-20 (Refe rralDate=2 017-12-28) , , § Rea son - line failed se rvice date rule (ref erral numb er is in t he ccra.re ferral tab le but dat e of servi ce not in the range of active Referral D ate) | ||
32 | service_li ne_number, 4, , o LX-4 – dec ision = PE NDING_REVI EW | ||
33 | charge_amo unt, $30,0 01, , o Reason – l ine passed all valid ation and business r ules edits but the c harge amou nt exceeds Claim Amo unt Thresh old (charg e amount > $30,000) | ||
34 | service_li ne_number, 5, , o LX-5 – dec ision = AP PROVED | ||
35 | f_institut ional_medi cal_claims _details, required f ields for reimbursem ent are po pulated, , § Reason – line pa sses all v alidation and busine ss rule ed its and is approved for reimbu rsement | ||
36 | service_li ne_number, 6, , o LX-6 – dec ision = SE NT_FOR_PAY MENT | ||
37 | f_institut ional_medi cal_claims _details, required f ields for reimbursem ent are po pulated, , § CCRS q ueries all lines wit h decision = APPROVE D and gene rates a re port for I PPS. The decision c hanges fro m APPROVED to SENT_F OR_PAYMENT . | ||
38 | |||
39 | claim_id, CCN1-837I- 0003, , · Invo ice ID CCN 1-837I-000 3 is Insti tutional O utpatient and has 2 lines. Th e claim he ader does not have t he referra l number a nd none of these lin es are flu shots. | ||
40 | referral_n umber, , , Referral Number is blank | ||
41 | service_li ne_number, 1, , o LX-1 – dec ision = RE JECTED | ||
42 | f_institut ional_medi cal_claims _details, other requ ired field s are popu lated, , § Reason – invoice h eader is m issing ref erral numb er | ||
43 | service_li ne_number, 2, , o LX-2 – dec ision = RE JECTED | ||
44 | f_institut ional_medi cal_claims _details, other requ ired field s are popu lated, , § Reason – invoice h eader is m issing ref erral numb er | ||
45 | |||
46 | claim_id, CCN1-837I- 0004, , · Invo ice ID CCN 1-837I-000 4 is Insti tutional O utpatient and has 1 line | ||
47 | service_li ne_number, 1, , o LX-1 – dec ision = DE NIED | ||
48 | procedure_ key, -1, , § Reason – missing procedure code | ||
49 | rendering provider n pi, 504, , § Reason – Renderi ng Provide r is on LE IE list | ||
50 | date_of_se rvice, 201 7-12-27 (R eferralDat e=2017-12- 28), , § Reason – D ate of ser vice is ou t of Refer ral active date rang e | ||
51 | |||
52 | BATCH, EDI _837I_2018 0105 | ||
53 | File Name, EDI_837P_ 20180104.D AT, , Scen ario 2 - F ile CCN1_8 37P_201801 04.DAT con tains 3 Pr ofessional Invoices processed as Batch E DI_837P_20 180104. | ||
54 | claim_id, CCN1-837P- 0001, , · Invo ice ID CCN 1-837P-000 1 is a Pro fessional invoice an d has 8 li nes. | ||
55 | referral_n umber, VA0 000000062, , Referra l Number e xists | ||
56 | service_li ne_number, 1, , o LX-1 – dec ision = RE JECTED | ||
57 | service_da te, blank, , § Reas on - line is missing service u nits | ||
58 | service_li ne_number, 2, , o LX-2 – dec ision = DE NIED | ||
59 | start_date - service _date, 201 80104 - 20 170901, , § Reason - line fai led timely filing ru le (start_ date – ser vice_date > 180 days ) | ||
60 | service_li ne_number, 3, , o LX-3 – dec ision = DE NIED | ||
61 | service_da te, 2017-1 1-15 (Refe rralDate=2 017-11-30) , , § Rea son - line failed se rvice date rule (ref erral numb er is in t he ccra.re ferral tab le but the service d ate is not in the ra nge of the ReferralD ate and Re ferralExpi rationDate ) | ||
62 | service_li ne_number, 4, , o LX-4 – dec ision = DE NIED | ||
63 | rendering provider n pi, 504, , § Reason – line fa iled LEIE rule (rend ering prov ider NPI e xists in t he LKUP_ P ROVIDER_SA NCTION tab le) | ||
64 | service_li ne_number, 5, , o LX-5 – dec ision = PE NDING_REVI EW | ||
65 | charge_amo unt, 10,50 0, , o R eason – li ne passed all valida tion and b usiness ru les edits but the ch arge amoun t exceeds Claim Amou nt Thresho ld (charge amount > $10,000) | ||
66 | service_li ne_number, 6, , o LX-6 – dec ision = AP PROVED | ||
67 | f_professi onal_medic al_claims_ details, r equired fi elds for r eimburseme nt are pop ulated, , § Reason – line pas ses all va lidation a nd busines s rule edi ts and is approved f or reimbur sement | ||
68 | service_li ne_number, 7, , o LX-7 – dec ision = AP PROVED | ||
69 | f_professi onal_medic al_claims_ details, r equired fi elds for r eimburseme nt are pop ulated, , § Reason – line pas ses all va lidation a nd busines s rule edi ts and is approved f or reimbur sement | ||
70 | service_li ne_number, 8, , o LX-8 – dec ision = SE NT_FOR_PAY MENT | ||
71 | f_professi onal_medic al_claims_ details, r equired fi elds for r eimburseme nt are pop ulated, , § CCRS qu eries all lines with decision = APPROVED and gener ates a rep ort for IP PS. The d ecision ch anges from APPROVED to SENT_FO R_PAYMENT. | ||
72 | |||
73 | claim_id, CCN1-837P- 0002, , · Invo ice ID CCN 1-837P-000 2 is a Pro fessional invoice an d has 7 li nes. | ||
74 | referral_n umber, VA0 000000095, , Referra l Number e xists | ||
75 | service_li ne_number, 1, , o LX-1 – dec ision = RE JECTED | ||
76 | service_da te, blank, , § Reas on - line is missing service l abel | ||
77 | service_li ne_number, 2, , o LX-2 – dec ision = DE NIED | ||
78 | start_date - service _date, 201 8-01-04 - 2017-09-01 , , § Rea son - line failed ti mely filin g rule (st art_date – service_d ate > 180 days) | ||
79 | service_li ne_number, 3, , o LX-3 – dec ision = DE NIED | ||
80 | service_da te, 2017-1 2-01 (Refe rralDate=2 017-12-02) , , § Rea son - line failed se rvice date rule (ref erral numb er is in t he ccra.re ferral tab le but the service d ate is not in the ra nge of the ReferralD ate and Re ferralExpi rationDate ) | ||
81 | service_li ne_number, 4, , o LX-4 – dec ision = DE NIED | ||
82 | rendering provider n pi, 504, , § Reason – line fa iled LEIE rule (rend ering prov ider NPI e xists in t he LKUP_ P ROVIDER_SA NCTION tab le) | ||
83 | service_li ne_number, 5, , o LX-5 – dec ision = PE NDING_REVI EW | ||
84 | charge_amo unt, 10,50 0, , o R eason – li ne passed all valida tion and b usiness ru les edits but the ch arge amoun t exceeds Claim Amou nt Thresho ld (charge amount > $10,000) | ||
85 | service_li ne_number, 6, , o LX-6 – dec ision = AP PROVED | ||
86 | f_professi onal_medic al_claims_ details, r equired fi elds for r eimburseme nt are pop ulated, , § Reason – line pas ses all va lidation a nd busines s rule edi ts and is approved f or reimbur sement | ||
87 | service_li ne_number, 7, , o LX-7 – dec ision = SE NT_FOR_PAY MENT | ||
88 | f_professi onal_medic al_claims_ details, r equired fi elds for r eimburseme nt are pop ulated, , § CCRS qu eries all lines with decision = APPROVED and gener ates a rep ort for IP PS. The d ecision ch anges from APPROVED to SENT_FO R_PAYMENT. | ||
89 | |||
90 | claim_id, CCN1-837P- 0003, , · Invo ice ID CCN 1-837P-000 3 is a Pro fessional invoice an d has 4 li nes. The invoice he ader is mi ssing the referral n umber and ICN | ||
91 | referral_n umber, , , Referral Number is blank, ICN is blank | ||
92 | service_li ne_number, 1, , o LX-1 – dec ision = RE JECTED | ||
93 | service_da te, blank, , § Reas on - line is missing referral number and ICN | ||
94 | service_li ne_number, 2, , o LX-2 – dec ision = DE NIED | ||
95 | start_date - service _date, 201 8-01-04 - 2017-09-15 , , § Rea son – line procedure code is f or flu sho t, does no t require a referral number bu t the fail ed timely filing rul e (start_d ate – serv ice_date > 180 days) | ||
96 | service_li ne_number, 3, , o LX-3 – dec ision = DE NIED | ||
97 | procedure_ code, , , o Reason – line pr ocedure co de is for flu shot, does not r equire a r eferral nu mber but f ailed Clai m Amount T hreshold o f > $10,00 0 | ||
98 | service_li ne_number, 4, , o LX-4 – dec ision = AP PROVED | ||
99 | f_professi onal_medic al_claims_ details, r equired fi elds for r eimburseme nt are pop ulated, , § Reason – line pro cedure cod e is for f lu shot an d passes a ll validat ion and bu siness rul e edits an d is appro ved for re imbursemen t | ||
100 | |||
101 | , , , Scen ario 3: | ||
102 | , , , · IPPS s ends confi rmation of payment t o CCRS wit h PAID sta tus. (CCR S will moc k up CSV f ile if IPP S cannot s end the fi le by then ). | ||
103 | |||
104 | , , , Scen ario 4: | ||
105 | , , , · RevOps staff use s Invoice Viewer (wi reframe mo ckup) to s how PAID i nvoices | ||
Araxis Merge (but not the data content of this report) is Copyright © 1993-2016 Araxis Ltd (www.araxis.com). All rights reserved.