User Guide. File. Format

Transcription

1 Inpatient Outpatient Data Collection System User Guide File Format Specifications Effective 10/1/2014 1

2 TABLE OF CONTENTS INFOH USER GUIDE I. Introduction pages 3-4 II. General Rules for Submission of INFOH Case Counts page 5 III. General Rules for Submission of INFHO Data pages 5 7 a. Assignment of Patient Type -----page 6 IV. Logging into INFOH page 8 V. Welcome to Data Services Screen page 9 VI. Submit Discharge Case Counts page 10 VII. Discharge Case Count Verification page 11 VIII. Submit Data Batches page 12 IX. Batch Review Screen page 13 X. Batch Detail Screen page 14 XI. Edit Record Screen page 15 XII. Correcting Edits pages XIII. Data Verification page 17 XIV. Data Verification Report page 18 XV. Find a Patient Record page 19 XVI. Create Reports page 20 XVII. NPI Upload page 21 XVIII. Support Submitting Requests page 22 XIX. Examples page 23 2

3 INFOH SUBMISSION MANUAL INTRODUCTION What is INFOH? INFOH stands for Information Network for Oregon Hospitals. This initiative was developed by Apprise Health Insights, the data subsidiary of the Oregon Association of Hospitals and Health Systems (OAHHS), in response to the need for hospital billing and discharge data that went beyond the Oregon state mandate requiring hospitals to submit quarterly inpatient and outpatient surgical data. INFOH expands hospital billing data collection to include emergency department and all other outpatient encounters. The expansion was approved by the full hospital membership in July of Why INFOH? Apprise will use the additional data, in coordination with OAHHS and the overall hospital membership, in order to better understand trends in hospital utilization and reimbursement, and to support its advocacy efforts on behalf of Oregon s community hospitals. Likewise, hospitals need additional data to support their planning efforts in an environment where more care is being provided in an outpatient setting. Understanding the full spectrum of care provided will be crucial in the era of Coordinated Care Organizations (CCOs) and overall health care transformation that focuses on value versus volume. Data Submission Requirements The Office for Oregon Health Policy and Research (OHPR) is authorized under Oregon Revised Statute to collect hospital inpatient and outpatient surgical claims data and free-standing ambulatory surgery center (ASC) claims data. Current reporting requirements began in 2008 and will continue. Per OHPR, data should conform to the Official UB-04 Data Specifications Manual (published and maintained by the National Uniform Billing Committee NUBC), for claim-specific codes were applicable. INFOH is a web-based data collection tool designed to effectively and efficiently collect inpatient discharge, outpatient surgical, emergency department, and all other outpatient encounter claims. Data will be required quarterly, but hospitals are strongly encouraged to submit data as frequently as possible to avoid last minute delays and allow for additional time for corrections. OAHHS recommends monthly data submission at a minimum as the volume of data being collected increases substantially with the addition of emergency department and all other outpatient encounters. Data can be submitted in either flat-file or 837i v5010 formats as specified in this manual. In addition to submitting actual claims records, facilities must also submit case counts by month for inpatient discharges, outpatient surgeries, emergency department visits, and total outpatient visits prior to the quarter close. These monthly counts are used to determine quarterly compliance with volume of error-free records submitted to INFOH. 3

4 Access to the secure program may be obtained by contacting System training will be required by Apprise before access is granted to a new user. Username and password information must not be shared. Due Dates INFOH specifies two different due dates. Initial data submissions are due 45 days after the end of the calendar quarter. Final due dates are 60 days after the end of the calendar quarter. Why two different due dates? Due to the volume of data submitted by hospitals, it is highly advised to comply with both due dates in order to provide the necessary time for corrections. Minimum compliance levels for quarterly data submission are as follows: Inpatient 95% Outpatient Surgical 95% Emergency Department 95% All Other Outpatient 75%* *It is anticipated that these compliance levels will be increased over time as hospitals gain experience with the error-correction capabilities provided by INFOH. Initial Due Dates (45 days after the end of the calendar quarter): Q1: January - March data is due May 15 Q2: April - June data is due August 15 Q3: July - September data is due November 15 Q4: October - December data is due February 15 Final Due Dates (60 days after the end of the calendar quarter): Q1: January - March data is due May 31 Q2: April - June data due is August 31 Q3: July - September data is due November 30 Q4: October - December data is due February 28 Use of this manual is effective for discharges of October 1, 2014 and after. 4

5 GENERAL RULES FOR SUBMISSION OF INFOH CASE COUNTS Facilities are required to submit monthly Case Count information for: Inpatient Outpatient Surgery Emergency Department Total Outpatient. NOTE: Inpatient and Total Outpatient discharges/visits are counted ONLY ONCE. Counts for Total Outpatient should include Outpatient Surgery and Emergency Department. Reference Appendix I Definition of Inpatient and Outpatient Records to determine definition of categories. Specific instructions on how to submit case counts will be updated when ready. GENERAL RULES FOR SUBMISSION INFOH DATA Facilities determine the submission format: Inpatient Flat, Outpatient Flat, or Apprise-specific 837i v5010. Inpatient Flat and Outpatient Flat formats are comma-delimited files with set fields lengths. There must be a line feed after position 2500 for every record. The Apprise-specific 837i v5010 format submission requires that these specifications be used as a companion guide to the corresponding ASC Health Care Claim: Institutional Consolidated Guide, version X223A2. Reference the ASC X12 837i Technical Reports Type 3 (TR3) and modify specific data elements to create the Apprise-specific transaction for submission. Apprise does not provide the TR3 documents, but they are available from the Washington Publishing Company at Modifications to the X12 837i v5010 are specified to ensure hospital compliance for submitting to INFOH through electronic administrative data. The modifications do not, however, contradict or otherwise modify the X12 837i v5010 in a manner that will make its use noncompliant. In addition, these changes are separate from and do not impact how claims are submitted for payment. General rules for batch compliance include but are not limited to: Flat files have fields with specific start and stop positions. X12 837i v5010 general compliance needs to be adhered to including but not limited to: o Inclusion of standard header (SE = beginning of transaction) and trailer (ST = end of transaction) sets. o Batch size is limited to a maximum of 100,000 CLM segments. o ISA and IEA must have exact same control numbers. o Detail information on the claim is comprised of hierarchical structure in a series of loops. Hierarchical level segments (HL) indicate the provider, subscriber and patient information. o HL segments are numbered sequentially within a transaction set (ST to SE) with the sequential number found in HL01, the first data element in the HL segment. HL segments must be unique. 5

6 o HLs may contain multiple child HLs which indicate an HL nested within the previous HL. Parent HLs are required when a child HL exists. Batch failures include but are not limited to: File is not in a compliant format. File is too large. File is missing required data elements (i.e. Facility NPI). More than 50% of batch contains duplicate records. ASSIGNMENT OF PATIENT TYPE Each facility determines whether a record is inpatient or outpatient. Inpatient Place of Service is also determined by each facility. Bill Type will define the Patient Type and the inpatient Place of Service of submitted records. Extreme care is required to assign patient records to the service they receive. Inpatient Patient Type and Place of Service assignment must occur as follows. See Appendix II. * Place of Service 1 Acute Inpatient Bill Type 0111 * Place of Service 2 Medical Rehab Bill Type 0151 * Place of Service 3 SNF/Swing Bed Bill Types 0181 and 0211 * Place of Service 4 Behavioral Health Bill Type 0171 Any other Bill Type will identify a record as Outpatient. This includes records submitted with invalid Bill Types. Outpatient Place of Service is determined in a hierarchical fashion depending on the Revenue Codes on each claim. See Appendix II. Apprise-specific format and field requirements include: Bill Type Bill Type will determine Patient Type (either Inpatient or Outpatient) AND inpatient Place of Service. See above. Hospital Number Each facility must coordinate with Apprise on a single organizational NPI for submitting required INFOH data. Race Required on all records. See Appendix V. Ethnicity Required on all records. See Appendix VI. Primary Expected Source of Pay, Secondary Expected Source of Pay, and Tertiary Expected Source of Pay need to be mapped to INFOH s Expected Source of Pay codes. See Appendix VII. Patient s First/Last Name Required on all records. Patient Address 1 Required on all records. Where Patient Address 1 is not available, for any reason, populate field with No Address Reported. Admission Date Required on all records. Admission Hour Required on all inpatient records. See Appendix VIII. Priority (Type) of Admission Required on all records. See Appendix IX. Point of Origin/Source of Admission Required on all records. See Appendix X. POA Required only on Inpatient Place of Service = 1 (Acute Care) principal, E-code, and other/additional diagnoses unless the ICD-9 code is exempt. See Appendix XII. 6

7 Other reporting requirements: Records (inpatient and non-recurring outpatient) should be submitted into the quarter of the Discharge Date. Recurring outpatient records should be submitted into the quarter matching the Dates of Service for that record. Inpatient o Service line information (revenue portion) should be summary level claim information where all the charges are summarized (rolled-up) by revenue code. o Inpatient procedure information is reported using ICD-9/10 procedure codes. o For 837i v5010, repeat HI segments to report ALL inpatient ICD-9/10 diagnoses and ALL inpatient ICD-9 procedures codes associated with each claim. Outpatient o Service line information (revenue portion) should be detail level claim information where all revenue lines are submitted. o Outpatient procedure information is reported using CPT and/or HCPCS. o For 837i v5010 Repeat HI segments to report ALL outpatient ICD-9/10 diagnoses associated with each claim. Repeat SV2 segments to report ALL outpatient CPT/HCPCS procedure codes associated with each outpatient claim. 7

8 INFOH USER S GUIDE LOGGING INTO INFOH Access INFOH Logon page at org/submit. To reset password, click I forgot my password. A program-generated will contain a link for user to input new password information. Username is full address. o Multi-hospital l users encounter second logon screen where a dropdown allows selection of facility. Name and facility name will appear in the top right of thee screen. o Change Facility (top right of page) allows multi-hospital userss to toggle between facilities. Note: More than 6 failed logon attempts will lock the user out. You must contact Apprise to have your password reset. DO NOT SHARE YOUR LOGON INFORMATION!! New user information should be communicated to Apprise by contacting INFOH@AppriseHealthInsights.com. 8

9 WELCOMEE TO DATA SERVICES SCREEN The Welcome to Data Services screen greets INFOH users. Important or new INFOH changes are communicated to users through messages on this screen. o INFOH reference materials available with links att the bottom of the page. Menu options include: o Submit batch o Batch Review o Discharge Case Counts o Find Patient Record o Create Report o NPI Upload Help initiates a Support Ticket to Apprise staff. 9

10 SUBMIT DISCHARGE CASE COUNTS Monthly Discharge Case Counts must be submitted prior to quarter completion for: o Inpatient o Outpatient Surgery o Emergency Department o Total Outpatient Case Counts will determine percent compliance. Percent compliance will be determined by count of valid quarterly records per the number of expected case counts entered. o Inpatient 95% o Outpatient Surgery 95% o Emergency Department 95% o Total Outpatient 75% 10

11 DISCHARGE CASE COUNT VERIFICATION Discharge Case Count Verification is a two-step process. o Ready to Verify o Mark As Complete READY TO VERIFY QUARTER Once monthly case counts have been submitted select Ready to Verify. Answer OK to the question To initiate the verification process for this quarter, click OK. Reports will be ed to the appropriate contacts for review. Are you sure you want to proceed?? (See example on page 20). Verify the informationn on report against internal information. Report any questionss or discrepancies to Apprise. It is possible that the quarter will need to re-opened if errors are discovered. MARK COMPLETE Once the Discharge Case Count Report has been reviewed for completeness and accuracy, click Markk As Complete on the Discharge Case Counts screen. Answer OK to the question To complete the verification process for this quarter, click OK. Are you sure you want to proceed? Mark Complete communicates the facility attestation too data accuracy and completeness. 11

12 SUBMIT DATA BATCHES There are multiple ways to gain access to the Submit Batch Screen: : o From the menu drop down, select Submit Batch OR o From the Welcome to Data Services page selectt the quarterr in which you want to submit OR o From the Batch Review screen, select Submit Batch button next to the quarter in which you want to submit Select Submit. o Note: Do not close Browser while file is being transmitted. Users will be taken to the Batch Review screen once thee file has been transmitted. The file will not immediately be listed on the Batch Review screen. It must first be processed. You may submit multiple batches for the same quarter. (For example, you may choose to transmit dataa daily, weekly or monthly; therefore you will submit multiple times for the same quarter). Only files matching the required Apprise-specific file formats will be accepted. See INFOH Manual for details. o Inpatient Flat File o Outpatient Flat File o Apprise-spec cific 837i v5010 An notificationn on status of the batch submission will be sent to Primary contacts at the facility. (See examples on page 21). 12

13 BATCH REVIEW SCREEN The Batch Review screen allows users to manage quarterly information, delete batches, gain access too records with edits, find records and create reports. Information about quarterly batches by batch number, upload date, total records and valid/invalid records are available. o Note: A batch will not appear until the data has been processed and your screen has been efreshed. To edit invalid records, select View next to the batch withh invalid records. This will take you to the Batchh Detail screen see page 14. To deletee a batch, select Delete next to the correspondin ng batch to mark it for deletion. Answer OK to the question Are you sure you want to permanently delete this batch file? WARNING: This operation cannot be undone. Your batch will not be able to be recovered. Replacement or new batches may be uploadedd immediately. 13

14 BATCH DETAIL SCREEN The Batch Detail Screen displays a list of records that have edits. Users have the option of working through edits from the list displayed or selecting specific fields from the drop down. By selecting a specific field, users will work that field until all edits are satisfied ignoring other edits on the records. Select Edit next to a record to gain access to the Edit Record screen. 14

15 EDIT RECORD SCREEN Records with edits display the following information: o Protected Information o Patient Information o Encounter Information o Diagnosis Information o Procedure Information o Revenue Information Fields are accessible to changes and correctionss with the following exceptions: o Patient Control o Patient City Derived from ZipCode o Place of Service Derived from Bill Typee o Discharge Date derived from Statement Covers Period Through date For privacy reasons, Protected information (which includes Patient Name and Patient Address information) is not immediately visible on the editt screen. Apprise audits access to this information periodically. CORRECTING EDITS Edits appear in yellow. When a required element is missing from the Protected Information area, the yield sign will appear next to the wordss Protected Information. Correct these edits byy clicking on the + sign, making corrections and updating the record. The type of edit and/or directions to correct the edit are explained by holding the cursor over thee yield sign next to the edit field. The cursor will appear in the field of the first edit on the page OR in the field of the edit type selected from the dropdown. Once corrections have been made, Enter or clickk on Update. Note: The record it sent back through the all edits to make sure all fields now agreee with updated information. Any new edits will be flagged by appearing in yellow. 15

16 If the error was corrected, the next record to be edited will appear. Selecting Next or Previous will take you to thee record with edits immediately before or immediately after. Select Deletee Record at the bottom of the page and answer OK to Are you sure you want to permanently delete this record? if you want to delete a record. (Example You may want to delete a record if it is a duplicate.) Select Createe Diagnosis, Create Procedures, or Create Revenue to add a code and other information where an omission has occurred. o Select the red X next to any line item that needs to be deleted. Answer OK to the question Are you sure you want to permanently delete this line? 16

17 DATA VERIFICATION Verification is a three-step process. o Ready to Verify Quarterr o Confirm hospital contacts o Mark Complete READY TO VERIFY QUARTER Selection of Verification Process on the Batch Review screen nextt to the desired quarter initiates a check of valid record counts against submitted case counts. Message on the Quarter Verification Screen will communicate status. Verification of quarterly data happens for four groups of record types: o Inpatient o Outpatient Surgery o Emergency Department o Total Outpatient If compliance is met for select record group, facility contact s Information is displayed for accuracy. Make changes to any field identified. Changes are not automatically accepted by INFOH but will be ed to Apprise staff for approval. Answer OK to the question To initiate the verification process for this quarter, click OK. Reports will bee ed to the Primary and General contacts for review. Are you sure you want to proceed? Mark the checkbox to communicate that you have reviewed the contact information and made necessary changes. Answer OK to To initiate the verification process for CATEGORY TYPE records, Click OK. Verificationn reports will be ed to the appropriate contacts for review. Are you sure you want to proceed? Verification Report will be automatically ed to appropriate contacts. (See example on page 21). Verify the informationn on all reports against internal information. Report any questionss or discrepancies to Apprise. It is possible that the quarter will need to re-opened dataa errors are discovered. MARK COMPLETE Once all reports have been reviewed for completeness and accuracy, click Mark Complete on the Batch Review screen. Answer Yes to the question Are you sure you are ready to mark this quarter complete? Clicking OK will communicate that you are inn agreementt with the reports and attest to their accuracy. NOTE: Changes to data after this point may incur a cost to your facility. Are you sure you want to proceed? Mark Complete communicates the facility attestation too data accuracy and completeness. 17

18 DATA VERIFICATION REPORT VERIFICATION REPORT INCLUDES Information automatically ed upon initiation of the verification process OR by selecting Verification Report from the Create Report menu show: Inpatient o Place of Service o Total Charges by Revenue Center o Patient Discharge Status o Gender o Priority (Type) of Admission o Point of Origin o Race o Ethnicity o Primary Payer o Secondary Payer o Condition Codes o Occurrence Codes o Occurrence Span Codes o Value Codes o Accident State o Birth Weight in Grams o Generic NPI o Diagnoses o Present on Admission o E-Codes o Procedures o Age o Length of Stay o Outlying Total Charges o MS-DRG o ZipCodes o State of Resident o Clinician (Attending and Operating) Outpatient Surgery, Emergency Department and Total Outpatient o Place of Service o Total Charges by Revenue Center o Patient Discharge Status o Type of Bill o Gender o Priority (Type) of Admission (Outpatient Surgery only) o Race o Ethnicity o Primary Payer o Secondary Payer o Condition Codes o Occurrence Codes o Occurrence Span Codes o Value Codes 18

19 o Accident State o Generic NPI o Diagnoses o E-Codes o Age o Length of Stay o Outlying Total Charges o ZipCodes o State of Residence o Clinician (Attending and Operating for Outpatient Surgery and ED only) Information on each report field should be validated against host system data. Report discrepancies to Apprise. 19

20 FIND A PATIENT RECORD To display any submitted record on the Edit Record Screen: Select Menu. Select Find Patient Record. Enter desired information in appropriate field or select item from dropdown. o NOTE: Information must match exactly. Records matching search will appear on the page. Select desired record to open it on the Edit Screen. Make corrections as needed and update the recordd to save changes. Changes can be made to open quarters only. o If data needs to be changed and the quarter has already begun the verification process, contactt Apprise to reopen the quarter in order to save changes. 20

21 CREATE REPORT TS Select Menu. Select Create Report. From Create a Report drop down, select the type of report you wish to run including: o Verification Report o Discharge Case Counts o Compliance Report o Error Summary Report o NPI Errors Each report has specific options allow you to select the information for reports. Disable popup blockers to run reports. 21

22 NPI UPLOAD Select NPI Upload from Menu. Download NPI Upload Template. Populate Excel spreadsheet with the following: Populate Excel spreadsheet with the following: o NPI* o First Name* o Middle Initial o Last Name* o Suffix o Credential* *Indicates required field Missing information for required fields will result in rejection of upload with message(s) communicating deficiencies. Browse for saved file. Submit. File upload is communicated to Apprise staff for validation of requested NPIs. 22

23 SUPPORT SUBMITTING REQUESTS HELP from any page on the top right will take user to a link to createe a support ticket. Information required includes: o address o Data Program (either INFOH or Dimensions date use tool) ) o Subject o Description of Problem o Priority ranking Tickets will be addressed by association staff routinely. 23

24 EXAMPLES Batch successfully loaded. Batch unsuccessfully loaded. o Multiple reasons for batch rejection exist. The message will specifically describe why the batch was not allowed to load. o Failures include but are not limited to: File is not compliant with X12 837I v50100 format. File does not have required data elements (i.e. Facility NPI). More than 50% of batch contains duplicate records. OR Discharge Case Count Verification sent to appropriate contacts. Verification sent to Primary and General contacts when all records are submitted and all edits are corrected. 24