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Briefing: Impacts of CHCS Provider Files Date: 20 March 2007 Time: 1510 - 1600

Briefing: Impacts of CHCS Provider Files Date: 20 March 2007 Time: 1510 - 1600. Overview. MHS Systems Review CHCS (Common File) Provider File Key Elements Common Errors Touch-Points Practical Options Conclusion Short Quiz CHCS Reports (Examples) Adding New Providers (Pharmacy).

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Briefing: Impacts of CHCS Provider Files Date: 20 March 2007 Time: 1510 - 1600

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  1. Briefing: Impacts of CHCS Provider Files Date: 20 March 2007 Time: 1510 - 1600

  2. Overview • MHS Systems Review • CHCS (Common File) Provider File • Key Elements • Common Errors • Touch-Points • Practical Options • Conclusion • Short Quiz • CHCS Reports (Examples) • Adding New Providers (Pharmacy)

  3. Systems Overview • The web we work in!

  4. Air Force Clinical Data Mart Navy TRICARE Ops Center Army Worldwide Workload Report WWR (Count Visits) DoD/VA SHARE MHS Data Repository MDR Coding Compliance Editor SADR (Encounters) CCE Standard Ambulatory Data Record Pop Health Portal ADM SADR 1/SADR 2 PDTS EAS IV Extract MHS Mart M2 EAS Repository TPOCS Billable Encounters WAM Count Visits & Raw Services EAS IV “Eligible” Encounters CPT Codes Units of Service Systems Overview Service Repository (BDQAS) Pharmacy Data Transaction System

  5. Key Elements • Provider File Key Elements • Name (last, first, middle initial) • Provider flag • Provider specialty code • Incorrect or null = No Money! • Location (= MEPRS) • Identification, (SSN, license, or DEA #) • Forthcoming National Provider Identification (NPI)

  6. Common Errors • Kinks in the chain • Provider specialty codes 500-518 & above 910 • 500-516 no longer available but may exist in records • Improper or incomplete naming conventions • Providers assigned to wrong location • Duplicate providers

  7. Common Errors • Other contributing factors • No formal guidance • No accountability/ownership • No functional experts • No training/continuity • Shared CHCS platforms • Differing viewpoints & business practices

  8. Touch-Points • Systems impacted • Third Party Outpatient Collection System (TPOCS) • Improper specialty code = No money • National Enrollment Database (NED) • Patient enrollments contain wrong specialty code • Pharmacy Data Transaction Service (PDTS) • Prescriptions filled with no DEA for provider • Medical Expense & Performance Reporting System (MEPRS) • Wrong workload credit

  9. Touch-Points • Where are the money and workload? • Lost/delayed Third Party Collection (TPC) claims • Time to correct errors • Perspective Payment System (PPS) • Credit for medical services provided • Lost Relative Value Unit (RVU) credit • Business plans

  10. Practical Options • Damage control • Restrict functional access • Who inputs new providers files? • Typically credentials, ancillary services, and systems • Access control (restrict use of Provider Specialty Codes) • Provide training • Medical group instruction/process ownership • CHCS reports • Who has specific functional access (minimize)? • All active providers in CHCS • New provider added (user-defined date range) • Correct discrepancies regularly

  11. Additional Information CHCS Reports Adding New Provider

  12. New Providers Added

  13. All Active Providers

  14. Adding New Providers Menu Path Pharmacy System Menu (PSMGR) Outpatient Menu (PSOMGR) Prescriptions Menu (PSO ORDERS) BPL Batch Print Labels RX New Prescription Entry RAP Refill a Prescription PRI Prescription Inquiry EAP Edit a Prescription RNW Renew a Prescription DAP Discontinue a Prescription LRP Label Reprint CCS Clinical Screening PEM Patient Education Monograph DRX Dispense a Prescription PPQ PDTS Prescription Inquiry SPM Secondary Prescriptions Menu IN TransLux Scan In Rx Label OUT TransLux Scan Out Rx Label Select Prescriptions Menu Option: Above is the menu option and menu path used by pharmacy staff to fill new prescriptions and the same option they add new providers. Note: The CHCS user account FILE MANAGER access must contain “P.”

  15. Adding New Providers PATIENT,ANY 20/555-55-5555 24 Jun 1962 M FE6 Select PATIENT: PATIENT,ANY Patient ID: 1088651150 Allergies: 1. NKDA Reaction(s): Unknown; Note: per pt 5jan05leq YOU MAY SELECT: A FOR ACTIVE PRESCRIPTIONS ONLY B FOR BOTH ACTIVE AND INACTIVE PRESCRIPTIONS R FOR RANGE OF DATES <RET> TO BYPASS PROFILE SELECTION: (Select an option above – in this example Carriage Return) Select DRUG: IBUPROFEN--PO 400MG TAB

  16. Adding New Providers PRESCRIPTION: ER1032155 New Prescription Entry Patient: PATIENT,ANY RX #: ER1032155 Pharmacy Comment: NONE Drug: IBUPROFEN--PO 100MG/5ML SUSR In: 120ML/BT Sig: T 1 TSP Q6H WF PP OR FFE #1 Quantity: 1 Metric Qty: Refills Allowed: 0 Provider: MEPRS Code: Days Supply: 10 Order Date/Time: 29 Jan 2007@1201 Expiration Date: 08 Feb 2007 Child Resistant Container: YES Comments: NONE Once the technician gets to the provider field, and enters a provider that is not “active” in the database, the user will be prompted, “Are you adding ‘PROVIDER, NEW’ as a new Provider?”

  17. Adding New Providers Quantity: 40 Metric Qty: Refills Allowed: 0 Provider: PROVIDER,NEW MEPRS Code: Days Supply: 10 Order Date/Time: 29 Nov 2006@1114 Expiration Date: 09 Dec 2006 [------------------------------------------------------------------------------] PROVIDER,NEW OK? Y [------------------------------------------------------------------------------] If adding a new provider, users should be aware the provider could already be in the system, use of standard naming conventions can help prevent duplicate files. This includes using additional punctuation and professional titles in the name. CHCS is case sensitive and will not distinguish the difference between: SMITH,JOHN J SMITH, JOHN J SMITH,JOHN J MD SMITH,JOHN J. The above examples can cause duplicate entries. Only the first is correct!

  18. Adding New Providers After being prompted are you adding, “PROVIDER,NEW” and the technician Answers Y for yes, another question is prompted, “Is ‘PROVIDER,NEW’ an outside Provider?” [------------------------------------------------------------------------------] Are you adding ‘PROVIDER,NEW' as a new PROVIDER? Y Is ‘PROVIDER,NEW' an outside Provider? NO//Yes [------------------------------------------------------------------------------] For ancillary services personnel; Pharmacy, Laboratory, and Radiology should always answer “Yes” to outside Provider, only credentials and systems personnel add internal providers.

  19. Adding New Providers PROVIDER: PROVIDER,NEW DA PROVIDER ADD Name: PROVIDER,NEW Provider Flag: PROVIDER Select PROVIDER SPECIALTY: 000 PROVIDER: PROVIDER,NEW DA PROVIDER EDIT EDI_PN: Provider Specialty Code: 000 Provider Specialty Description: GENERAL MEDICAL OFFICER HIPAA Provider Taxonomy Code: 208D00000X HIPAA Provider Taxonomy Description: PHYSICIANS/ALLOPATHIC/OSTEOPATHIC/GENERAL PRACTICE CMAC Provider Class: 01 - MEDICAL DOCTOR/DOCTOR OSTEOPATHY If an improper specialty code is used (e.g., 500-518 and above 910), the HIPAA Provider Taxonomy Code, HIPAA Provider Taxonomy Description, and CMAC Provider Class will be blank. This has a direct, negative impact on Third Party Collections and PPS.

  20. Adding New Providers PROVIDER: PROVIDER,NEW DA PROVIDER ADD Name: PROVIDER,NEW Provider Flag: PROVIDER Select PROVIDER SPECIALTY: 000 Class: Location: Provider ID: Req. Supervising Provider?: Person Identifier: DEA#: HCP#: Clinic ID: Department ID: DOB: RANK: LICENSE #: SEX: ACTIVE CHCS II ACCOUNT: OUTSIDE PROVIDER CHAMPUS SUPPORT or OTHER MTF PRONEW (See Notes Below) Yes Civilian or appropriate Rank DEA #s are preferred. If provider does not have a DEA # and the License field is used, enter the state abbreviation then the number (i.e., FL123456). If the provider is from another MTF and does not have either a DEA or State License #, enter the Provider’s SSN in the License field with “SSN” in front of the number (i.e., SSN123456789). NOTE: Provider ID is a local policy; it should be standardized. Example, first three & last 3 initials of last & first name. Fields left blank – These are only required for MTF providers.

  21. Summary • Systems Overview(s) • CHCS provider file • Key elements & common errors • Systems impacted • Damage control & options

  22. Quiz 1. What type of provider file should have a specialty code 910 & above? a. Non-Professional Staff b. None c. Non-MTF Staff d. All Files

  23. Quiz 2. Of the examples listed below, what is a proper CHCS Provider file naming convention? a. SMITH, JOHN J b. SMITH,J c. SMITH,JOHN J MD d. SMITH,JOHN J

  24. Quiz 3. Who typically should add new providers? a. Anyone who wants to b. Credentials c. Ancillary staff d. Systems e. Credentials, ancillary staff, and systems

  25. Quiz 4. TPOCS will generate a claim if a provider has a specialty code 910 and above, or is blank a. True b. False

  26. Quiz/Answers 1. What type of provider file should have a specialty code 910 & above? a. Non-Professional Staff b. None c. Non-MTF Staff d. All Files 2. Of the examples listed below, what is a proper CHCS Provider File Naming Convention? a. SMITH, JOHN J b. SMITH,J c. SMITH,JOHN J MD d. SMITH,JOHN J 3. Who typically should add new providers? a. Anyone who wants to b. Credentials c. Ancillary Staff d. Systems e. Credentials, Ancillary Staff, and Systems 4. Will TPOCS generate a claim if a provider has a specialty code 910 and above or is blank? a. True b. False

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