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Classroom Rules

Classroom Rules. Please TURN Cellular Phones/Pagers to VIBRATE or OFF DO NOT Check Emails or Surf Internet During Class Sessions Be Courteous To Others - NO SIDE BAR CONVERSATIONS - PLEASE Ask Questions When Prompted By The Instructor We Thank You for Cooperating. OBJECTIVES.

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Classroom Rules

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  1. UBO/UBU Conference - TPOCS - 22-25 March 2010

  2. Classroom Rules • Please • TURN Cellular Phones/Pagers to VIBRATE or OFF • DO NOT Check Emails or Surf Internet During Class Sessions • Be Courteous To Others - NO SIDE BAR CONVERSATIONS - PLEASE • Ask Questions When Prompted By The Instructor • We Thank You for Cooperating UBO/UBU Conference - TPOCS - 22-25 March 2010

  3. OBJECTIVES • Overview of TPOCS Data Transfer Criteria • Explain the Process and Purpose for the Daily files from CHCS • Explain the Purpose for TPOCS Initialization and Supplemental Files • Identify and Explain CHCS/TPOCS Data Triggers UBO/UBU Conference - TPOCS - 22-25 March 2010

  4. OBJECTIVES • Explain Layout of TPOCS Interface Report • Explain Error Report Layout • Discuss Error Messages UBO/UBU Conference - TPOCS - 22-25 March 2010

  5. CHCS/TPOCS Data Transfer Integration Criteria and Data Files UBO/UBU Conference - TPOCS - 22-25 March 2010

  6. Data Transfer - Integration Criteria • CHCS transfers all TPOCS billing data daily • Unidirectional process - CHCS >TPOCS • Six (6) files transmitted daily • CHCS Electronic Transfer Utility (SY_ETU) • System Manager/BOC must ensure SY_ETU parameters are established and maintained UBO/UBU Conference - TPOCS - 22-25 March 2010

  7. Data Transfer - Data Files There are four (4) types of CHCS data files that update and maintain the TPOCS database: Daily Files CPT Files Initialization Files Supplemental Files UBO/UBU Conference - TPOCS - 22-25 March 2010

  8. Data Transfer - Daily Files CHCS will create the six (6) TPOCS data files on a daily basis: DSIT -Daily Standard Insurance Table file DPROV - Daily Provider file DOHI - Daily Other Health Insurance file ADM - Ambulatory Data Module (Clinic) file LAB_RAD - Laboratory and Radiology file PHR - Pharmacy file UBO/UBU Conference - TPOCS - 22-25 March 2010

  9. Data Transfer - Daily Files • Six (6) files are transmitted daily and must be processed in the appropriate order: Group Files: ADM LAB_RAD PHR Host Files: DSIT DPROV DOHI UBO/UBU Conference - TPOCS - 22-25 March 2010

  10. Data Transfer - CPT-4 File CPT File - CPT-4 Procedure Codes • Annual updatefor the CPT-4 codes in TPOCS • Automatically generatedby CHCS when CPT code update is loaded • Updates the Procedure Tablein TPOCS NOTE:Not related to the CPT Rates update UBO/UBU Conference - TPOCS - 22-25 March 2010

  11. Data Transfer - Initialization Files • Purpose is for recovery of current data file if • server access is lost. • Snapshot of current data at that moment • Manually generated • Two (2) types of Initialization files: • IPROV - Initialization Provider file • IOHI - Initialization OHI file UBO/UBU Conference - TPOCS - 22-25 March 2010

  12. Data Transfer - Supplemental Files • Purpose is to re-synchronize TPOCS and CHCS data file that may be out of sync. • Displays last 90 days only • Manually generated • Two (2) types of Supplemental files: • SSIT - Supplemental SIT file • SOHI - Supplemental OHI file UBO/UBU Conference - TPOCS - 22-25 March 2010

  13. Data Transfer Process Single and Multi-Site Billing (Six 6 Daily Files) (DMIS ID) Host - A Group - A, B, C Site A CHCS HOST DMIS ID 3 - CHCS Host Files DPROV DSIT DOHI 3 - CHCS Group Files ADM LAB/RAD Pharmacy Site A TPOCS (Group DMIS ID) Site B TPOCS (Group DMIS ID) Site C TPOCS (Group DMIS ID) UBO/UBU Conference - TPOCS - 22-25 March 2010

  14. TPOCS Data Triggers UBO/UBU Conference - TPOCS - 22-25 March 2010

  15. Data Triggers • There are specific events that triggers CHCS to include data records in the file transmission to TPOCS. • There are data triggers for each TPOCS file transmitted. UBO/UBU Conference - TPOCS - 22-25 March 2010

  16. Data Triggers Daily Standard Insurance Table - DSIT • New record is added • Active record is edited • Existing record is inactivated/reactivated • Temporary insurance company is upgraded to a standard entry UBO/UBU Conference - TPOCS - 22-25 March 2010

  17. Data Triggers Daily Provider - DPROV • New provider record added • Existing provider record edited • Provider file is initialized UBO/UBU Conference - TPOCS - 22-25 March 2010

  18. Data Triggers Daily Provider - DPROV Screening Logic for Initial Provider Transmission: • Provider must be DBA active • Provider Specialty • Associated CMAC Provider Class UBO/UBU Conference - TPOCS - 22-25 March 2010

  19. Data Triggers Daily Provider - DPROV No Provider Specialty - External • Provider Flag = 1 • DEA number is populated • Use Provider Specialty-000 • Enter CMAC Provider Class UBO/UBU Conference - TPOCS - 22-25 March 2010

  20. Data Triggers Daily Other Health Insurance - DOHI • Records for this file type (OHI) are captured • automatically with OHI enter/edit activity of • the policy or demographic data on CHCS. • Record Type O - Other Health Insurance • Changes in policy ranking (P/S/T/N) • Record Type D - Patient Demographics (Pt Name, Address, Pt SSN, Gender, PATCAT, etc.) UBO/UBU Conference - TPOCS - 22-25 March 2010

  21. Data Triggers Ambulatory Data Module - ADM • Four (4) Record Types: • E (Encounter) • P (Procedure) • U (Update) • C (Cancel) UBO/UBU Conference - TPOCS - 22-25 March 2010

  22. Data Triggers Laboratory/Radiology - LAB_RAD • Record Type L - Laboratory is sent to TPOCS • When Process Flag = N (New) or C (Cancel). • Final Certification of a Lab and flagged - N • CPT code is added and flagged - N • CPT code has been removed from an accession and flagged - C UBO/UBU Conference - TPOCS - 22-25 March 2010

  23. Data Triggers Laboratory/Radiology - LAB_RAD Record Type R - Radiology exam is sent to TPOCS when process Flag is N - (New) with CPT modifier(s): • -26 - Report Only • -TC - Technical Only • -32 - Exam Only • -00 - Complete UBO/UBU Conference - TPOCS - 22-25 March 2010

  24. Data Triggers Pharmacy - PHR Pharmacy Processing Flags • N (New) - New or Refill prescription • U (Update) - Label is edited, partially filled prescription • C (Cancelled) - Prescription is cancelled UBO/UBU Conference - TPOCS - 22-25 March 2010

  25. To Access the TPOCS Interface Load Statistics Report: From the TPOCS Toolbar Select the Reports option Select File Upload Status From the Drop-Down Menu UBO/UBU Conference - TPOCS - 22-25 March 2010

  26. File Upload Report Error Messages and Explanations UBO/UBU Conference - TPOCS - 22-25 March 2010

  27. TPOCS Data Integration Review UBO/UBU Conference - TPOCS - 22-25 March 2010

  28. Data Flow Review • DATA TRANSFER checks to ensure TPOCS file and record integration. • DATA TRIGGERS identifies CHCS logic for processing data to be transmitted to TPOCS. • LOAD ERROR REPORT identifies data that did not populate in TPOCS. UBO/UBU Conference - TPOCS - 22-25 March 2010

  29. ??? QUESTIONS ??? What Can I Do To Assure Data Files Transfer Into TPOCS Timely? TPOCS and CHCS use FTP to accommodate the successful delivery of the six daily files. What If Data Does Not Transfer Into TPOCS? CHCS and TPOCS maintains a log of files and records and the time each file successfully transmitted. UBO/UBU Conference - TPOCS - 22-25 March 2010

  30. ??? QUESTIONS ??? How Do I Resolve Data Discrepancies? Who Is Responsible For Resolving TPOCS Data Discrepancies? All data discrepancies are verified and corrected at the point of origin. UBO/UBU Conference - TPOCS - 22-25 March 2010

  31. System Layout for Data Files/Tables DPROV = Provider Table/CHCS DSIT = Standard Insurance Table/CHCS DOHI = Policy Table/CHCS ADM = Clinic/ADM-CHCS *LAB_RAD = LAB Table/CHCS = RAD Table/CHCS PHR = Pharmacy Table/CHCS UBO/UBU Conference - TPOCS - 22-25 March 2010

  32. ??? QUESTIONS ??? UBO/UBU Conference - TPOCS - 22-25 March 2010

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