Quick Guide QA Review March 22, 2018

Transcription

1 Quick Guide QA Review March 22, 2018 Release date 03/22/18 BHSDSTAR.org

2 Overview (QA Review) The QA Review functionality is a mechanism by which paid services can be recouped. There are 4 stages involved in the QA Review process: Stages Stage 1: Reviewable Stage 2: Flagged Stage 2a: Flagged by File Stage 3: Confirmed for Recoupment Stage 4: Repayment Process Stage 4a: Confirmed for Refund Definition All paid services (encounters and claims) that can be flagged for recoupment. All paid services that have been flagged for recoupment by either the Lead Agency or the Vendor. Services flagged for recoupment through a file of records identified by Lead Agency Analysis. All paid services that have been flagged for recoupment and agreed to be recouped by both Parties or identified for recoupment in the first place by the Vendor. Once services have been identified for recoupment, it is necessary for Falling Colors to get the funding back from the Vendor. This can be done through the reduction of payment against a future invoice or by the Vendor sending a check. Both can be done in increments. Services that have been repaid by the Vendor and identified as needing to be refunded to the Vendor. In this guide, we will be discussing the Boxing Ring only. The Boxing Ring is how a service moves from Stage 2 to Stage 4 or is released from the recoupment process along the way.

3 Overview (QA Review) Boxing Ring Lead Agency must contact and inform the Vendor in order to start the clock for recoupment. Ø Lead Agency is required to enter when and who they contacted for records to be available for a Vendor to review. Vendors can choose to accept the recoupment, in which case they agree to make repayment via future payment offsets or by sending Falling Colors a check. (Stage 4) Vendors can petition records flagged for recoupment and attach supporting documentation to accommodate the petition. After a petition is made, the Lead Agency can request clarification on the petition. Ø Lead Agency may or may not require the Vendor to include supporting documentation as part of clarification. Vendors and Lead Agencies can go back-and-forth between 'Clarification Required' and 'Clarification Provided' as many times as necessary. Ø Note: Lead Agency can also choose at any time to 'force' a recoupment or accept the petition. Actions completed by either side during the negotiation results in a deadline being set for the other side to respond.

4 Icon Definitions Icon Definition Record has been flagged for Recoupment by the Lead Agency Pending Vendor Notification by the Lead Agency Clarification of Petition has been provided to the Lead Agency by the Vendor Clarification of Petition Requested by the Lead Agency Recoupment has been Confirmed by the Vendor Recoupment has been Released by the Lead Agency

5 Client Tracking Check-In Required

6 QA Review - Dashboard Records flagged for QA review are ordered inside groups with nearest auto-recoupment deadline on top. Click a record to see details in the Record Status, Record Details, and Record History sections.

7 QA Review - Dashboard Record Status section for each Record will display the number of days remaining for your action to be completed before the record is either auto-recouped or auto-released.

8 QA Review - Dashboard

9 To Accept Record(s) marked for Recoupment Click Cancel to stop and return to previous action Click Submit to confirm the acceptance Status icon for the record(s) will change from the Orange triangle to a handshake icon

10 To Petition Record(s) marked for Recoupment Click in text box to indicate why the selected records are being petitioned. Click Cancel to stop and return to previous action Click Submit to confirm the petition To add supporting documents, Click here or Drag & Drop file here. Status icon for the record(s) will change from the Orange triangle to a Petition icon

11 To Submit Clarification on Record(s) marked for Recoupment Click in text box to indicate why the selected records are being petitioned. Click Cancel to stop and return to previous action Click Submit to confirm the petition To add supporting documents, Click here or Drag & Drop file here. Status icon for the record(s) will change from the Question mark icon to a Petition icon

12 An excel csv file will be displayed. To Export Record(s) marked for Recoupment to Excel Click the Record(s) in the Checkmark column to highlight. You can select ALL records in a group, by clicking on the check mark in the group header (circled in green). Click Export to CSV.

13 Additional QA Review User Information

14 Additional QA Review User Information Examples of the error messages you may encounter while using the QA Review function.

15 BHSDSTAR Contact Information Website: Phone Number: (505)