A Pend Code is an alphanumeric code used to identify a pend which is an escalation on a Chase. Each Pend Code has a description associated with it.
NOTE: Retrieval pends are worked by Reveleer’s escalation team for Services Customers only. If the Customer is set-up for co-retrieval, the chase Retriever must be Reveleer. This means the Retriever for a chase must be updated from Client to Reveleer.
| Pend Code | Pend Description | When to Use | Can be Disabled? |
| Clinical Codes | |||
| PC 300 | Clinical Overread 2 Ticket | For Services Clients: When clients are over-reading work performed by Reveleer, this gives them the ability to submit questions to Reveleer via use of a pend code.
| No |
| PC 301 | Clinical Overread 1 Ticket | When performing initial over-read, this gives the over-reader an opportunity to submit questions to their supervisors. This is used by both Services and Platform Clients. | No |
| PC 302 | DOB is incomplete or missing | When the DOB/Gender is missing from the medical record, this will flag this chase as deficient for DOB/Gender. | No |
| PC 303 | New Chase Needs to be Opened | Flags chases that require new chase creation based on medical record review.
| No |
| PC 304 | Clinical Clarification Question | When performing initial abstraction/coding, this gives the primary abstractor/coder the ability to submit questions to their supervisor. This is used by both Service and Platform Clients. | No |
| Close Chases | |||
| PC 1001 | Duplicate Request | There is an identical Chase | Yes |
| PC 1003 | Terminated Chases (Terminated chases after Organization work began) | It is decided that the retrieval of chart/medical records is not needed after the retrieval team started outreach. | Yes |
| PC 1004 | Terminated Chases (Terminated prior to work performed by Organization) | It is decided that the retrieval of chart/medical records is not needed before the retrieval team starts outreach. | Yes |
| PC 1005 | Chase closed due to ADMIN REFRESH | After an Admin Refresh, Chases with measures that have already been validated are closed. | No |
| PC 1006 | Chase closed due to HEDIS Compliance on Another Chase | Another Chase for the same member has satisfied all requirements for HEDIS for that Chase. | No |
| PC 1007 | Collection Only Chart | Automated closing of the chase which will move the chase to Delivery. | Yes |
| PC 1008 | Invoice Above Threshold / Client Denied | Facility requires payment above the approved threshold and Client is denying further attempts to retrieve medical record/chart. Pend is auto-generated upon Client denial. | Yes |
| Codes Used During Data Loads | |||
| PC 506 | Copy Over Chart from Existing Chase | Back end process done by Data Management Team to copy over charts | No |
| Failure To Locate Medical Records | |||
| PC 101 | Provider Office Closed | Retrieval team has recognized that the Provider office is closed by researching and confirming:
| Yes |
| PC 102 | Provider Left Location | Provider has left location or entity and took all their patient’s medical records and no further information available either from location or web search | No |
| PC 103 | Provider Unable to Locate Chart | Facility confirms Provider, all information on file, and patient, however, they cannot find the chart or medical records | No |
| PC 111 | Unable to Confirm Provider Demographics | Retrieval team is unable to find Provider at a location and the current location states Provider does not practice at their facility | No |
| PC 112 | EMR Member not found in EMR | Unable to locate member's records in provider's EMR system | Yes |
| 3rd Party | |||
| PC 131 | Payment Required or Exceeds Threshold – Non-Third Party | Facility requests payment to produce records. Facility will not process provide records without receiving payment, offered alternate retrieval methods, and refused.
Called phone number (T): (000) 000-0000 on file. Spoke to Taylor in medical records for Mercy Health, stated once the request is received there will be a fee of $11 per chart. Informed Taylor the request was for 1 chart/patient or 1 chase, but Taylor insisted that a payment is needed before records can be released. Advised Taylor that no fees have been approved for this project, Taylor insisted the only way she could release records was after an invoice is processed. Please contact Taylor at (T): (000) 000-0000 to follow up. | No |
| PC 132 | 3rd Party Approval After Denial | Yes | |
| PC 133 | Vendor not Contracted with Site | Vendor does not work with the specified site. | Yes |
| PC 134 | HCA Hospital Agreement Required | Need Hospital agreement from HCA to proceed | Yes |
| Financial Approval (not available on all Orgs) | |||
| PC 104 | Payment Required or Exceeds Threshold – Non-Third Party | COD facility requires payment above the approved threshold | No |
| PC 105 | Requested On-Site Retrieval (less than 10 Chases) | Provider or facility’s personnel request a field technician to visit the site to retrieve medical records indifferent of the number of Chases. Facility will not process the request through any other retrieval methods. | No |
| General Codes | |||
| PC 901 | Chase closed | Automated Pend Code generated for Member Centric Chases when a chart is received against it. | No |
| PC 135 | Research Required | Chase requires more research(contact information, AID where chase belongs, etc) | Yes |
| Provider Indicated Cannot Retrieve | |||
| PC 109 | Member Nt My Patient | Facility confirms the Provider is on file but the member is not their patient. The retrieval team confirms that the Provider listed does not practice in any other location | No |
| PC 110 | Member Nt Seen During Review Period | Facility confirms the Provider on file and the member is their patient, however, the medical records for the current review period are not available. The retrieval team confirms that the Provider does not practice in any other location | No |
| PC 130 | Provider reported they do not offer service requested | Provider or facility’s personnel state that the requested medical records are not available since they do not offer that specific service | Yes |
| Refusal / Request Rejected | |||
| PC 100 | Provider Refusal | Provider or facility’s personnel refuses to:
| Yes |
| PC 106 | Requested On-Site Coding/Abstraction (N chart copies) | Provider or facility’s personnel requested for a coder or abstractor to visit the site and process records at facility as the facility will not process the request through any other retrieval methods. Records are Not Allowed to leave facility. | Yes |
| PC 107 | Exhausted Attempts | Retrieval team has exhausted all attempts in reaching the Provider or facility’s personnel. | Yes |
| PC 108 | Requires Member Permission/Signature | Provider or facility’s personnel insists on the member/patient to sign a release of information document or form. Without this form or document request will not be processed. | No |
| PC 115 | Provider Office Requires Access Forms for HDVI Staff | Provider or facility’s personnel requires completed Access Forms by a specific member of the retrieval team. Without this form medical records will not be released. | No |
| PC 119 | Field Tech Onsite/Access Refused by Location | Provider or facility's personnel did not allow the field technician to enter premises and/or access medical records during the appointment date. | Yes |
| PC 125 | Provider Refusal or Mbr Signature Required for Behavior/Mental Health | Provider or facility’s personnel states they are unable to release medical records since their office only contains behavior/mental health records. | No |
| PC 600 | Provider Concern, See Notes | Provider or facility’s personnel has specific concerns regarding audit and retrieval. | Yes |
The Pend Codes below are no longer in use by Reveleer and are saved for historical reference.
| Pend Code | Pend Description | Reason for Retiring |
|---|---|---|
| Retired Pend Codes | ||
| PC 900 | Chase request to Move | Obsolete - No longer needed approval |
| PC 113 | Chart Assigned to HDVI for retrieval & coding, | Obsolete |
| PC 115 | Provider Office Requires Access Forms for HDVI Staff | Obsolete |
| PC 116 | Abstraction/Coding ONLY (client to retrieve chart and HDVI data enter) | Replaced by co-retrieval functionality |
| PC 117 | Payment Required or Exceeds Threshold - 3rd Party Retrieval | Obsolete |
| PC 120 | Chart Received, Invoice Included, Above Threshold | Obsolete |
| PC 123 | Site flagged as EMR Remote Access on load | Replaced by Special Handling |
| PC 124 | Site Flagged as Onsite Review On Load | Replaced by Special Handling |
| PC 126 | Approved for Managed Vendor Process | Replaced by Special Handling |
| PC 127 | DOB Missing or Incomplete | Obsolete |
| PC 128 | IVA Only - Missing Gender | Obsolete |
| PC 129 | DOB and Gender Missing | Obsolete |
| PC 200 | PSR - Payment Required - Chart Fee - Awaiting Invoice | Replaced by invoicing module |
| PC 201 | PSR - Payment Required - Charge Per Pg Fee - Awaiting Invoice | Replaced by invoicing module |
| PC 501 | Invoice approved for payment | Obsolete |
| PC 502 | Invoice paid, waiting for chart | Obsolete |
| PC 505 | Invoice ready to be paid | Obsolete |
| PC 600 | Provider Concern, See Notes | Obsolete |
| PC 1000 | Organization Scheduled to Retrieve &/or Code - Chase completed by HP | Replaced by co-retrieval |
| PC 1009 | Non clinical | Obsolete |
| PC 1012 | CNR of PC109 | Obsolete |