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Document QA Review

Steven Dozal
Modified on: Wed, 20 Jul, 2022 at 5:08 PM

Here is where chase documents are reviewed before going to Data Entry.

   

TABLE OF CONTENTS

TABLE OF CONTENTS

Document QA Review Page Overview

  1. Chart Tab: The document for you to review and identify. 
  2. Comments Tab: This is where you can read and add comments about this Chase. Comments will show Username, date, time, and message.
  3. Timeline Tab: This is a complete history of this Chase. It is organized by date, newest to oldest. All timeline entries include the Action taken, User, Date, Time
  4. Member Detail: Basic information about the member such as name, DOB and Gender.
  5. Move Back: This will move the chase back to Retrieval for Chart Collection
  6. View Source: This will show you the original document(s). They appear as tabs to the right of the Timeline tab
  7. Submit: This will submit the document
  8. Submit & Get Next: This will submit the document and load a new document
  9. Download: This will create a download request, when complete it can be downloaded from the Chart Download page (see chart download section of manual on page TK)
  10. Assign: Managers and above can assign directly from a Doc QA.
  11. Member Verification: This is where you validate the member. 
  12. Identify as Chase: This is where you associate page(s) as a Chase
  13. Identify as an Invoice: This is where you associate page(s) as an Invoice
  14. Identify as a Pend: This is where you associate page(s) as a part of a Pend
  15. Identify as to be deleted: This is where you associate page(s) that need to be removed. 
  16. Working Pages Table: Working pages is where you can see all pages identified as chases or to be ignored prior to assignment. 
  17. Commit Button: This will commit all the pages to a chase. 
  18. Committed Pages Table: Committed Pages is where you can see all pages attached to Chases, Pends, and Invoices.
  19. Document Viewer: This is the document for review. You can expand, zoom in, zoom out, rotate, search text, navigate through pages, and freely move the page within the viewer

 

Member Validation

Member Validation – Is Valid

  1. From the Review tab, If Member is valid, click Yes

 

Member Validation – Is Not Valid

  1. From the Review tab, click No
  2. Select Reason
  3. Enter page number
  4. Click Submit
  5. A new Document will load

Chase moves back to chart collection to be requested and retrieved again

 

Member and DOS Validation 

Member is Not Valid

  1. From the Review tab, click No
  2. Select Reason
  3. Enter page number
  4. Click Submit
  5. A new Document will load

 

Chase moves back to chart collection to be requested and retrieved again

 

Member, DOS, and All Provider Signatures are Valid/Present on Parent Chase

  1. For Member, click Yes
  2. For DOS, click Yes
  3. For Provider Signature, click Yes
  4. Enter Page Number
  5. Repeat steps 2-4 until all are DOS have been reviewed
  6. Click Submit

 

Chase moves to next status (either Data Entry or Completed)

 

Member, DOS, and All Provider Signatures are Valid/Present on Pursuit Chase

  1. For Member, click Yes
  2. For DOS, click Yes
  3. For Provider Signature, click Yes
  4. Enter Page Number
  5. Repeat steps 2-4 until all are DOS have been reviewed
  6. Click Submit

 

Pages are copied from pursuit to parent chase, parent chase PC700 gets resolved, and Pursuit is pended and closed with PC700

 

 Member is Valid but Missing a DOS

  1. For Member, click Yes
  2. For DOS, click No
  3. Repeat steps 2 until all are DOS have been reviewed
  4. Click Submit

 

A 'Pre-Screen' pursuit is created which contains all missing DOS, Parent Chase is pended PC700

 

Member is Valid, all DOS Present but Missing Signature

  1. For Member, click Yes
  2. For DOS, click Yes
  3. For Provider Signature, click No
  4. Repeat steps 2-3 until all are DOS have been reviewed
  5. Click Submit

 

A 'Pre-Screen' pursuit is created which contains all missing provider signatures, Parent Chase is pended PC700

 

Member is Valid, DOS and Signature are Missing

  1. For Member, click Yes
  2. For DOS, click No
  3. For Signature, click No
  4. Repeat steps 2 until all are DOS have been reviewed
  5. Click Submit

 

A 'Pre-Screen' pursuit is created which contains all missing DOS and provider signatures, Parent Chase is pended PC700

 

Identification

Identify as Chase - Have Chase ID

  1. Click This Page is Part of a Chase
  2. Enter Start Page Number
  3. Enter End Page Number
  4. Enter Chase ID
  5. Click Accept
  6. Chase pages will appear in the Working Pages table as a Medical Record
  7. Prior to submission, click Commit Chase Assignments 






Identify as Chase – Search Chase ID

  1. Click This Page is Part of a Chase
  2. Enter Start Page Number
  3. Enter End Page Number
  4. Click Search
  5. Enter any combination of search criteria, click search
  6. From the results table, click radio button of desired Chase
  7. To Continue, click Use This Chase
  8. To Cancel, click "x” in top left.
  9. To finalize, click Accept
  10. Chase pages will appear in the Working Pages table as a Medical Record
  11. Prior to submission, click Commit Chase Assignments









 

Identify as Invoice - Have Chase ID

  1. Click This Page is Part of an Invoice
  2. Enter Start Page Number
  3. Enter End Page Number
  4. Enter Chase ID
  5. Click Accept




Identify as Invoice – Search Chase ID

  1. Click This Page is Part of an Invoice
  2. Enter Start Page Number
  3. Enter End Page Number
  4. Click Search
  5. Enter any combination of search criteria, click search
  6. From the results table, click radio button of desired Chase
  7. To continue, click Use This Chase
  8. To cancel, click "x” in top left.
  9. To finalize, click Accept








Identify as Pend - Have Chase ID

  1. Click This Page is Part of a Pend
  2. Enter Start Page Number
  3. Enter End Page Number
  4. Select Pend Code
  5. Enter Chase ID
  6. Click Accept




Identify as Pend– Search Chase ID

  1. Click This Page is Part of a Pend
  2. Enter Start Page Number
  3. Enter End Page Number
  4. Select Pend Code
  5. Click Search
  6. Enter any combination of search criteria, click search
  7. From the results table, click radio button of desired Chase
  8. To continue, click Use This Chase
  9. To cancel, click "x” in top left.
  10. To finalize, click Accept







 

Identify as to be Deleted

  1. Click This Page Should Be Deleted
  2. Enter Start Page Number
  3. Enter End Page Number
  4. Click Accept



 

Note: 

Pages can be restored in the Document Page History section by clicking Restore. 

  

Move Back

  1. At the top of the page, click Move Back
  2. When prompted, enter reason for move back
  3. To finalize, click Save
  4. To cancel, click Cancel



 

Submit Document

  1. At the top of the page, click Submit
  2. Once submitted, you will default back to your homepage

 

Submit & Get Next Document

  1. At the top of the page, click Submit & Get Next
  2. Once submitted, a new Document will automatically load 

 

Note: 

If pages have not been associated, you will be prompted to Cancel or click Yes to Submit Document.

 

Based on Service Organization settings, if pages have not been viewed you will be prompted that you cannot submit until all pages have been viewed. 

 

Download

  1. At the top of the page, click Download 
  2. You download request will process under Jobs, located at the top of the screen
  3. Click the Chase ID to finalize download

 

User Permissions
 Administrator

Lead: Retrieval Lead

Manager: Document QA Manager

Employee: Document QA Employee

 

 

 

 


 

 

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