Risk Adjustment NLP Total Capture

Abbi Folk

Modified on: Wed, 27 Jan, 2021 at 7:06 PM

The Risk Adjustment NLP bot performs First Pass Coding. This tool is how you review the bot’s findings.

TABLE OF CONTENTS

Risk NLP Page Overview
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Risk NLP Page Overview

1. Encounter (DOS) Totals: These are your Total Encounters and their source breakdown by Admin, Coder, or Bot. 2. Encounter Bot Legend: Green dot indicates the Bot found a valid Admin encounter. Red dot indicates the Bot did not find a valid Admin encounter. 3. Encounter Table: The Encounters table displays: Claim ID, DOS (from and thru), Provider Name, Encounter Validation of F2F Visit, Bot Result, Source (type of provider visit), and Total Diagnosis for that Encounter.
4. Diagnosis Totals: These are your Total Diagnoses per Encounter and their source breakdown by Admin, Coder, or Bot. 5. Diagnosis Bot Legend: Green dot indicates the Bot found a valid Admin Diagnosis for that Encounter. Red dot indicates the Bot did not find a valid Admin Diagnosis for that DOS. Yellow dot indicated the Bot found a partial match for the Admin encounter, meaning only the Admin DOS was found. 6. Diagnosis Table: The Diagnoses table displays: Clickable page number, DOS (from and thru), ICD, HCC Category, VRC, Admin Bot Result, and Source (Admin data, Net New Add by the Bot or Add by the Coder)
7. Evidence Tools (Left to Right) Evidence Search: Here is where you can quickly navigate Evidence Terms found in the Medical Record that are associated to a Diagnosis with a valid Encounter Highlight Tool: Here is where you can highlight evidence that you found Negative Exclusion Tool: This will show you ICD code that we excluded from the data entry tool. These are typically ICD codes that do not contain MEAT/TAMPER, such as, Medical History, Diagnosis History, Problem List, Health Maintenance, Problems, Past Medical Hx, Past Surgical Hx, Past OB Hx Medical Record OCR Mapping Tool: This tool will show you on the medical record what was captured by OCR. Member Details Tool: This will highlight the Members Name, DOB, and Gender

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1. From My Chase, click a Chase ID to access the chart
2. Validate the Member 3. Click Submit
4. Validate the DOB is Present/Valid a. This is defaulted to yes to avoid extra clicks by the coder
5. Validate Gender is present a. This is defaulted to yes to avoid extra clicks by the coder
6. Review list of Encounters 7. Confirm from the Service Dates (start and thru) information 8. Confirm from the provider information
9. Review diagnosis codes for each encounter 10. Click the arrows to navigate through the evidence 11. Input/Update diagnosis information based on chart review
12. Enter a VRC for each diagnosis 13. Click the X to delete any invalid Bot diagnoses 14. When coding is complete, click Submit

Note:

If DOB/Gender are not present in the medical record for IVA a pursuit is launched. For VDA projects missing DOB/Gender is captured for reporting, but no pursuit is launched.

If an Encounter cannot be validated (appropriate F2F visit based on your medical record review), you will be prompted to stop coding for that Encounter.

Risk NLP Page Overview

Remove Bot Results

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