This content will give you a detailed overview of Reveleer’s Document Ingestion, Document Routing Automation, and Document Approval Settings.
TABLE OF CONTENTS
Document Ingestion
This section will cover the different ways in which documents are ingested into Reveleer and attached to their respective chases. Depending on the method of document ingestion, it may be directly attached to a chase, reviewed by automation for chase matches or sent to Document Intake for manual review.
Fax/Mail
When a provider faxes documents to the number found on the request, the documents are ingested directly into the Reveleer Platform. Upon ingestion, the document will be analyzed by the Document Routing Automation (if enabled) or will go to Document Intake for manual review. If a record is mailed to the address provided on the request, it will be scanned and converted to a PDF. It is ingested in the same manner as a faxed document.
SFTP
When documents are submitted to Reveleer through an SFTP, the naming convention of the document is checked by the Document Routing Automation. If the document is named after one of the supported naming conventions, it will be automatically attached to the appropriate chase. If there is no supported naming convention for the document, it will be analyzed by the Document Routing Automation (if enabled) or will go to Document Intake for manual review.
Provider Gateway
When documents are submitted to Reveleer through the Provider Gateway Portal, the naming convention of the document is checked by Reveleer. If the document is named after one of the supported naming conventions, it will be automatically attached to the appropriate chase. If there is no supported naming convention for the document, it will be analyzed by the Document Routing Automation (if enabled) or will go to Document Intake for manual review. When viewing the Document in Intake, users can see the Address ID from which it was submitted.
Bulk Upload
When documents are submitted to Reveleer through a Bulk Upload, users can select a specific naming convention for their documents, if applicable. Any documents submitted using the selected naming convention will be routed to the appropriate chase. If the documents contain a combination of different naming conventions, users can select ‘Documents for Intake’ as the format type, in which case documents will be checked for all supported naming conventions. If no naming conventions apply to any of the documents, they will then be analyzed by the Document Routing Automation (if enabled) or will go to Document Intake for manual review.
Direct Uploads
Documents can be uploaded directly to chases in a variety of different ways. One of these ways is through the chase by selecting ‘Add Document’ and uploading one or more documents. Users can also navigate to the Address and click ‘Upload’ to quickly attach documents to multiple chases. In either scenario, all documents uploaded are attached to the selected chase.
Document Naming Conventions
If a document is named with one of the supported naming conventions and the chase has not been submitted in data entry, it will be attached to the chase. Below are the naming conventions supported by Reveleer.
Chase ID
Documents can be named directly as the Chase ID. This will attach the full document to the chase when uploading through Provider Gateway, Bulk Upload, and SFTP.
Example: 1234567.pdf
Client Chase Key
Documents can be named directly as the Client Chase Key as provided in Data Load or entered when creating a Chase. This will attach the full document to the chase when uploading through Provider Gateway, Bulk Upload, and SFTP.
Example: ClientChaseKey.pdf
Image Name
Documents can be named directly as the Image Name as provided in Data Load file. This will attach the full document to the chase when uploading through Provider Gateway, Bulk Upload, and SFTP.
Example: MyDocument.pdf
No Naming Convention
If a document is ingested without one of the supported naming conventions or being directly attached to a chase, it will be analyzed and attached by the Document Routing Automation (if enabled) or it will be sent to Document Intake to be reviewed manually.
Document Routing Automation
If a document is ingested without one of the supported naming conventions and without being directly attached to a chase, it will be analyzed by the Document Routing Automation if it is enabled in your service organization settings.
Page Identification
When a document is analyzed by the chart routing automation, all text is extracted from each page using OCR technology. The automation attempts to match the extracted text to a member’s name, DOB and provider in order to match that page to a chase. Each page in a document may be routed separately and assigned to one of the destinations below.
Member Pull List
If a member pull list is returned by the provider as part of the document, it is recognized by the automation and the page will be reviewed manually in intake. This is to ensure that any pends or notes left by a provider on the pull list can be reviewed and acted on accordingly.
Ignore
The first thing the automation does when analyzing a document is determine if there are any pages which can be ignored. A variety of pages are programmed to be automatically ignored by the automation in order to allow it to effectively analyze the medical records within a document. Pages that are ignored are fax cover sheets, provider packets, and blank pages. Additionally, pages can be configured to be ignored specifically for a certain organization.
Invoice
The next thing the automation looks for is invoices. Invoices can be identified by the automation or associated with a specific vendor, and when they are identified, they are sent to the invoice page. If the invoice was generated by MRO, Ciox or ScanStat, the chase ID may be automatically entered for the given invoice.
Medical Record
If text that pertains to a specific chase can be identified on a page, it will be assigned to that chase. In order to make this match, the automation must find the member’s name, DOB and provider depending on how the automation is configured for your organization.
QA
Depending on the configurations for an organization, the routing automation may return results of QA for a particular page. This result will only be returned if a chase was identified containing 3 or fewer pages, and if this setting is enabled for the organization. When QA is assigned for a page, it will appear in ‘working pages’ when reviewing the document in intake.
Unassigned
If the automation is unable to associate a given page with any of the page types above, it will remain unassigned and the document will be sent to intake for manual review.
Configurations
The Document Routing Automation can be configured in multiple ways to best suit the needs of a specific organization. The following settings are controlled behind the scenes, for adjustments to your organizations settings, please discuss with your CSM.
Provider Match
The presence of a provider’s name may be required to match a page to a chase if it is configured as such. This setting is disabled by default, meaning a provider’s name is not needed to match a page to any chase.
QA
A threshold of 3 pages can be set to send short medical records to be manually reviewed if desired. If this is enabled, any chase identified by the automation that contains 3 or fewer pages will appear as “QA” in working pages. This will cause someone to manually review the pages and determine if they should be attached or not. By default, this setting is disabled.
Multiple Matches
When the automation determines that there are multiple equally valid chases that a page can be assigned to, the result is determined by the “Multiple Matches” setting. The possible configurations for this scenario are to attach the pages to all the chases identified, attach the pages only to the first chase identified, or send the document to intake for manual review. By default, this setting is configured to send a document to intake when multiple matches are found for any given page.
Pull List
Member Pull lists may need to be manually reviewed to determine if there are any pends or notes that must be acted upon. Whether member pull lists are ignored or sent to intake for manual review is controlled by a setting. By default, this is configured to send member pull lists to intake for manual review, where they will appear as ‘Pull List’ in working pages.
Enabling and Disabling Automation
The Document Routing Automation can be manually enabled and disabled for an organization in the service organization setting sunder the “Document Routing” tab. This can be enabled specifically for each of the following document ingestion methods: Bulk Upload, Fax, FTP and Mail. Note: Users will have ability to enable or disable specifically for Provider Gateway as of 2/16.
Working and Committed Pages
When viewing a document in intake, users will see two tables that may contain assignments for pages in a document. The top grid is called “Working Pages” and contains all the assignments that have been made, but not committed (attached to a chase). If an assignment is made but not committed, that means that the pages are not actually attached to their assigned chase. The bottom table is called “Committed Pages” and contains all assignments that have been committed. Once an assignment is committed, then the pages are attached to the chase allowing it to move to data entry.
If any page in a document remains ‘unassigned’ after analysis, the document is sent to intake to be reviewed manually with any assignments made by the automation appearing in the ‘Working Pages’ table. If there are no ‘Unassigned’ pages but any page is identified as QA or Pull List, then the document will also be sent to intake to be reviewed manually, however any chases identified in the record will be automatically committed and will appear in the “Committed Pages” table.
Document Approval Center Settings
When pages are attached to a chase that is either inactive or has already gone through data entry, the document approval center settings will determine what happens to those pages. Unless a document is attached in full, directly to a chase by clicking ‘Add Document’ from the chase document viewer, the project settings will be applied as described in this section.
Child Chase Creation
When a chase has already gone through data entry and is in a status of overread or beyond, any pages that are either manually or automatically assigned to the chase will be subject to project settings. Depending on these settings, a ‘Child Chase’ may be created, which is a new chase that inherits all of the properties of the original chase and receives the new pages. The different project configurations for creating child chases are described below.
Automatically Approve
If child chase creation is set to automatically approve for a project, then whenever pages are assigned to a chase that has already been data entered for that project a child chase will automatically be created. The pages assigned to the original chase will then be attached to the new chase, which will move into a status of data entry. Until this chase has been submitted in data entry, any new pages assigned to the original chase or the child chase going forward will be appended to the pages already attached to the child chase.
Automatically Deny
If child chase creation is set to automatically deny for a project, then whenever pages are assigned to a chase that has already been data entered for that project they will automatically be denied. This means that no child chase will be created, and the pages must be viewed in the archive section of document intake where they can be reassigned if needed.
Send to Approval Center
If child chase creation is set to send to the approval center for a project, then whenever pages are assigned to a chase that has already been data entered for that project, they will appear in the document approval center. From here, each chase can be reviewed individually, and it can be manually decided if a child chase should be created or not.
Inactive Chases
When chases are inactive, they are in a status of ‘dataload’ and are not included in outreach for a project. However, if pages are manually or automatically attached to a chase in this status, the following project settings determine what happens to the chase.
Automatically Approve
If Chase activation is set to automatically approve for a project, then whenever pages are assigned to an inactive chase for that project the chase will become active and the pages will be attached. The chase will then move to data entry.
Automatically Deny
If Chase activation is set to automatically deny for a project, then whenever pages are assigned to an inactive chase for that project the chase will not become active and the pages will not be attached. They will remain in the archive of the approval center where they can be reassigned if necessary.
Send to Approval Center
If Chase activation is set to send to the approval center for a project, then whenever pages are assigned to an inactive chase for that project the chase will appear in the document approval center. From here, each chase can be reviewed individually, and it can be manually decided if the chase should become activated or not.
Document Routing Troubleshooting
There may be cases where documents don't attach to chases as initially expected. Below are some of the common reasons that can be. Please check these before submitting a ticket.
- Routing bot is off for the routing type the document came into the system and a naming convention is not being used
- Routing bot is not able to find a matching member/chase
- Chase not in the system
- Chase loaded after chart has been ingested - If chase is currently visible in the system, the timeline of the chase and document can be compared
- Chart illegible (rare)
- Naming convention incorrect - named for something that doesn't exist in the system
- Settings:
- Provider match setting set to yes: Need to find a provider that matches the provider on the chase. If the routing bot doesn't find a provider match to the chase the document will go to intake. (by default this setting is disabled)
- QA for documents 3 or fewer pages set to yes. If a document comes in and and is 3 or fewer pages and this setting is on, any documents 3 or fewer pages will be sent to intake for manual review. (by default this setting is disabled)
- Multiple matches: By default this setting is set to send things to intake. This means that if a document would match multiple chases for a member it will go to intake for manual review. This is one of the most common reasons that documents end up in intake, when there is a clearly matching chase in the system.