Doc Routing Cheat Sheet

Naming Conventions and Supported Ingestion Types

Documents named according to the conventions below, with no submitted chase in data entry, will attach directly to the chase. If not, they will follow the New Pages setting or be routed to the Approval Center.

Supported Naming Conventions and Ingestion Types

Ingestion Types

• Provider Gateway Chart Drop: Upload via web browser with a pin.

• Customer SFTP: Folder setup for routing files to the appropriate SO.

• Vendor SFTP: Designed for third-party vendor interactions.

• Bulk Upload: Platform bulk upload feature.

Naming Convention Support

*Image names must be provided at data load for associated chases.
**Multiple chases can be attached with underscores (e.g., 12345678_12345679.pdf) for CIOX Managed vendor folders only.

If a naming convention isn’t used, documents will be routed via the bot based on member name/DOB but may end up in intake if multiple chases exist. It doesn’t matter how the document is named. However, if there is more than one chase for the member it will likely end up in intake as the routing bot will not know which of the chases to attach the document to. If there is more than one chase for the same member, it is recommended to use naming conventions or turn multi-match behavior to attach to all chases depending on the situation. Please reach out to the Provider Gateway Squad leader for more clarification.

Back-End Configurations for Routing Bot (Service Organization (SO) Level)

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 service organization settings, please discuss with product to work with ENG to update them. Back-end routing bot settings are at a SO level. This is not configurable at a project level.

Routing Automation Configuration:

• Provider Match: Requires provider name for match (disabled by default - a provider’s name is not needed to match a page to any chase). 

• QA Review: Sends documents with 3 or fewer pages for manual review (disabled by default). 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 require manual review of the pages and determine if they should be attached or not. 

• Multiple Matches: Determines action when multiple valid chases exist. 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 (default: send to intake).

• Member Pull Lists: Member Pull lists may need to be manually reviewed to determine if there are any pends or notes that must be acted upon. Sent to intake for manual review by default where they will appear as ‘Pull List’ in working pages.

Additional Routing Configuration Options

CCD Documents

Continuity of Care Documents (CCDs) may be uploaded to the platform, but their utility varies by program. The routing bot identifies CCDs during ingestion by detecting the phrase "continuity of care," tagging them accordingly. By default, these documents are processed for matches but are routed to QA pages for user review.

If a Service Organization (SO) prefers to use CCD documents without the QA step, this setting can be adjusted to allow direct attachment to the relevant chases.

Customized File Name Matching through SFTP (RegEx Expressions)

This optional configuration can be set up for SFTP folders used for chart ingestion, allowing flexibility in file naming for direct chase matching. To implement this, please contact ENG.

This configuration supports extracting ChaseID from file names, regardless of organization.

Example: If a customer wants to attach multiple documents to the same chase, RegEx can be configured to recognize everything before the first underscore. This enables direct attachment using the ChaseID naming convention, even when the file name includes additional information. Customers may also want to utilize this to include additional information in the file name and still route to specific chases while not utilizing the image name convention.

• ChaseID.pdf, ChaseID_1.pdf, ChaseID_2.pdf, etc could all be dropped to the sftp and we would route on specifically ChaseID.

• ChaseID_planID_memberID_doc1.pdf, ChaseID_planID_memberID_doc2.pdf, ChaseID_planID_memberID_doc3.pdf could all be dropped to the sftp and we would route on specifically ChaseID.

Common Reasons Documents Land in Intake

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 Off. No naming convention used.

• No Matching Member/Chase Found.

  • Chase Not in System.

  • Ingested Before Chase Created. If chase is currently visible in the system, the timeline of the chase and document can be compared

  • Mismatched DOB/Name. Charles vs Charlie or other legal vs preferred name issues. 

  • Illegible Chart.

• Naming Convention Incorrect. Document named for something that doesn't exist in the system, typos where image name doesn’t match what was loaded on chase, or duplicate chases with same image name

• Back End 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. (Most Common setting reason things end in intake)

FAQs

• Do we support naming conventions like ChaseID_1.pdf, ChaseID_2.pdf for attaching multiple documents to the same chase?

  • Yes, this is supported via RegEx expressions on SFTP only. This isn’t standard functionality, so a ticket is required for configuration. Customers must adhere to consistent naming conventions, which can include suffixes like _a, _b, _Jan, _Feb, etc., as long as the ChaseID appears first in the file name.

• Can documents be named anything and still attach to the correct chase?

  • Yes, if there is only one chase for the member and the routing bot successfully identifies matching member information (name/DOB). However, this should not be communicated as a blanket statement; the project setup must be understood to determine the reliability of this approach.

    No, if there are multiple active chases for the same member. In this case, if the document isn’t named for a specific chase, the routing bot may find several matches, leading to the document being sent to intake for manual review. 

• Can we rerun the routing bot on everything in intake to find additional matches?

  • Yes, if there is a clear reason documents didn’t attach initially and rerunning is likely to yield results. This process is costly, so identifying the root cause is essential to prevent recurrence. Common reasons include loading charts before chases or having the same image name linked to multiple chases.

    No, if there isn’t a clear reason why a rerun would produce results. Rerunning without justification is not advisable, as it can be an expensive endeavor.

• What document types can be ingested?

  • PDFs (all methods), TIFFs(SFTP only), PNGs(SFTP only), JPGs (SFTP only).

• New Pages vs. Approval Pages?

  • New Pages: For quality projects, documents can prompt additional coding. The automation will look to the new pages settings for that project to determine if that chase needs to move back for additional coding to take place on the new document or not.

  • Approval Pages: For all non-quality project types, when a document is ingested and a chase is in Data Entry or further along, the document will be matched to the corresponding chase and routed to the Approval Center as an approval page. This process allows for an association with the correct chase, enabling users to review and decide whether the document should be utilized. 

    • Users can view the document in the Approval Center, where they can assess its relevance and accuracy regarding the associated chase.

    • If a document is approved, a child chase is automatically created. This child chase will be coded separately, ensuring that all relevant details are captured while still being linked back to the original member within the project.

    • The approval process maintains a clear audit trail, documenting decisions made on the use of each document and ensuring accountability.

    • If a document is not approved, the document will show “Approval Denied” and will move to the Intake archive, preventing any misrouting of critical information.

Related Documentation

https://reveleer.freshdesk.com/support/solutions/articles/48001208209-document-ingestion-routing