We have just released multiple Claim Document enhancements that will ease the navigation through pending documents with attached encounters and to manage each encounter more easily before sending the batch to Nphies for their insurance approval. See every new feature in this article.
Encounter Status Filters
First, we added a new dynamic filter to the Claim Document that will allow you to view the attached encounters more easily and to fix those with issues by applying this filter. The new filter is not a search filter but an encounter status filter that will display options according to the encounters that are attached.
The encounter status could be any of the following :
Pending. Meaning that this document is currently pending from Nphies response or that this document is not yet sent*.
Queued. If the encounter was successfully sent to Nphies and did not receive any error feedback message, it will appear as Queued.
*No document. If any pending encounter does not have the Summary PDF file attached, you will see the No document error message. Fix this before sending to Nphies.
You can apply any of the filters to view only those records with this status or leave it as blank to view every attached encounter :
Notes : An additional Error response status will be displayed when Nphies gives an error message response. Queued will mean that no errors were found.
Missing Documents and Issues Functionality
If any encounter has issues that must be fixed before sending to Nphies, you can view the list of every of these errors on Issues Log (context menu). In addition to this, we will now highlight in red color every encounter that has issues, letting users know that these encounters must be fixed before sending them out to Nphies.
If the given error is that this encounter still has missing their summary PDF file, you will be able to view this on Status column and to apply the Encounter Status filter :
It is very important to fix these issues before trying to send these encounters to Nphies. No Document status must be fixed by attaching the PDF for Nphies or else users will not be allowed to send the Claim to Nphies.
Outpatient Claim Settings
Abstracting window has two Outpatient Claim Types available : Oral and Vision. Now, you can perform this same process in Outpatient claim settings option from context menu. Click on it to open this window :
The Outpatient Claim settings pop-up window will open, here you will see the two available Claim Types for outpatients :
Oral
Vision
Note : This functionality is only displaying subitems for Oral type of claims but in the upcoming releases we will also include more details for the Vision type of claim.
Now, select the Oral Sub Site and the Oral Body Site from the list and Confirm :
Columns Improvements
Patient Type column
In addition to the forementioned features, we have also included a new Patient Type column, that will display the patient type for every encounter (Outpatient, Inpatient, Emergency ) :
Encounter Status Update in Items Detail
Also, in order to improve the communications with Nphies, we will now display Error or Queued after sending these encounters to Nphies. This will appear in the status of the encounters list and in the given error in the items attached to every encounter (Status column and Adjudication Reason Code).
See columns example :
Send Validity Days to Nphies
In order to better communication details about medications prescribed, we will now send to Nphies the validity days of every drug prescribed attached to the Claim Documents. If these meds were direct charges, then they will be automatically set to 1 day.
See medication charge example :
Sending of Attached PDFs
If this encounter has a Summary PDF file attached or any Nphies document (a PDF set to be sent to Nphies), then the encounter may be sent to Nphies since the No document status has changed.
See attached PDF examples :
This is very important for being able to send the claims to Nphies since if any encounter does not have any attached file for Nphies then the Claim will not be sent correctly.
We hope this improves your Cirrus experience. Remember to share this information and ask for help if you need it.
Date: November 21, 2023.