Clinical Report This module will discuss the different reports - - PowerPoint PPT Presentation

Clinical Report

This module will discuss the different reports created by CDP.

1

Daily Reports

2

3

319 – Patient Encounters entered

• Listing of encounters entered in a clinic for the

previous business day

• Summary of CPT codes & RBRV’s
• Summary by provider
• Summary by operator
• Rejected A/R

4

902 – PEF’s Assigned

• Listing of patient who had a PEF # assigned
• Shows Sex, Race, Income, Medicaid and

Medicare Status

5

850 – Outstanding PEF’s

• Listing of PEF #’s assigned but did not get

entered

• This report is cumulative

6

419 Daily Encounter summary

• This report is by county
• Summary of CPT codes & RBRV’s
• Summary by provider
• Summary by operator

7

519 Daily Encounter summary

• This report is by district
• Summary of CPT codes & RBRV’s
• Summary by provider
• Summary by operator

8

352 – Daily Invoices

• Report shows invoices set up for previous day

by pay code

9

358 – Daily receipts

• Report shows any money collected or adjusted

for the previous day by pay code

• Also shows money that was electronically

posted

10

773 – PEF’s updated

• Listing of PEF’s that had changes made the

previous day

• If the encounter was changed 5 times, it will

show on the report 5 times.

11

666 – Patient Merge Log

• Listing of Patient ID’s that were merged

together.

12

865 – No Show Report

• Listing of patients that missed their

appointment for the previous day

• If not getting this report, you can request to

receive daily

13

864 – No Show Labels

• Labels for patients on 865 report to send a

postcard to reschedule appointments

14

2864 – No Show Labels - Zebra

• These are the same as the 864 but are

formatted to print on a Zebra Printer

15

300 – Appointment List

• Listing of appointments for a particular day
• This report is requested thru the CDS288

16

301 – Appointment Labels

• Labels for the patients pulled on the 300

report

• Originally these labels were used as PEF

labels.

• Shows income, number in house, Medicaid,

Medicare and Insurance status

17

2301 – Appointment Labels

• Labels for the patients pulled on the 300

report for printing on a Zebra printer

18

703 – No Phone # Labels

19

2803 – No Phone # Labels

20

601 – Supplemental Encounter List

• List of Supplemental encounters entered the

previous day.

21

615 – Community Health Service List

• List of Community Health Services entered the

previous day.

22

Clinical Monthly Reports

23

108 – Supplemental Activity by Type, Discipline, and Age.

• Breakdown of Supplemental encounters by

type, discipline and age.

• This report is cumulative from the beginning
• f the fiscal year.
• Report runs the second weekend of the

month.

24

359 – Monthly Aging Report

• Listing of all A/R invoices with an open

balance and # of days past due

• Report runs first weekend of the month or last

day of the month if it falls on a weekend

25

360 – Monthly Invoice listing

• List all invoices set up for the previous month

by pay code

• Runs the last day of the month

26

361 – Monthly receipt listing

• Report shows any money collected or

adjusted for the previous month by pay code

• Also shows money that was electronically

posted

• Report runs last day of the month

27

597 – Private Pay Statements

• Statement that can be sent to the patient

showing balance due for Pay code 1 and 15

• Available for plain paper or mailers
• Statement amounts are determined by the

agency

28

598 – Statement labels

• Labels for the private pay statements
• Only receive if your statements are printed
• n plain paper.

29

2898 – Statement lables

• Same labels as the 598 only they are for

printing on the Zebra printers

30

439 – Positive Pregnancy Log

• Listing of patients who tested positive for

pregnancy

• Runs first weekend of the month
• This report is also produced in an Excel format

31

323 – Pap Log Report

• Listing of patient who received a pap the

previous month and the results of the pap, if they were entered.

32

617 – Supplemental Encounter List

• Listing of supplemental encounters entered

during the previous month.

• This report runs on the night of the 15th of the

month.

33

676 – Mam Log Report

• Listing of patient who had results entered the

previous month.

• If results are slow to come back, let us know

and we can adjust your run.

34

570 – Summary of Immunizations

• Summary of immunizations by age
• Categorized by Medicaid, Insurance, Insurance

skip, and American Indian

• This summary from the start of the Fiscal year

to the end of the previous month.

35

571 – Quarterly Summary of Immunizations

• Summary of immunizations by age
• Categorized by Medicaid, Insurance, Insurance

skip, and American Indian

• This report runs in Jan, Apr, Jul, and Oct for

the previous quarter.

36

572 – Summary of Immunizations

• Summary of immunzations by age
• Categorized by Medicaid, Insurance, Insurance

skip, and American Indian

37

219 – FYTD Encounter Summary

• This report is by site
• Summaries by CPT code, provider and

Operator

• Report is from the beginning of the Fiscal

year to the end of the previous month

38

701 – FYTD Encounter Summary

• This is a county version of the 219 report
• Summaries by CPT code, provider and

Operator

• Report is from the beginning of the Fiscal year

to the end of the previous month

39

700 – FYTD Encounter Summary

• This is a district version of the 219 report
• Summaries by CPT code, provider and

Operator

• Report is from the beginning of the Fiscal year

to the end of the previous month

40

375 – Medicaid encounters with MDCD Status of A, P, or M

• This report list those Medicaid encounters

that have a Medicaid status of A, P, or M.

• The encouters with these status will NOT bill
• ut until the status has changed.

41

135 – Unduplicated Patient Counts

• Report is broken out by Cost Center, race, and

sex

• Report is cumulative from the beginning of

the Fiscal year

42

138 – Unduplicated Patient Counts

• Report is broken out by Cost Center, race, and

sex

• Report is for only one month

43

353 – Number of Services by cost center

• Report is broken out by Cost Center and pay

codes

• Report is cumulative from the beginning of

the Fiscal year

• This report is in a .CSV format and must be
• pened with Excel
• A clinic, county, and District version will be

created

• Report will be named –

Site-XXXX_Rpt-0353_Clinic_MM-DD-YYYY

44

758 – Number of Services by cost center

• Report is for Radiology/Laboratory/Pathology

services

• Report is broken out by Cost Center and pay

codes

• Report is cumulative from the beginning of the

Fiscal year

• This report is in a .CSV format and must be
• pened with Excel.
• A clinic, county, and District version will be

created

• Report will be named –

Site-XXXX_Rpt-0758_Clinic_MM-DD-YYYY

45

677 – Death Index

• Listing of patient who died in your county or

are from your county.

• Report runs when the state gets us a file. This

is usually quarterly

46

Insurance Billing Reports

47

When does Insurance billing run?

Pre-bill runs 1st & 3rd Sunday of the Month Live billing runs 2nd & 4th Sunday of the Month

48

Pre-Billing Reports

• 729 – Pre-bill Invoice Register

(Paper)

• 733 – Pre-bill reject report

(electronic/paper)

• 2729 – Pre-bill Invoice Register

(electronic)

49

729 – Insurance Pre-bill Register Paper claims only

• This report runs on the 1st and 3rd Sunday of

the month.

• This report is for reviewing the claims before

they bill out.

• This report will only show those claims that

will be billed out on paper (HCFA1500)

50

733 – Insurance Reject Report

51

2729 – Insurance Pre-bill Register Electronic claims only

• This report runs on the 1st and 3rd Sunday of

the month.

• This report is for reviewing the claims before

they bill out.

• This report will only show those claims that

will be billed out electronically (not on HCFA)

52

Live Billing Reports

• 730 – Invoice Register (Paper)
• 731 – CMS 1500 forms (HCFA’s)
• 732 – Labels for CMS 1500 forms
• 733 – Reject Report (paper & electronic)
• 2730 – Invoice Register (electronic)
• 2734 – Re-bill Invoice Register

53

Insurance Acknowledgment report

• 1830 – Acknowledgement report
• Available Wednesday after 2nd Sunday
• P = Processed (not paid)
• R = REJECTED

54

1830 – Insurance Ack Report

55

977 – Insurance company listing

• Listing of the insurance companies for your

district

• User can request report when they need it
• From GUI, click billing, click insurance codes,

then click create report 977. Report will be ready very shortly.

56

Medicaid Billing & Remittance Reports

57

Medicaid Billing Reports

58

When does Medicaid billing run? All Medicaid runs weekly.

Kentucky Medicaid Billing Reports

• 3062 – Claims not billed to Medicaid

Claims CDP could not bill due to errors

• 3072 – KY Medicaid Expected Revenue
• 3082 – KY Medicaid Invoice Register
• 3092 – KY Medicaid Rebill Invoice Register

59

60

3062 – Medicaid Reject Report

Passport Medicaid Billing Reports

• 250 - Amerihealth Invoice Register
• 3063 – Claims not billed to Passport Medicaid

Claims CDP could not bill due to errors

• 3083 – Passport Medicaid Invoice Register
• 3093 – Passport Medicaid Rebill Invoice

Register

61

Coventry Medicaid Billing Reports

• 3062 – Claims not billed to Coventry Medicaid

Claims CDP could not bill due to errors

• 3086 – Coventry Medicaid Invoice Register
• 3096 – Coventry Medicaid Re-bill Invoice

Register

62

KY Spirit Medicaid Billing Reports

• 3062 – Claims not billed to KY Spirit Medicaid

Claims CDP could not bill due to errors

• 3087 – KY Spirit Medicaid Invoice Register
• 3097 – KY Spirit Medicaid Re-bill Invoice

Register

63

Wellcare Medicaid Billing Reports

• 3062 – Claims not billed to Wellcare Medicaid

Claims CDP could not bill due to errors

• 3088 – Wellcare Medicaid Invoice Register
• 3098 – Wellcare Medicaid Re-bill Invoice

Register

64

Humana Medicaid Billing Reports

• 3062 – Claims not billed to Humana Medicaid

Claims CDP could not bill due to errors

• 3089 – Humana Medicaid Invoice Register
• 3099 – Humana Medicaid Re-bill Invoice

Register

65

66

Medicaid Remittance Reports

67

When do Medicaid remittance reports run? KY Medicaid – Tuesday Night MCO Medicaid – when we get them

68

KY Medicaid Remit Reports

• 432 – Paid Medicaid claims report
• 578 – Denied Medicaid claims report
• 579 – Medicaid claims in suspense
• 580 – Medicaid A/R rejects
• 581 – Medicaid Summary by Service and

Cost Center – FYTD

• 582 – Medicaid District Summary by Service

and Cost Center – FYTD

• 794 – Medicaid Payment Summary by Service

and Cost Center - FYTD

• 795 – Medicaid District Payment Summary by

Service and Cost Center - FYTD

69

Example of A/R Reject Report

70

Lead Remit Reports

• 2532 – Paid Lead claims report
• 2578 – Denied Lead claims report
• 2579 – Lead claims in suspense
• 2580 – Lead A/R rejects
• 2581 – Lead Summary by Service and Cost

Center – FYTD

• 2582 – Lead District Summary by Service and

Cost Center – FYTD

• 2588 – Adjusted Lead claims report

71

Passport Remit Reports

• 532 – Paid Passport claims report
• 530 – Denied Passport claims report
• 531 – Passport A/R rejects

72

Coventry Remit Reports

• 436 – Paid Coventry claims report
• 678 – Denied Coventry claims report
• 580 – Coventry A/R rejects
• 583 – Adjusted Coventry claims report
• 3681 – Coventry Summary by Service and Cost

Center – FYTD

• 3682 – Coventry District Summary by Service

and Cost Center – FYTD

• 3694 – Coventry Payment Summary by Service

and Cost Center - FYTD

• 3695 – Coventry District Payment Summary by

Service and Cost Center - FYTD

73

KY Spirit Remit Reports

• 437 – Paid KY Spirit claims report
• 778 – Denied KY Spirit claims report
• 580 – KY Spirit A/R rejects
• 583 – Adjusted KY Spirit claims report
• 3781 – KY Spirit Summary by Service and Cost

Center – FYTD

• 3782 – KY Spirit District Summary by Service

and Cost Center – FYTD

• 3894 – KY Spirit Payment Summary by Service

and Cost Center - FYTD

• 3895 – KY Spirit District Payment Summary by

Service and Cost Center - FYTD

74

Wellcare Remit Reports

• 438 – Paid Wellcare claims report
• 878 – Denied Wellcare claims report
• 580 – Wellcare A/R rejects
• 583 – Adjusted Wellcare claims report
• 3881 – Wellcare Summary by Service and Cost

Center – FYTD

• 3882 – Wellcare District Summary by Service

and Cost Center – FYTD

• 3894 – Wellcare Payment Summary by Service

and Cost Center - FYTD

• 3895 – Wellcare District Payment Summary by

Service and Cost Center - FYTD

75

Humana Remit Reports

• 439 – Paid Humana claims report
• 879 – Denied Humana claims report
• 580 – Humana A/R rejects
• 583 – Adjusted Humana claims report
• 3981 – Humana Summary by Service and Cost

Center – FYTD

• 3982 – Humana District Summary by Service

and Cost Center – FYTD

• 3994 – Medicaid Payment Summary by Service

and Cost Center - FYTD

• 3995 – Medicaid District Payment Summary by

Service and Cost Center - FYTD

3100 – Emdeon claims reject report

• This report show MCO claims that were

rejected by Emdeon, the clearinghouse for MCO claims.

• This report runs at the beginning of each

month.

• Sites will only receive this report if they had

claims that were rejected by Emdeon.

76

3101 – MCO claim reject report

• This report show MCO claims that were

rejected by the MCO. This report will include claims that have been rejected by all MCO’s.

• This report runs at the beginning of each

month.

• Sites will only receive this report if they had

claims that were rejected by Emdeon.

77

78

Medicare Billing Reports

79

When does billing run? Every Sunday

80

Billing Reports

• 533 – Invoice Register – Regular Medicare
• 534 – Invoice Register – Railroad Medicare
• 535 – Invoice Register – Passport Advantage
• 633 – Re-bill Invoice Register – Regular Medicare
• 536 - Acknowledgement Report

Ready to print on Thursday after 1st Sunday

• 537 - Reject Report

Claims CDP could not send due to problems

81

Report 536 example

82

Report 537 example

83

When do Medicare remittance reports run? Monday Nights

84

Medicare Remittance Reports

• 115 – Paid Medicare claims report
• 116 – Denied Medicare claims report
• 119 – A/R Reject Report

85

119 – MDCR A/R reject report

86

Contract Billing Reports

87

When does billing run? First Sunday of the month

88

Billing Reports

• 736 – Invoice Register
• 737 – HCFA 1500 forms
• 735 – Mailing Labels for HCFA 1500 forms

89

Billing Reports - continued

• 978 – Listing of contract payers
• This is an on-demand report
• To request from GUI, click billing, click

contract codes, then click create report 978

90

Humana Vitality Reports

91

2657 – Humana Vitality Roster billing

• Listing of the Humana Vitality visits entered

into the system for the previous month.

• This report runs at the beginning of the month

for visits entered the previous month.