Bulk uploading event codes
Event codes can be uploaded in bulk, enabling a client to configure a spreadsheet of all event codes to be implemented. This will enable the load of all event codes to be approved in a single action. To perform a bulk load, select the Bulk import button in the Event code list screen. The bulk import status screen will be displayed. This provides a status of all the bulk imports performed along with the ability to download the event code import template and perform the import event code process.
The fields on the bulk import list screen show the case for each import, along with the status, user and date, and the number of rows read, validated, imported, approved, and rejected.
The event code import template provides a tab containing a sample file, along with a read me tab detailing the fields utilized in the template file. The event code import template, contains the following fields:
Field | Required flag | Valid format or values | Instructions |
Version start | Yes | Valid date in MM/DD/YYYY format | The date the event code becomes active in the system; must be today or a date in the future. |
Version end | Yes | Valid date in MM/DD/YYYY format | The date the event code becomes inactive in the system; must be today or a date in the future and must be greater than or equal to the version start date |
ModuleID | Yes | 3-digit module acronym | The acronym for the module that assigns this event code. For example, SVE for Process validation edits or SGB for global events. |
Event code number | Yes | Event code number must be in the correct range for the implementation ID chosen | |
Event name | Yes | Alphanumeric characters | Enter up to 256 characters to cover the name of the event code |
Description | Yes | Alphanumeric characters | Enter up to 1024characters to provide a description for the event code |
Category | Yes | Business or System | The category of the event code |
Applies to | Yes | Claim or Claim line | Where the event code is raised on the claim; either at the claim (header) level or the claim line level |
Client Number | No | All characters | Enter up to 15 characters to provide the unique client number or ID. |
Implementation ID | Yes | The implementation layer ID for the event code. | |
Clean claim | Yes | True or False | Indicates whether claim generating this event code can be considered clean |
DOS start | Yes | Valid date in MM/DD/YYYY format | The first date of service (DOS) which the configuration applies to; can be any date in the past or future. |
DOS end | Yes | Valid date in MM/DD/YYYY format | The last date of service (DOS) which the configuration applies to; can be any date in the past or future and must be greater than or equal to the DOS start date |
Claim type | Yes | All or D, I, O, P | All or D (Dental), I (Inpatient), O (Outpatient), P (Professional). Multiple values may be chosen and separated by comma. (For example, "D,P") |
Claim identifier | Yes | All or Chargeable, Medicaid reclamation, Reporting | All or Chargeable, Medicaid reclamation, Reporting. Multiple values may be chosen and separated by comma. (For example, "Chargeable, Reporting") |
Disposition - claim type | Yes | All or D, I, O, P | Choose a value from the dropdown. All, D (Dental), I (Inpatient), O (Outpatient), P (Professional). |
Disposition - claim identifier | Yes | All or Chargeable, Medicaid reclamation, Reporting | Choose a value from the dropdown |
Disposition - submission type | Yes | All or New, Adjustment/replacement, Void/cancel | Choose a value from the dropdown |
Disposition - media type | Yes | All or EDI POS, Electronic Batch, Paper, VAN POS, Web POS | Choose a value from the dropdown |
Disposition - processing start date | Yes | Valid date in MM/DD/YYYY format | The date the defined disposition becomes active in the system; must be today or a date in the future. |
Disposition - processing end date | Yes | Valid date in MM/DD/YYYY format | The date the defined disposition becomes inactive in the system; must be today or a date in the future and must be greater than or equal to the disposition processing start date |
Disposition - action | Yes | Suspend or Deny, Informational, Ignore | Choose a value from the dropdown |
Disposition priority | No | Any number from 1-10 | For suspend events only - if not populated, priority will default to 1. |
Suspend - claim level resolution process | No | For suspend events - if not populated, claim level events will apply the default process defined in system settings. | |
Suspend claim line level resolution process | No | For suspend events - if not populated, claim level events will apply the default process defined in system settings. | |
Suspend resolution role | Situational | Required for suspend events - defines the user role that may resolve the event | |
Override event | Situational | True or False or <blank> | Adds the resolution action to the event code resolution screens. Blank is equal to false |
Override role | Situational | Must be populated if Override event is set to True. Defines the user role that may override the event | |
No action required | Situational | True or False or <blank> | Adds the resolution action to the event code resolution screens. Blank is equal to false |
Update claim | Situational | True or False or <blank> | Adds the resolution action to the event code resolution screens. Blank is equal to false |
Update claim line | Situational | True or False or <blank> | Adds the resolution action to the event code resolution screens. Blank is equal to false |
Deny claim | Situational | True or False or <blank> | Adds the resolution action to the event code resolution screens. Blank is equal to false |
Deny claim line | Situational | True or False or <blank> | Adds the resolution action to the event code resolution screens. Blank is equal to false |
Cancel claim | Situational | True or False or <blank> | Adds the resolution action to the event code resolution screens. Blank is equal to false |
Manually price claim line | Situational | True or False or <blank> | Adds the resolution action to the event code resolution screens. Blank is equal to false |
Suspend response - claim status category code | Situational | Valid claim status category code | Required if disposition action is set to suspend |
Suspend response - claim status code | Situational | Valid claim status code | Required if disposition action is set to suspend |
Deny response - claim adjustment group code | Situational | Valid claim adjustment group code | Required if disposition action is set to suspend or deny |
Deny response - claim adjustment reason code | Situational | Valid claim adjustment reason code | Required if disposition action is set to suspend or deny |
Deny response - claim status category code | Situational | Valid claim status category code | Required if disposition action is set to suspend or deny |
Deny response - claim status code | Situational | Valid claim status code | Required if disposition action is set to suspend or deny |
Deny response - liability assignment | Yes | Provider or Member | Determines how the system applies liability for denials |
Deny response - member calculation | Situational | Billed or Allowed | Required if liability assignment is set to member |
EOB description | No | Alphanumeric characters | Description for EOB (explanation of benefits); communication to the member. |
EOP description | No | Alphanumeric characters | Description for EOP (explanation of payment); communication to the provider. |
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