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 |
| Module ID | 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 1024 characters 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. |
Notes:
- Only use the first tab for data entry
- Do not delete the additional tabs
- Do not change the column names
- If there are multiple dispositions needed for a single event code, duplicate the rows and update the disposition information appropriately
- If the event is a claim level event, only claim level resolution actions need to be completed. The line level resolution actions should remain blank
- If the event is a claim line level event, only claim line level resolution actions need to be completed. The claim level resolution actions should remain blank
- The file must be saved in .csv format prior to import. CSW UTF-8 is not a valid upload format
- Additions or modifications to event codes should be made in the template and not directly in the csv file to avoid any data loss
The process to import a completed file is initiated by selecting the Import event codes button. The Event codes bulk import screen is displayed and starts the standard multi-step process to perform the import.
- Select the file to be imported by clicking Choose File and then Next once the appropriate file has been selected.
- Validate the mappings. If changes or extensions to the event code data model have been made in the implementation, then these mappings may need to be modified. If not, select Next.
- Create a name for the data import and select Start validation. Note
- validations are required to run by default during the import, so the
selection of the skip validation check boxes do not stop this from
occurring.
- The validation process is now executed and will present the following
information:
- Start time: Time the validation process began.
- Running time: Total time to execute the validation process.
- Valid rows: Number of rows in the uploaded file that have successfully passed all the validations.
- Invalid rows: Number of rows in the uploaded file which have failed the validations.
The user can select continue to process the import into the system, or download the error file, make the corrections, and start again. The error file has a description of the error at the end of each record. If any records are valid, then these can be loaded by selecting Continue import. Any errored records corrected and loaded through another bulk import process.
- The records are added to the system and the import statistics are presented. Selecting Finish will take the user to the summary screen ready for to be sent for approval. Note: Added records identifies the number of event codes that will be added to the system upon approval.
- The summary screen will show the list of event codes ready to be imported. The
comment section will need to be filled and the load process can then be sent for
approval by selecting Finish.
The new bulk import case will be now be displayed on the Bulk import list screen with a status of Pending-Approval. Selecting the case will show the Bulk import statistics screen with the import and, if applicable; error, files attached.
Bulk import approval processLike other configurations, the bulk import approvals are routed through the system manager work queue. The bulk import approval task can be approved or rejected based upon the review. If approved, the event codes will be approved and made active, and the task will be Resolved-Completed. If rejected, all the event codes will be removed, and the task will be Resolved-Rejected.
As part of the approval process, the event codes listed are re-validated to ensure the configurations are still applicable. The result of this creates some scenarios that will present different selections to the approver. These are defined below:
| Scenario | Instructions |
| Approval is received on or after the version start or end date of all the event codes | Only the Reject button will be available, and an alert will be displayed in the approval task. |
| The uploaded event codes encountered errors prior to the approval process. The status of the approval task will be Pending-Errors. | Options to Try again and Force complete are available. to reprocess in this scenario. For Try again, the codes are reprocessed to see if the errors are resolved. For Force complete, the task will be resolved and any codes with an error will be deleted. |
| The uploaded event codes encountered errors prior to the approval process and all the event codes have a version start or end date in the past. The status of the approval task will be Pending-Errors. | Only the Force complete option is available for the user to resolve this work-object. This will resolve this task. The process to reload the event codes will need to be restarted. |
On completion of the approval task, the following information is displayed:
- Codes approved: Codes successfully approved
- Codes skipped: Codes not uploaded because duplicate event code is already present in SCE
- Codes failed to process: The event codes not uploaded due to re-validation errors are moved to the codes failed to upload section.
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