PLATORAC Track EHR Module

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.

Overview

Contents

Denial Overturn Reason

EHR Status Code

Image Code

Record Type

Plato RAC Track has an extension module which integrates with EHR - Executive Health Resources Group RAC application. If RAC requests entered in Plato RAC Track, need to appealed through EHR, the cases can be assigned to EHR from within Plato RAC Track. Thereafter transactions and records entered in one application seamlessly transfer to the other application.

Following is the summary of codes used by the integration module:

Denial Overturn Reason

MEDNEC: Care provided was found to be medically necessary

NOREA: No reason provided by entity overturning the denial

NOJUST: RACs have not provided accurate justification for reopening a claim after a certain period of time

OTHER: Other

EHR Status Code

CASERECV: Initial case assignment received but EHR not ready to begin appeal process

READY: All documentation and information submitted to EHR to begin appeal process

SUBMISSION: Appeal has been submitted

RECEIVED: Appeal has been received and acknowledged by QIC,MAC, or ALJ

HEARINGDATE: ALJ Hearing date received and being sent

RESOLVEDWOH: Denial overturned without hearing

UPHELD: Decision upheld

OVERTURNED: Denial overturned

NOFURAPP: Closed with no further appeal

WOAPP: Closed without appeal

WOREV: Closed without review

NOMEDNEC: Closed because was not Medical Necessity denial

Image code

MR: Medical Record

AR: Admission Record

AOR: Signed Release form authorizing EHR to represent facility

RACDEN: RAC Demand Letter

RACDEMA: Demand letter from RAC

RACMDRCD: RAC medical record request letter

RACRVEW: RAC review result letter

MACAP: MAC Lvl1 Appeal letter

MACACK: MAC letter acknowledging receipt of appeal

MACDET: MAC Determination Letter

QICAP: QIC Lvl2 Appeal Letter

QICACK: QIC letter acknowledging receipt of appeal

QICDET: QIC Determination Letter

ALJAP: ALJ Appeal Letter

ALJACK: ALJ letter acknowledging receipt of appeal

ALJSC: ALJ Schedule date letter

ALJDET: ALJ determination Letter

OTH: Other documents

Record Type

ASSGN: Assignment of case to EHR

STATUS: Daily transmission type from vendor to EHR to indicate status of each active case

EHRRECV: EHR acknowledging receipt of initial case assignment data

EHRREADY: EHR acknowledging receipt of all documentation needed to start working case

HEADER: First record in the data file containing information about the .zip file contents

LVL1: Information about Level 1 appeal being sent

LVL1RSLT: Information about the result of the level 1 appeal

LVL2: Information about Level 2 appeal being sent

LVL2RSLT: Information about the result of the level 2 appeal

ALJAPRV: Decision by Facility on desire to have EHR file ALJ level appeal or close out case after level 2 appeal

ALJ: Information about Administrative Law Judge appeal being sent

ALJRSLT: Information about the result of the ALJ appeal

FACLOSE: Case is closed in Vendor system- may happen at the end of any level of appeal based on Facility’s decision.

EHRCLOSE: Case is closed in EHR system – may happen at the end of any level of appeal based on positive decision to overturn denial or a decision not to appeal further

IMAGE: Information about an image file (Metadata)

Related

PlatoRACTrackTrainingGuidePartI, PlatoRACTrackTrainingGuidePartII