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Bulk uploading event codes

Suggest edit Updated on April 26, 2021

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:

FieldRequired flagValid format or valuesInstructions
Version startYesValid date in MM/DD/YYYY formatThe date the event code becomes active in the system; must be today or a date in the future.
Version endYesValid date in MM/DD/YYYY formatThe 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
ModuleIDYes3-digit module acronymThe acronym for the module that assigns this event code. For example, SVE for Process validation edits or SGB for global events.
Event code numberYesEvent code number must be in the correct range for the implementation ID chosen
Event nameYesAlphanumeric charactersEnter up to 256 characters to cover the name of the event code
DescriptionYesAlphanumeric charactersEnter up to 1024characters to provide a description for the event code
CategoryYesBusiness or SystemThe category of the event code
Applies toYesClaim or Claim lineWhere the event code is raised on the claim; either at the claim (header) level or the claim line level
Client NumberNoAll charactersEnter up to 15 characters to provide the unique client number or ID.
Implementation IDYesThe implementation layer ID for the event code.
Clean claimYesTrue or FalseIndicates whether claim generating this event code can be considered clean
DOS startYesValid date in MM/DD/YYYY formatThe first date of service (DOS) which the configuration applies to; can be any date in the past or future.
DOS endYesValid date in MM/DD/YYYY formatThe 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 typeYesAll or D, I, O, PAll or D (Dental), I (Inpatient), O (Outpatient), P (Professional). Multiple values may be chosen and separated by comma. (For example, "D,P")
Claim identifierYesAll or Chargeable, Medicaid reclamation, ReportingAll or Chargeable, Medicaid reclamation, Reporting. Multiple values may be chosen and separated by comma. (For example, "Chargeable, Reporting")
Disposition - claim typeYesAll or D, I, O, PChoose a value from the dropdown. All, D (Dental), I (Inpatient), O (Outpatient), P (Professional).
Disposition - claim identifierYesAll or Chargeable, Medicaid reclamation, ReportingChoose a value from the dropdown
Disposition - submission typeYesAll or New, Adjustment/replacement, Void/cancelChoose a value from the dropdown
Disposition - media typeYesAll or EDI POS, Electronic Batch, Paper, VAN POS, Web POSChoose a value from the dropdown
Disposition - processing start dateYesValid date in MM/DD/YYYY formatThe date the defined disposition becomes active in the system; must be today or a date in the future.
Disposition - processing end dateYesValid date in MM/DD/YYYY formatThe 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 - actionYesSuspend or Deny, Informational, IgnoreChoose a value from the dropdown
Disposition priorityNoAny number from 1-10For suspend events only - if not populated, priority will default to 1.
Suspend - claim level resolution processNoFor suspend events - if not populated, claim level events will apply the default process defined in system settings.
Suspend claim line level resolution processNoFor suspend events - if not populated, claim level events will apply the default process defined in system settings.
Suspend resolution roleSituationalRequired for suspend events - defines the user role that may resolve the event
Override eventSituationalTrue or False or <blank>Adds the resolution action to the event code resolution screens. Blank is equal to false
Override roleSituationalMust be populated if Override event is set to True. Defines the user role that may override the event
No action requiredSituationalTrue or False or <blank>Adds the resolution action to the event code resolution screens. Blank is equal to false
Update claimSituationalTrue or False or <blank>Adds the resolution action to the event code resolution screens. Blank is equal to false
Update claim lineSituationalTrue or False or <blank>Adds the resolution action to the event code resolution screens. Blank is equal to false
Deny claimSituationalTrue or False or <blank>Adds the resolution action to the event code resolution screens. Blank is equal to false
Deny claim lineSituationalTrue or False or <blank>Adds the resolution action to the event code resolution screens. Blank is equal to false
Cancel claimSituationalTrue or False or <blank>Adds the resolution action to the event code resolution screens. Blank is equal to false
Manually price claim lineSituationalTrue or False or <blank>Adds the resolution action to the event code resolution screens. Blank is equal to false
Suspend response - claim status category codeSituationalValid claim status category codeRequired if disposition action is set to suspend
Suspend response - claim status codeSituationalValid claim status codeRequired if disposition action is set to suspend
Deny response - claim adjustment group codeSituationalValid claim adjustment group codeRequired if disposition action is set to suspend or deny
Deny response - claim adjustment reason codeSituationalValid claim adjustment reason codeRequired if disposition action is set to suspend or deny
Deny response - claim status category codeSituationalValid claim status category codeRequired if disposition action is set to suspend or deny
Deny response - claim status codeSituationalValid claim status codeRequired if disposition action is set to suspend or deny
Deny response - liability assignmentYesProvider or MemberDetermines how the system applies liability for denials
Deny response - member calculationSituationalBilled or AllowedRequired if liability assignment is set to member
EOB descriptionNoAlphanumeric charactersDescription for EOB (explanation of benefits); communication to the member.
EOP descriptionNoAlphanumeric charactersDescription for EOP (explanation of payment); communication to the provider.
Note:
  • 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.

  1. Select the file to be imported by clicking Choose File and then Next once the appropriate file has been selected.
  2. 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.
  3. 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.
  4. 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.

  5. 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.
  6. 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.

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