HEDIS SYSTEMS INTERFACE DOCUMENTATION

1999 REPORT REQUIRED FIELDS

Overview

AMISYS Users need the ability to report HEDIS data from the Health database and related information from AMISYS.

The HEDIS report is used for the following:

The department use the report to:

1. Track all patients who are in the hospital or outpatient.

2. Determine which hospitalized patients on the current day they need a

Clinical update for.

3. Determine which hospital the patient is in.

4. Determine how many days were authorized so far.

5. What the next review date is.

6. Determine which nurse is following each patient.

Process

1. Extract Member-Span records that are active at run time and utilizing an Anniversary Date as selected by the user at run time using SUPRTOOL.
2. Consider, the following data Sets:

MEMBER

MEMBER-SPAN

AUTHORIZATION

ADMISSION

AUTH-DETAIL

CLAIM

SERVICE

AFFILIATION

ADDRESS

CODE-DETAIL

SUPER-TABLE

For Report records,

1. We must check to make sure the Program# = "@" for all records.
2. We must find has anything changed, so we’ll use the data sets listed above

1. For every data set, do a Suprtool extract based on Ymdeff defined : Item Ymdeff <= ($ending), we’ll want to pull that CLAIM# and put it into a list (Base list -> list of CLAIM#s.)
2. If there exists a Medical records, pull the SERVICE# for members that are in the list of CLAIM#s, starting backwards. Ignore voided records.
3. If they have record qualified, extract the CLAIM#, Effdate and Enddate.

1. If there exists a authorization where none of the members span existed, you’ll skip that Member and Data will be written to a flat file CLAIM100? (Job stream will do this.)

1. We’ll RUN the report through AMISYS; it can be run weekly; daily; or Monthly.
2. Enter "RS" in the action field.
3. Enter "MM0300" in the screen box.
4. Select "HEDIS CLAIM REPORT" option # may vary.
5. The system prompts you to enter the beginning date of YMDEFF (YYYYMMDD)
6. You may run the report at the HP colon prompt:

:STREAMJ XCLAIM100.REPORTS,2

 

Flat file Heading

A Report & Interface Solution for Managed Care

>

DETAIL-AUTH#, X16 <

>

MEMBER#, X12 <

>

EPISODE#, X22 <

>

DISCHG-PLAN#, X12 <

>

ACCEPTASSIGN, X2

ACTION-TRIGGER, X2

AFF#, X16

AFF-STATUS, X2

AMOUNT-ACTUAL, I2

AMOUNT-AUTH, I2

AMOUNT-EST, I2

AMOUNT-ORG, I2

AMTCHARGE, I2

APPROVED-BY, X4

AS-CODE, X4

AUTH-CTR, X2

AUTH-REASON, X2

AUTH-TYPE, X2

AVOID-DAYS, I2

AVOID-REASON, X2

BYPASS, X2

CLAIM-TYPE, X2

COORD-OP, X4

COUNT-ACTUAL, I2

COUNT-AUTH, I2

COUNT-ORG, I2

COUNT-REQ, I2

COUNTER, X10

DEPARTMENT, X2

DIAG#, X6

DIAG2#, X6

DIVISION#, X10

EX-ARRAY, X12

EXPLAIN, X2

LOCATION, X2

MINUTES, I2

MODIFIER, X2

MODIFIER2, X2

OFFICE#, X4

OP#, X4

OUTCOME, X2

PLUS-UNITS, I2

PRAC#, X4

PROC#, X6

PROC-CLASS, X2

PROTOCOL#, X4

RECORD#, X12

REF-AFF#, X16

REVIEWED-BY, X8

SCREEN, X2

SERV-BITS, I2

SPEC1, X2

STATUS, X2

TEMPLATE#, X4

TRANSCODE, X2

TRANSFER, X2

TREATMENT-TYPE, X2

VOID, X2

YMDAPPROVAL, X8

YMDCANCELLED, X8

YMDEFF-ACTUAL, X8

YMDEFF-AUTH, X8

YMDEFF-ORG, X8

YMDEFF-REQ, X8

YMDEND-ACTUAL, X8

YMDEND-AUTH, X8

YMDEND-ORG, X8

YMDEND-REQ, X8

YMDNEXT, X8

YMDREP, X8

YMDREVIEW, X8

YMDTRANS, X8

YMDTRANSFER, X8

SEQ#, X4 <>

INDEXES:

CAPACITY: 150003 ENTRIES: 49081

SET NAME:

ADMISSION,DETAIL

ITEMS:

AUTHORIZATION#, X12 <

>

MEMBER#, X12 <

>

EPISODE#, X22 <

>

DETAIL-AUTH#, X16 <

>

DISCHG-PLAN#, X12 <

>

ACCEPTASSIGN, X2

ACTION-TRIGGER, X2

AFF#, X16

ADMIT, X2

ADMIT-NOTE, X4

ADMIT-TYPE, X2

ADMIT2, X2

ADMIT3, X2

ALTCOV, X2

AMOUNT-ACTUAL, I2

AMOUNT-AUTH, I2

AMOUNT-EST, I2

AMTCHARGE, I2

APPROVED-BY, X4

AS-CODE, X4

AUTH-PLANNING, X2

AUTH-REASON, X2

AUTH-TIMEADMIT, I2

AUTH-TYPE, X2

BIRTHWEIGHT, I2

BYPASS, X2

CENSUS, X2

COMPLIANCE, X2

DAYS-ACTUAL, I2

DAYS-AUTH, I2

DAYS-ICU, I2

DAYS-LOS, I2

DAYS-REQ, I2

DIAG#, X6

DIAG-DAYS, I2

DIAG-GROUP#, X4

DIAG2#, X6

DIAG3#, X6

DIAG4#, X6

DIAG5#, X6

DIAG6#, X6

DISCHARGE, X2

DISCHARGE-DIAG, X6

DISCHARGE-DIAG2, X6

DISCHARGE-DIAG3, X6

DISCHARGE-DIAG4, X6

DISCHARGE-DIAG5, X6

DISCHARGE-DIAG6, X6

DISCHARGE-DRG, X4

DISCHARGE-NOTE, X4

DISCHARGE2, X2

DISCHARGE3, X2

DIVISION#, X10

DRG#, X4

EX-ARRAY, X12

EXPLAIN, X2

INPATDAYS, I2

LOCATION, X2

MINUTES, I2

MODIFIER, X2

OP#, X4

OUTCOME, X2

PLUS-UNITS, I2

PROC#, X6

PROC-CLASS, X2

PROC-DAYS, I2

PROC-GROUP#, X4

PROC2#, X6

PROC3#, X6

PROC4#, X6

PROC5#, X6

PROC6#, X6

PROTOCOL#, X4

PROV-ADMIT, X12

PROV-ATTEND, X12

PROV-DISCHARGE, X12

RECORD#, X12

REF-AFF#, X16

REVIEWED-BY, X8

ROOM#, X6

ROOM-APPR, X2

SERV-BITS, I2

STATUS, X2

TOT-DAYS-ACTUAL, I2

TOT-DAYS-AUTH, I2

TOT-DAYS-REQ, I2

TRANSCODE, X2

TRANSFER, X2

TREATMENT-TYPE, X2

VOID, X2

YMDADMIT, X8

YMDADMIT-EST, X8

YMDAPPROVAL, X8

YMDCANCELLED, X8

YMDCENSUS, X8

YMDCLOSE, X8

YMDDISCHARGE, X8

YMDDISCHARGE-EST, X8

YMDNEXT, X8

YMDREP, X8

YMDREVIEW, X8

YMDSURG, X8

YMDSURG2, X8

YMDSURG3, X8

YMDTRANS, X8

YMDTRANSFER, X8

SEQ#, X4 <>

INDEXES:

CAPACITY: 75000 ENTRIES: 1960

 

 

 

>

SET NAME:

AUTHORIZATION,DETAIL

ITEMS:

AUTHORIZATION#, X12 <

>

EPISODE#, X22 <

>

MEMBER#, X12 <

>

ACTION-TRIGGER, X2

ADMIT-DIAG, X6

AFF#, X16

AMTCHARGE, I2

AS-CODE, X4

AUTH-BY, X8

AUTH-REASON, X2

AUTH-TYPE, X2

AUTHCAT, X4

BENEFIT-PKG, X2

BUSINESS-UNIT, X2

CARRIER, X2

CASE#, X16

CASE-OVERRIDE, X2

DIAG#, X6

EXPLAIN, X2

ILLNESS, X2

INSURANCE, X2

LAST-DETAIL#, X4

LOCK, X6

OP#, X4

OUTCOME, X2

PCP-AFF#, X16

PROC#, X6

PROG#, X2

PROTOCOL#, X4

PROV#, X12

REF-AFF#, X16

REGION, X2

RESOLUTION, X2

SOURCE, X4

STATUS, X2

SUBSYSTEM, X2

TRANSB#, X12

TRANSCODE, X2

VENDOR-AUTH, X16

VENDOR-ID, X16

VOID, X2

YMDCLOSE, X8

YMDEFF, X8

YMDEND, X8

YMDENTERED, X8

YMDINIT, X8

YMDTRANS, X8

INDEXES:

CAPACITY: 70005 ENTRIES: 30459

 

Assumptions

1. Attending provider and Referring Provider are kept in the Medical Records (Auth-Detail).
2. Only blank template# is extracted in the report.

 

Approval

 

The signatures below indicate approval of the Inpatient Census report Extract technical specifications.

 

 

Name / Date:

 

 

 

Name / Date:

 

Technical Information

Job Name: XHER0400.REPORTS

 

Cobol Program Name: HER0400.COBOL

 

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Copyright © Sophorn Reporting Systems, Sophorn Interface Systems. All rights reserved.
Revised: May 13, 2000.

 

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