Release Date: September 4, 2018
- Fix error: CCL260 Invalid record: PCP_PHYSN_CNT.
- Fix error: CCL270 Overflow on array: CONTROL->PREF[pix_800xx_xx].CVG…
- Fix defect: Mother/child records were not being retrieved after discharge of mother. This suppressed ENCBIRTH records for historical retrieval. All mother/child records are now retrieved including after discharge.
- Add ENCXD (MJMC) Encounter Detail Provides multiple encounter attributes, including:
- Inpatient Admit Date Time, financial encounter status, bill status, collection status/agency/balance, bad debt date/balance, Last Dates for: charge, adjustment, claim, patient payment, statement; Original bill submit date, Zero Balance date, payment plan status, Service begin/end dates (for recurring encounters), recurring encounter sequence/type, Totals for: charge events, orders, clinical events/discrete/documents, surgical cases, claims, denials, collection actions; Combine counts for: person, encounter, financial encounter [indicates if other persons/encounters/fin encounters have been combined into this encounter].
- Add ENCXD (MJMC) Diagnosis-Related Grouper Provides all grouper records, including:
- MS-DRG, APR-DRG, APC, EAPG, ICD-10-CM, state-specific groupers [Medicaid]; weighting, ROM, SOI, MDC, APR-MDC, LOS, Outlier Cost/Reimb Cost, Est Value/Reimb Value, Source of grouper [Cerner, 3M, etc], Last Changed By/When/Change Count.
- Not all fields populated in all Millennium configurations. Relies on scope of inbound grouper interface, and user activity in AccessHIM.
- Add ENCXD (MJMC) Collections Assignment Provides one record for every collection agency assignment, balance at assignment, current balance, etc. Will include send backs and re-assignments.
- Completely re-built queries for Encounter Payors/Plans and related payments/adjustments, including:
- ENCPAYH-3 (sort_cd) renumbering for complex scenarios,
- Invalid/voided and late charge benefit orders that contain financial transactions (incl. net zero),
- Will support field-specific claim detail in future release.
- Add ENCPYRXD (MJMC) Benefit Order/Charge Grp Provides one record for every benefit order / charge group the health plan of the ENCPAYOR belongs within. Includes:
- Charge Group (billing template), effective date/time, created by/date, bill template, bill type, first/last/total payment/adjustment amount and dates, statement status.
- Add ENCPYRXD (MJMC) Bill/Claim Provides one record for every claim, invoice, statement, and letter generated, for each related (MJMC) Benefit Order/Charge Grp record.
- Will include claims that have been denied, cancelled, or re-submitted;
- Will include statements sent to the patient.
- Will not include client invoices (these are not related to Benefit Orders; possible future development; your feedback is encouraged).
- Will include letters to the patient (demands for payment, dunning letters, etc).
- Add ENCPYRXD (MJMC) Denial Provides one record for every denial, for each related (MJMC) Bill/Claim record. Contains detail on when the denial was received and why denied (including technical denials).
- Add (MJMC) Denial Detail Provides one record for every denial attribute, for each related (MJMC) Denial record. Contians additional attributes related to the denial.
- Add ENCPYRXD (MJMC) Heath Plan Detail Provides one (or no) record on each (MJMC) Benefit Order/Charge Group. Includes: detailed information specific to the health plan (group name and number, subscriber number, etc), signature on file / capture method, insurance verification. Record may be suppressed for health plans that do not have this information (e.g. Self Pay).
- Add ENCPYRXD (MJMC) Authorizations/Referrals Provides one record for every authorization and referral, for each related (MJMC) Health Plan Detail.
- Add ENCPYRXD (MJMC) Eligib/Benefits/Coverage Provides one record for every eligibility check with benefit and coverage breakdown for each (MJMC) Health Plan Detail record. May include current coverages and benefit levels (copays, coinsurance, deductible, network status, etc) with current balances.
- Add RVUs to ENCSI-26.
- Add pref for service items that have both HCPCS and CPT code to determine which to populate in ENCSI-46.
- Add the following fields to (MJMC) Service Item Detail:
- Fields 72-77: RVU breakdown.
- Fields 78-79: distinctly separate CPT and HCPCS codes (in case a charge has both; ENCSI-46 can hold only one). These field will always populate regardless of preference setting 40271.
- Fields 80-81: multiple bill code and >4 modifiers flags.
- Add Address extraction preferences:
- Address effective at time of encounter, and grace period, or
- Address currently effective on person.
- Charge Detail extension references the proper bill_item_id when the chargeable bill_item is an alpha charge. [This is a workaround to a defect in the Millennium data model.]
- Create generic DEPT records for every entity (not just one default).
- Create generic self-pay PAYOR and PLAN records.
- For SSN, FIN, and MRN, provide pref to indicate which alias to use when multiple active aliases exist (applicable for combined encounter, persons).
- Add pref to supply a generic full name when PRAHDR-9, ENCHDR-12, RESPHDR-9, INSURHDR-9 are null.
- Add pref to either substitute field or suppress MAILADDR, HOMEADDR record when minimum elements are null (street, zip, country).
- Add pref to allow unauthenticated EMPLOYER records to be included, or else suppress.
- Add pref to include current day activity in qualification phase for lookback queries. Allows activity occurring in current day to qualify an encounter for extraction.
- This pref only affects qualification of encounters. Extraction program continues to extract all activity through present time on qualified encounters, regardless of this pref setting.
- License keys now required for extraction operation. Keys will be provided annually, and are specific to client domain, license period, and billing entity.
- Inactive insurance companies and inactive health plans are now included in files 1 and 2, respectively. Plans (PAYORS) no longer require a financial class. Org-plan relationships [CARRIER] must remain active/effective to include insurance company of health plan.
- Support ending for concatenated payor-plan option, or discrete payor and plan in PAYOR and PLAN records, respectively. All plans now replicated as PAYOR records. Discrete payor and plan info in PAYRXD and PLANXD extensions. Pref 48010 deprecated.
- Confirm your current config has pref 48010 in codeset 103934 = 4. If not, log support request to transition to this option before upgrading.
- Support ending for PAYRXD (MJMC) Payor Fin Class extension. Pref 48000 deprecated.
- Screen echoes improved.
- Program input parameters now logged and priority logic improved for ops vs. back-end operation.
- DRG Weight in Diagnosis-Related Grouper extension is null in all cases. Contact support for latest fix.
- Key definition in HPM for Diagnosis-Related Grouper uses DRG Encounter Extension ID. This can cause a secondary record to appear when a DRG initially has no extension, and then later comes to have one. This is resolved in v4.1.
- Service Item HCPCS/CPT code has only a HCPCS and not CPT when a CPT is present. This is resolved in v4.1.
Scope and Limitations
When upgrading to v4 or later, the interface contains a completely re-built section for Encounter Payors, including payments and adjustments. Previously, voided / invalid and late charge benefit orders with their adjustments and payments are excluded. In unusual situations, other benefit orders may be excluded. v4 now accommodates these situations with advanced COB numbering for unusual, invalid / voided, and late charge benefit orders. Thus, a full re-extract and reload is required. Client is advised to validate payment and adjustment amounts, and include test cases for unusual, invalid / voided, and late charge benefit orders. MJMC can assist with locating these unusual scenarios.
Reload of Data
- Cerner Millennium
- CHANGE Healthcare Performance Analytics
- Cerner CCL
v18.0 and newer
rev 8.11.xx and later