Utilization Review User Guide - CPSI Application Documentation

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18Utilization Review User Guide4.5 Cross Reference FileThe cross-reference file serves two purposes. The commercial financial class category boxdescriptions are stored in this file. The financial class codes are also referenced to the financialclass categories so that the patient’s financial class will pull the appropriate criteria for thefinancial class.To access the Cross Reference File:1. Select the UR Maintenance Options from the Utilization Review Base Screen.2. Select Edit Commercial Cross Reference File from the UR Criteria Manual Maintenancescreen.Commercial Name BoxThere are 12 commercial category options to allow for up to 12 individual sets of criteria inaddition to Medicare, Medicaid, and Blue cross/Blue shield. To set up a commercial box, thefollowing codes should be used:· Commercial 1 = C1· Commercial 2 = C2· Commercial 3 = C3· Commercial 4 = C4· Commercial 5 = C5· Commercial 6 = C6· Commercial 7 = C7· Commercial 8 = C8· Commercial 9 = C9· Commercial 10 = Ca· Commercial 11 = Cb· Commercial 12 = CcThese codes should be placed in the fifth and sixth spaces on a line in the ”Commercial CrossReference File” document followed by the desired description beginning in the eighth space.· There is a 21-character description limit to the box display.· The commercial names must be entered before the financial class cross reference codes.© 2009 Computer Programs and Systems, Inc.
Form Maintenance 19· After editing the commercial box names, you must exit the Utilization Review application andre-access the Medical Records option from the Department Functions screen. The CrossReference file will be read by the system and will display changes that were made.Financial Class Cross ReferenceNOTE: The patient’s financial class in field eight on page two of Patient Registration determineswhich criteria will be generated into the patient’s UR form.The Financial Class Cross Reference document is used to link the different financial class codeswith the different sets of criteria.EXAMPLE: If a patient has insurance which is coded as financial class“CO5” for PrudentialInsurance, and this insurance company uses United Insurance criteria which has been set up inthe commercial 1 box, the cross reference document would link the CO5 financial class code toC1 which is the code for the United Insurance criteria.The criteria cross-reference is entered in the cross-reference file below the commercial box nameinformation. The complete CPSI financial class code is entered in the first, second, and thirdpositions of the document. If the financial class code is less than three digits, these positionsshould be left blank. The commercial criteria code is entered in the eighth and ninth positions ofthe document.Select Base Menu > Master Selection > Medical Records > Quality Improvement > UtilizationReview > UR Maintenance Options > Edit Commercial Cross Reference FileFigure 4.8 UR Cross Reference File Document© 2009 Computer Programs and Systems, Inc.
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Page 11 and 12: System Log On / Off 5NOTE: Payroll
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Print Reports 71Blank UR Forms for
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Print Reports 73UR for All Patients
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Print Reports 75Denial Letter (Samp
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Print Reports 918.9 Readmission Rep
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