Create a Patient List from Claims

1. Access the Create Patient List (from Claims) page:
   • Select Go To > Contract Modeling > Advanced Contract Modeling. The Contract Modeling page opens.
   • Select the Patient Lists tab.
   • Select Patient List from Claims from the Create Patient List button.

   Note: This button defaults to Patient List from Bills. To select a different type of worklist, click the arrow to the right of the button and select the type of worklist you want to create.

2. The Create Patient List (from Claims) page opens. 
3. Type a name for the patient list in the Name field.
   • Use a name that allows you to easily identify the patient list. This is the name that appears in the list of available patient lists when creating a model.
4. Click each facility you want to include in your patient list to move it to the Selected facilities column.
   • To remove a facility, click the facility name in the Selected facilities column.
5. Enter the criteria used to identify accounts to include in your patient list.
   • Click Add in the Criteria section. The Add Criteria window opens and displays a list of all available criteria.
   • To add a criteria to your patient list, click the criteria field name.
     • When you click a field name, the field name is added to the Selected Field Names list.
     • To remove the criteria from your patient list, click the field name in the Selected Field Names list. The criteria is moved back to the list of available field names.
     • You can add multiple date criteria, including multiple criteria of the same type, but you can only select one Contract or Product criteria for your patient list.
     • You can also search for a specific criteria by typing the field name in the Search field. For example, to search for Admission Date, type Adm in the Search field.
     • You can also limit the list of criteria by category, such as date. For example, to limit the list to field names related to dates, type Date in the Search field.
     • For more information about a specific criteria, refer to the Field Descriptions table below.
   • When you have selected all of the criteria you want to add to your patient list, click Apply. The Add Criteria window closes, and your selected criteria display in the Criteria section.
6. Define the specific values for each criteria.
   • Most criteria include an operator list that allows you to select an operator, such as Equals, Less Than, Greater Than, and so on, in addition to the value field. For example, you can select a hospital service code that equals "1234".
   • For more information about creating complex, contract-based, or product-based patient list criteria, refer to the following:
     • Create Complex Patient List Criteria
     • Create Contract or Product Based Patient List Criteria
     • Uploading a list of patient numbers
7. To remove a criteria, click next to the criteria.

Note: To clear all of the criteria you created and return the patient list to the default criteria, click Clear All.

8. To see an estimate of how many accounts your patient list would include before you save it, click Estimate. The Patient List Estimate page opens and displays the number of accounts for the patient list, by facility.

9. Review the estimate of accounts.

Note: Click the Account Number Estimate link to display the list of accounts.

10. Close the Patient List Estimate window.
11. Click Save to save your patient list and make it available to models.

Note: If you estimated the number of accounts for your patient list, your estimate is also saved and can be viewed on the Patient Lists tab of the Create Model or Editing Model page.

 For more information, refer to the following:

• Create a Model
• Edit an Existing Model

The following table describes each of the fields on the Create Patient List (from Claims) page. The fields are sorted by section and listed in alphabetical order.

Field	Description
General
Name	Name of the patient list
Facilities
Click on a facility to be included	Allows you to select the facilities you want to include in your patient list. This list is limited to the facilities that you have access to. Click a facility name to move it to the list of selected facilities.
Selected facilities	The list of facilities included in your patient list. Click a facility name to remove it from this list.
Criteria
Admit Date	Date of admission for the account
Attending Physician NPI	National Provider Identification (NPI) number of the attending physician on the account
Bill Type	The 3 digit code displayed on a UB that provides specific information about the intent of the claim. The first digit describes the type of facility, the second digit classifies the type of care being billed, and the third digit indicates the sequence of the bill for a specific episode of care.
Broker	Person(s) or agency who supports the use of the coverage plan and is associated with the claims included in the patient list
Claim Type	Allows you to limit your patient list to either ICD-9 or ICD-10 claims
Contract or Product	Allows you to include accounts using a specific contract or product, by facility (multiple selection allowed). Includes all In Audit contracts. The name includes either an A (Admit Date) or D (Discharge Date) at the end indicating if the contract rates are based on the admit date of the contract or discharge date of the contract. Use the filter to display Medicare IP/OP, Medicare IP, Medicare OP, or MPFS contracts/products. The Medicare filter is only available when the Contracts radio button is selected. Show me Click image to play video and click video to close.
Diagnosis Code	Diagnosis code associated with the account
Discharge Status	Patient’s destination upon discharge (home, LTC, etc.), to include or exclude in the search
DRG	Specific DRG(s) that appear on the claim
Facility NPI	National Provider Identification (NPI) number for the facility
Financial Class	Financial class code.
HCPCS/CPT	HCPCS/CPT code associated with the account. Select Between from the drop down to create a HCPCS or CPT range. Codes are captured regardless if modifiers are present. Fields allow up to 5 alpha numeric characters. Show me Click image to play video and click video to close.
Hospital Service Code	Hospital service code(s) associated with the claim.
Message Code	Allows you to include (or exclude) accounts using message codes.
Operating Physician NPI	National Provider Identification (NPI) number of the operating physician on the account
Other Physician NPI	National Provider Identification (NPI) number of the physician on the account, other than the attending or operating physician
Patient Age	Age range for the patient age on the claims.
Patient Number	Patient account number (for UB claims) or insured ID (for CMS-1500 claims) to include or exclude in the patient list.
Patient Sex	Patient’s gender
Patient Type	Patient type assigned to the account: Inpatient/Outpatient
Patient Zip Code	Patient zip code associated with the account
Plan ID	Identification code(s) of the coverage plan to include or exclude in the search
Procedure Code	Procedure code associated with the account
Provider Name	Name of the healthcare provider
Provider Number	Provider’s tax ID number or ten-digit National Provider Identification (NPI) number required on all claims
Provider State	Use the lookup option to determine if a state is available for a facility prior to executing the patient list. Show me Click image to play video and click video to close.
Provider Zip Code	Postal zip code for the service provider on the account
Revenue Code	Revenue code associated with the account
Service From Date	First date of service rendered to the patient
Service Through Date	Last date of service for the account
Severity of Illness	Severity code value associated with the DRG. Use Severity of Illness together with DRG to find accounts based on APR-DRG. Valid values for severity of illness are 1, 2, 3, 4, or blank.
Submit Date	Date the claim was initially submitted for payment
Tax ID	Provider’s tax ID
Taxonomy Code	Provider/specialty type associated with the account
Total Charges	Dollar amount of the total charges billed on the account