Edit an Existing Patient List from Claims

The Editing Patient List (from Claims) page allows you to modify the criteria used to select accounts for a specific patient list based on original claim data directly from the data source.

Note: You can only edit patient lists that you created. To edit patient lists created by other users, you must first create a copy of the patient list. To create a copy, click the name of the patient list you want to copy and click Copy at the bottom of the Editing Patient List page.

  1. Access the Editing Patient List (from Claims) page:
    • Select Go To > Contract Modeling > Advanced Contract Modeling. The Contract Modeling page opens.
    • Select the Patient Lists tab.
    • Click the name of the patient list based on claim data that you want to edit in the Name column. The Editing Patient List (from Claims) page opens. 
  2. To change the name of the patient list, type a new name in the Name field.

    3. Note: 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.

  3. To change the facilities included in your patient list, click each facility you want to include in your patient list to move it to the Selected facilities column.

    4. Note: To remove a facility, click the facility name in the Selected facilities column.

  4. Make the desired changes to the criteria for your patient list. For more information about specific criteria, refer to the Field Descriptions table below or Create a Patient List from Bills.
  5. To remove a criteria, click next to the criteria.
  6. 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.

  1. Review the estimate of accounts.

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

  2. Close the Patient List Estimate window.
  3. To create a copy of the patient list you are currently viewing:
    • Click Copy. The Editing Patient List page opens.
    • Make the desired changes to the patient list.

      • Note: The Name field defaults to the original patient list name followed by a parenthetical note indicating the user that made the copy and the date and time the copy was made. You can override this field to give the patient list a unique name.

    • Click Save to save your changes.
  4. Click Save to save your changes.
    • To exit without saving your changes, click Cancel.
    • 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:

The following table describes each of the fields on the Editing 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.

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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.

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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.

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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