Define a New Patient List

1. Access the Model - Define Patient List page.
   • Select Go To > Contract Modeling > Model Document Management. The Model Document Management page opens.
   • Click Add Model Document at the top of the page. The Model Document Add page opens.
   • Click Define Patient List. The Model - Define Patient List page opens.
2. Type a name for the new list in the Patient List Name field.
3. Select one of the following from the Claim Source list:
   • Claim Master – Original claim data directly from claims in your facility.
   • Bill Master – Claim data from claims in your facility that have been charge-compiled (claims that have been grouped together by account). This includes critical changes (changes that are made directly to the claim or the account).
   • Canary Claim Master – An existing canary claim group.
     • Selecting this option requires you to select a group from the Canary Claim Group list. You can only select one group from this list.
     • Selecting Canary Claim Group restricts the fields and lists that are available.
     • This option is only available if canary claims are enabled for your facility. For more information about canary claims, refer to Canary Claims.
4. Specify the remaining criteria for your group.
   • For detailed descriptions of each criteria, refer to the Field Descriptions table below.
   • When entering patient numbers in the Patient Number field, you can enter multiple patient numbers, separated by a comma with no spaces; for example, 1234567,2345678.
   • You can select the Exclude check boxes to exclude criteria rather than include. For example, you can enter a discharge status in the Discharge Status field to search for claims with the entered status, or you can enter a status and select the Exclude check box to search for claims with every status except the entered status.
   • Plan ID effective and termination dates are considered during the patient lists creation process so that termed plan ID codes for the selected payor are excluded from the patient list.
   • The Define Patient List page only uses primary payors when creating patient lists.
5. Select the Additional Extended Search Criteria check box to search for specific ranges or individual Revenue Codes, Procedure Codes, HCPCS/Rates, Diagnosis Codes, Condition Codes, Tax IDs, Patient Zip Codes, and Provider Zip Codes.
6. Select the Contracts, Products, or Plan Names radio button for a list of contract, products, or plan names to include in your group.
7. Select the contracts, products, or plan names to include in your patient list.
   • Use Ctrl + Click to select multiple items in the list.
   • When you select a contract, product, or plan name, the associated plan IDs display in the box to the right.
     • By default, all associated plan IDs are selected, but you can select the specific plan IDs you want to include or exclude.
     • To select all associated plan IDs, click Select All.
     • To exclude all associated plan IDs, click Unselect All.
8. If you have permission to enter SQL queries to define your patient list, you can use the following steps to manually create a query:
   • Click Enter SQL. The SQL Query field displays.
   • Type the query in the SQL Query field.
   • Click Quick Estimate of Patient List Size. The number of accounts that match your query display.
     • If there is a syntax error in your query, an error message displays that shows you the line in your query where the error occurred.
     • To return to previously entered criteria on this page, click Enter Criteria. Do not click Back on your browser window. Clicking Back reloads the page and deletes your previously entered criteria.
9. Click Quick Estimate of Patient List Size or Thorough Estimate of Patient List Size. The number of accounts that met your criteria displays
10. Click Save Patient List to save the list and return to the Model Document Add page. For more information, refer to Create a Model Document.

Note: The Patient List is not actually created until the Model is executed. The Save function just saves the Patient List criteria.

11. Optionally, you can click or check:
    • Reset to Defaults returns all fields to their default settings.
    • Cancel clears your entries or changes and returns you to the Model Document Add page.
    • Include Claims Where No Contract Service Types Matched
    • Include Claims Which Have Been Reversed
    • Allow Patient List Definition To Be Saved Without Performing Estimate Of Patient List Size – use this if your patient list is so large that you experience timing out issues. If you check this feature and then click Save, the claims amount will show 0 until the model has been executed.

The following table describes the fields on the Model - Define Patient List page.