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Centene ACA 2024 Guideline Training

The Centene ACA 2024 Guideline Training focuses on Commercial Risk Adjustment for the 2024 date of service, emphasizing the importance of achieving a 95% quality standard. It outlines various rejection reasons for charts in the Arch system, detailing specific error comments and requirements for medical records. Additionally, it highlights the need for proper documentation, including patient identifiers and acceptable provider types, to ensure compliance with administrative requirements.

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Akshitha NS
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109 views17 pages

Centene ACA 2024 Guideline Training

The Centene ACA 2024 Guideline Training focuses on Commercial Risk Adjustment for the 2024 date of service, emphasizing the importance of achieving a 95% quality standard. It outlines various rejection reasons for charts in the Arch system, detailing specific error comments and requirements for medical records. Additionally, it highlights the need for proper documentation, including patient identifiers and acceptable provider types, to ensure compliance with administrative requirements.

Uploaded by

Akshitha NS
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Centene ACA 2024

Guideline Training

Recorded Guideline Training


Client Profile
Centene ACA 2024
Project Scope: Commercial Risk Adjustment
DOS to Reviewed: 2024 DOS

Focus Area: HHS-HCC V07


Reporting Frequency: HCC Category once per year

Required Quality: 95%

2
Arch Rejection Reasons Definitions
Rejecting a Chart in
Incorrect Patient The chart belongs to a different member.
Arch
Comingled-Multiple Patients in File There is more than one patient record within
the chart.

No Attachment or Illegible Content The chart contains no attachments or pdf.

• When reviewing a chart in Arch, coders need to


Facesheet/Coversheet Only The chart contains only a face sheet or
coversheet and no additional documents. ensure the medical record meets the requirements
for a codable record.
No Visits Within DOS Range The entire chart contains DOS outside of the
DOS range. • Charts should only be rejected when there is no
appropriate code complete option AND the rejection
reason applies to the ENTIRE chart!

GL Page 6
Error Comment Description Code Level Error Comments
Unlinked Medication When diagnoses documented in
PMH/PL or documented as "history
of“ and is only supported by an
unlinked medication
• The following error comments are to be used in the
project when applicable.
• Note: Chart level error comments should only be
used if the flag applies to the ENTIRE chart!
• Chart level error comments should only be appended
to charts without codes entered.

GL Page 6
Error Comment Description Chart Level Error Comments
No HCC Codes If no HCC codes are found in the
entire record

• The following error comments are to be used in the


Non Risk Adjustable
Provider
The entire chart is contains notes signed
by a non risk adjustable provider
project when applicable.
For example: labs, X-Rays, Missing Face-
to-Face • Note: Chart level error comments should only be
used if the flag applies to the ENTIRE chart!
Incomplete Notes The entire chart contains notes that are
not complete (missing pages). • Chart level error comments should only be appended
to charts without codes entered.

GL Page 6
Signatures
This project does not have a signature issue flag.
Diagnoses with a signature deficit should still be
captured.

6
Substantiation

GL PG 15
7
Long Term Use

GL PG 16
8
Medications Used
As Support

GL PG 16-17
9
Medication

10 GLs PG 17
Medical Records Requirements
• Patient identifiers
• An approved document
• Acceptable provider type and specialty
Medical Records • Each patient encounter must stand alone
• Face-to-face encounter
Administrative
Requirements
Patient Identifiers

Patient Identifiers
& Medical Records
Requirements

GLs PG 7

11
Medical Records
Administrative
Requirements

Acceptable Types
of Medical
Records

GLs PG 8-9

12
Medical Records
Administrative
Requirements

Radiology

GLs PG 9

13
Condition
Specific
Guidance

Status Codes

GLs PG 18

14
Condition
Specific
Guidance

GLs PG 18-19

15
Condition
Specific
Guidance

GLs PG 19

16
Thank you

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