February 2013 Presented By: CROWN Data Discrepancy Support (CDDS) The analyses upon which this publication is based were performed under Contract Number HHSM C, entitled “CROWN Data Discrepancy Support (CDDS)”, sponsored by the Centers for Medicare & Medicaid Services, Department of Health and Human Services.

CROWNWeb EDI Goals Provide timely data Eliminate collection redundancy Strengthen community collaboration Promote quality improvement Improve the lives of individuals with ESRD CROWNWeb EDI TrainingFebruary SoftDev Inc.2

EDI Process Overview Background CROWNWeb and Conditions for Coverage Submission Methods BSO vs. HIE process On-boarding process Batch and LDOs NRAA/HIE Registration Process & Qualification Testing CROWNWeb EDI TrainingFebruary SoftDev Inc.3

EDI Data Collection File Submission Type File Contents Patient Demographics Admissions/Discharges Modalities Physicians Clinical HD Labs PD Labs Vascular Access Infections Hospitalizations Vaccinations Medication Allergies ESA Prescription Iron Prescription Fluid Weight Management Vitamin D Analog CROWNWeb EDI TrainingFebruary SoftDev Inc.4

EDI Data Prerequisites Patient Submissions Facility Mapping: Org Facility Code to CROWNWeb Facility Identifier Unique Org Patient ID Unique Org Admission ID Unique Org Modality ID Unique Org Physician ID CROWNWeb EDI TrainingFebruary SoftDev Inc.5

EDI Data Prerequisites (cont.) Clinical Submissions Facility Mapping Org Facility Code and CROWNWeb Facility Identifier Patient Mapping: Org Patient ID and CROWNWeb Patient Identifier Admission and treatment modality during the clinical submission period CROWNWeb EDI TrainingFebruary SoftDev Inc. 6

Facility Mappings How are Facility Mappings… Created Batch - Delegation of Authority Form NRAA/HIE - Participation Agreement Validated Mappings are confirmed accurate before insertion Deleted Upon Request CROWNWeb EDI TrainingFebruary SoftDev Inc.7

Facility Mappings (cont.) Why Facility Mappings are important... Establishes a link between external systems that submit data to CROWNWeb (external data model) and CROWNWeb’s internal data model Ensures submissions are authorized CROWNWeb EDI TrainingFebruary SoftDev Inc.8

Facility Mappings (cont.) CROWNWeb EDI TrainingFebruary SoftDev Inc.9

Patient Mappings How are Patient Mappings… Created – through the successful processing of a submitted patient Validated – Batch Patient Mapping validation (quarterly) Deleted – Patient deletions in the SUI, patient merge requests, Batch Patient Mapping validations or an EDI user submits a help desk ticket request CROWNWeb EDI TrainingFebruary SoftDev Inc.10

Patient Mappings (cont.) Why Patient Mappings are important… Quick identification of patient in CROWNWeb Bypasses additional patient matching processing (reduces potential for near match errors) Prerequisite for CROWNWeb’s clinical data submission processing Provides explicit Patient identification in reports to EDI organizations and facilities CROWNWeb EDI TrainingFebruary SoftDev Inc.11

Patient Matching Process “Patient Matching” runs when submitted patient data does not have an existing patient mapping. There are 3 possible results of Patient Matching: No match – patient is added to CROWNWeb; a patient mapping is established and processing continues Exact match – Unique CROWNWeb patient already identified; processing continues Near match – Cannot explicitly identify one patient; EDI facility and its ESRD Network act to uniquely identify a specific patient CROWNWeb EDI TrainingFebruary SoftDev Inc.12

EDI Process Flow Diagram CROWNWeb EDI TrainingFebruary SoftDev Inc.13

Admit/Discharge Mappings How are Admit/Discharge Mappings… Created – If the Admit/Discharge’s Org Unique ID is not mapped to a CROWNWeb Admit/Discharge record when the record is processed Validated - N/A Deleted – Admit/Discharge mappings are deleted when an Admit/Discharge record is deleted via the SUI. 14CROWNWeb EDI TrainingFebruary SoftDev Inc.

Admit/Discharge Mappings (cont.) 15 Why Admit/Discharge Mappings are important… Maintain data integrity for linking existing CROWNWeb data with new and updated admissions in EDI submissions. Bypasses admission matching processing (reduces potential for Admit/Discharge errors) CROWNWeb EDI TrainingFebruary SoftDev Inc.

Admission Processing Flow Diagram CROWNWeb EDI TrainingFebruary SoftDev Inc.16

Treatment Mappings How are Treatment Mappings… Created – If the Modality’s Org Unique ID is not mapped to a CROWNWeb Treatment record when the record is processed Validated – N/A Deleted - Treatment mappings are deleted when a treatment record is deleted via the SUI. Why Treatment Mappings are important Maintain data integrity for linking existing CROWNWeb data with new and updated treatments in EDI submissions. 17CROWNWeb EDI TrainingFebruary SoftDev Inc.

Physician Mappings How are Physician Mappings… Created – If Physician Unique ID is not mapped to a CROWNWeb personnel record when modality record is processed Validated – N/A Deleted – Personnel deletions and EDI user submits help desk ticket request Why are Physician Mappings important Quick identification of physician in CROWNWeb CROWNWeb EDI TrainingFebruary SoftDev Inc.18

Treatment Processing Flow Diagram CROWNWeb EDI TrainingFebruary SoftDev Inc.19

CROWNWeb EDI TrainingFebruary SoftDev Inc. Updating Elements For Existing Patients within CROWNWeb Schema Type Name Element or Attribute Name If populated, can value be updated? Notes PatientIdentifierlastNameNo PatientIdentifierfirstNameNo PatientIdentifierhicnumNoCannot update this patient identifier via batch. Can add data if field is NULL PatientIdentifierssnNo PatientIdentifiercrownPatientIdNo PatientIdentifiergenderNo PatientIdentifierdobNo 20 Fields that cannot be updated with EDI

Processing Results to EDI Submitters CROWNWeb EDI Training Batch submitters are able to view processing summary statistics for XML files loaded and download Feedback XML files. NRAA submitters receive a Deferred Response XML file. Feedback/Deferred Response XML files contain: Errors and warnings on submitted patient and clinical records in order for organizations and/or facilities to resolve discrepancies. Feedback can be traced to a patient by using patient and facility attributes: orgPatientId, crownPatientId, orgFacilityCode, and crownFacilityId February SoftDev Inc.21

Errors Overview CROWNWeb EDI Training An error is returned when the data provided does not meet the business requirements attached to a specific element or operation. Submission source data IS NOT KEPT by the system. Errors may occur at the Schema, File, and Record Level. February SoftDev Inc.22

Error Levels CROWNWeb EDI Training Schema-level Error Occurs while the system performs initial parsing of XML submission. File does not process properly, an error message is returned. Batch - Error message appears on the SUI screen after the file uploads NwHIN – Error message is presented in a Deferred Response file Example Schema Error: XML Validation Errors Found: Line number 24, Fatal Error-cvc- enumeration-valid: Value 'Employed Part Time' is not facet-valid with respect to enumeration '[Unemployed, FullTime, PartTime, Homemaker, RetiredAgePref, RetiredDisability, MedicalLeave, or Student]'. It must be a value from the enumeration. February SoftDev Inc.23

Error Levels (cont.) CROWNWeb EDI Training File-level Error An error that occurs within the initial stages of file processing after the schema was considered valid by the system Results in entire file failure prior to processing individual records Example File Error: 601- Clinical Month is frozen. Requirement: A user must provide a valid open clinical period when submitting clinical data. February SoftDev Inc.24

Error Levels (cont.) CROWNWeb EDI Training Record-level Error (Two categories ) High Level – processing stops for that patient. Validation moves to the next record in the file, if one exists Patient has possible matches Could not find a unique patient for the submitted orgPatientId Low Level – when returned, processing of the file is not interrupted. It is possible to receive multiple errors or warnings for a single patient record Admit Date cannot be a future date Race has been entered. Ethnicity is Required. February SoftDev Inc.25

RankPatient Error Description Medicare Enrollment Effective Date of {0} already exists in the system for Medicare Enrollment Status Invalid Admit Reason: An exact match patient was found and the Admit Reason selected is invalid based on the previous admission record's Discharge Reason 3204 Admission process cancelled, Patient already admitted to the current facility Patient could not be processed due to possible matches Mailing Address is required Physical Address is required Invalid Admit Reason: An exact match patient was found and the Admit Reason selected is invalid based on the previous admission record’s Admit Reason with the same Transient Status ({0}) Invalid Admit Date: An exact match patient was found and the Admit Date is more than 5 days prior to the patient’s previous admission record’s Discharge Date with the same Transient Status ({0}) Medicare Enrollment Effective Date is mandatory when Current Medicare Enrollment Status is populated Discharge Date cannot be after the patients next admission date ({0}). Global Patient Error Trends CROWNWeb EDI TrainingFebruary SoftDev Inc.26

Global Patient Error Trends (cont.) CROWNWeb EDI Training 11222/11225: Admit Reason does not fit with the existing Admit or Discharge Reason (Exact patient found) Resolution: Establish Admit (or previous Discharge) Reason… that works February SoftDev Inc.27

Global Patient Error Trends (cont.) CROWNWeb EDI Training 11222/11225: Admit Reason does not fit with the existing Admit or Discharge Reason (Exact patient found) Resolution: Establish Admit (or previous Discharge) Reason… that works February SoftDev Inc.28

Discharges Allowed CROWNWeb EDI TrainingFebruary SoftDev Inc.29

Global Patient Error Trends (cont.) 11185/11186: Mailing or Physical Address is missing State Resolution Currently CROWNWeb requires State code for both address types. Update the state code and resubmit the patient. CROWNWeb EDI TrainingFebruary SoftDev Inc.30

Global Patient Error Trends (cont.) CROWNWeb EDI Training 11216: Admit Date is more than 5 days prior to the patient’s previous admission record's Discharge Date. Resolution CROWNWeb record’s Discharge Date or the source system’s Admit Date needs to be changed. Corrections are resubmitted for successful processing. February SoftDev Inc.31

Global Patient Error Trends (cont.) CROWNWeb EDI Training : Discharge Date cannot be after the patient’s next admission date ({0}). Resolution#1: Change EDI submitted date to a value before the patient’s next CROWNWeb admission date and resubmit. Resolution#2: Change admission date to a value that is after the EDI submitted discharge date and resubmit. Note: If patient’s next admission (in CROWNWeb) is out of scope, Network assistance is needed. February SoftDev Inc.32

Global Patient Error Trends (cont.) CROWNWeb EDI Training 100: Near Match One or more submitted patient identifiers are not an EXACT match (spelling, number position, etc.) with the patient identifiers existing in CROWNWeb: First Name, Last Name, Date of Birth, SSN, HICNUM, Gender Resolution: A manual correction of the data is needed (either in CROWNWeb or in the EDI data). Near Match report can be referenced to help isolate the data needing update. February SoftDev Inc.33

Near Match Report Overview Data Sources: Last EDI-submitted patient having an unresolved Near Match EDI identifiers from submission CROWNWeb identifiers from Near Match (at the time of the Near Match) NW scope based on CROWNWeb patient’s last admit/discharge Attributes: Discrepancy between EDI and CROWNWeb value for each identifier is highlighted in yellow For Section 508 compliance and filtering usability, separate “Flag” columns indicate discrepancies CROWNWeb EDI TrainingFebruary SoftDev Inc.34

Near Match Report Overview (cont.) Expectations: Recipients focus on rows containing a blank in the flg_NwNotified column. Resubmission is necessary after corrections have been made to complete the admission process. Resubmit all rows having a value in the flg_NwNotified column after corrections are made by the Network. Questions/feedback on Near Match Report are submitted to the Help Desk indicating escalation to CDDS. February SoftDev Inc.CROWNWeb EDI Training35

Near Match Report Overview (cont.) Resolution Process The following diagram is a High-level Patient Processing workflow February SoftDev Inc.CROWNWeb EDI Training36

Near Match Report Overview (cont.) February SoftDev Inc.37CROWNWeb EDI Training

Global Patient Error Trends (cont.) CROWNWeb EDI Training 204: Patient has an active admission to the same facility. Resolution #1: If submitting an earlier admission than the patient’s current admission at the same facility: Submit this admission by itself – not including the later (current) admission. Submit the admission’s discharge date and discharge reason. Resolution #2: If submitting a current admission: Include the prior admission at the same facility with the discharge date and discharge reason in the submission (if the discharge information has not already successfully been processed). Include the current admission in the submission. Arrange the admissions in chronological order on Admit Da te. February SoftDev Inc.38

Global Patient Error Trends (cont.) CROWNWeb EDI Training : Medicare Enrollment Effective Date already exists for Medicare Enrollment Status : Medicare Enrollment Effective Date is mandatory when Current Medicare Enrollment Status is populated. Resolution: Include the Medicare Enrollment effective date from the error message in the EDI submission and resubmit. Known Issue: Errors may be erroneously due to warning “200”, restricting Patient attribute updates. Issue is currently being vetted by CMS and a solution is being prioritized for implementation. February SoftDev Inc.39

Global Patient Error Trends (cont.) CROWNWeb EDI Training 11221: Patient has a later admission with the same transient status. The submitted admission’s Admit Reason conflicts with the later admission’s Admit Reason based on the Admit/Discharge Reason rules. Resolution #1: Admit Reason should be set to an appropriate value based on the rules. Include the Discharge Date and Discharge Reason. Resubmit the patient for successful processing. Resolution #2: If corrections are needed for the later admission in CROWNWeb, contact the Network to review and make necessary corrections to the data. Resubmit the patient for successful processing. February SoftDev Inc.40

Global Patient Error Trends (cont.) CROWNWeb EDI Training 11297: Patient has an unexpected Medicare Claim Number (HICNUM). Resolution: The patient’s Medicare Enrollment Status should be set to ‘Enrolled’. Resubmit the patient for successful processing. February SoftDev Inc.41

Global Patient Error Trends (cont.) CROWNWeb EDI Training 99999: (Unidentified) submission failure during file processing. Resolution: Contact the QualityNet Help Desk and the issue will be investigated further by one of the CROWNWeb support teams. February SoftDev Inc.42

Global Clinical Error Trends CROWNWeb EDI Training RankPatient Error Description 1401 Could not find a unique patient with the given orgPatientId Patient is not receiving Hemodialysis at the selected facility as of the Date of Reported Dialysis Session entered Maturing AVF Present should not be provided based on the Current Access Type populated Vaccination data is required for HD or PD clinical submissions {0} is an invalid value for {1}. The valid values are {2}. mg is an invalid value for ESA Dose Measure. The valid values are Units, mcg, Other. units is an invalid value for Intravenous (IV) Iron Dose. The valid values are g, mg, Other Date Access Type Changed is prior to patient's admit date when no previous admission or treatment records exist Cannot process {0} because patient is not receiving HD or PD treatment as of {1} Could not find Clinical Question for the patient's collection type Could not find an unique facility with the given orgFacilityCode Clinic Weight is mandatory when Creatinine Clearance, Dialysate Volume, Dialysate Urea Nitrogen, Dialysate Creatinine, Urine Volume, Serum BUN, or Serum Creatinine is populated. February SoftDev Inc.43

Global Clinical Error Trends (cont.) 44CROWNWeb EDI Training 400: There is no CROWNWeb mapping for the Org Facility Code used in a clinical file. Resolution: A facility mapping needs to be established in CROWNWeb for the submitted facility. BSO facilities should follow the Delegation of Authority (DOA) process; DOA forms are submitted to the QualityNet Help Desk to establish a facility mapping. NRAA HIE provides contracted NRAA facility information to the QualityNet Help Desk to establish a facility mapping. February SoftDev Inc.

Global Clinical Error Trends (cont.) 45CROWNWeb EDI Training 401: There is no CROWNWeb Patient Mapping for the Org Patient ID used in a clinical file. Resolution: A patient mapping needs to be established in CROWNWeb for the submitted patient. Submit the patient data. Resolve any outstanding patient errors received in the feedback/deferred response file. Resubmit the patient data. February SoftDev Inc.

Global Clinical Error Trends (cont.) 46CROWNWeb EDI Training 12721: Patient does not have an admission or an expected modality at the facility for the clinical period. Resolution: The patient’s admission record for the facility with the appropriate modality should be submitted and successfully processed. Submit the patient admission and modality. Resolve any outstanding patient admit/discharge and modality errors received in the feedback/deferred response file. Resubmit the patient data. February SoftDev Inc.

Global Clinical Error Trends (cont.) 47CROWNWeb EDI Training 20045: Patient is currently ‘AV Fistula Only (with 2 needles)’, ‘AV Fistula Combined with an AV Graft’ or ‘AV Fistula Combined with a Catheter’, but Maturing AVF Present is submitted, or exists in CROWNWeb’s Vascular Access record. Resolution: Maturing AVF Present should not be submitted for the access type indicated above. Update facility system to remove the value for the Maturing AVF Present for this condition. Resubmit the patient’s clinical data. Known Issue: Error may arise from CROWNWeb having a Maturing AVF Present value. A script has/will be run to remove these invalid Maturing AVF Present values to avert future errors. February SoftDev Inc.

Global Clinical Error Trends (cont.) CROWNWeb EDI Training 20037: Vaccination data is required for HD or PD clinical submissions. Resolution: Include vaccination data in HD or PD clinical resubmission. This error may result when previously submitted clinical records did not contain vaccination data and these HD, PD or VA records for a clinical month are being updated. February SoftDev Inc.48

Global Clinical Error Trends (cont.) 49CROWNWeb EDI Training 20057: Value provided is not allowable for the element. Particular text that was the most popular message in January: “mg is an invalid value for ESA Dose Measure. The valid values are Units, mcg, Other.” Resolution: Supply an allowable value for the element. Refer to the error message or the Data Dictionary for additional information. Resolve the clinical error received in the feedback/deferred response file. Resubmit the clinical data. February SoftDev Inc.

Global Clinical Error Trends (cont.) CROWNWeb EDI Training 12860: Patient lacks a previous admission or treatment record at the facility prior to a “Change” of Date Access Type. Resolution: The patient’s admission and/or treatment date should be on or prior to the submitted Date Access Type Changed. Resolve any outstanding patient admit/discharge and modality errors received in the feedback/deferred response file. Resubmit the patient data. February SoftDev Inc.50

Global Clinical Error Trends (cont.) 51CROWNWeb EDI Training 604: Patient is not admitted at the facility, or unexpected modality for clinical data (in the clinical period.) Resolution: Submit the patient’s admission and modality. Resolve any outstanding patient admit/discharge and modality errors received in the feedback/deferred response file. Resubmit the patient data. February SoftDev Inc.

Global Clinical Error Trends (cont.) 52CROWNWeb EDI Training 13429: Unexpected Clinical data element (patient’s modality) Resolution: Submit the patient’s admission and modality Resolve patient admit/discharge and modality errors in the feedback/deferred response file. Resubmit the patient data. February SoftDev Inc.

Global Clinical Error Trends (cont.) CROWNWeb EDI Training 12631: Missing Clinic Weight (PD clinical submission) Resolution: Include the Clinic Weight element and value in the patient’s PD clinical submission and resubmit. February SoftDev Inc.53

Questions? CROWNWeb EDI TrainingFebruary SoftDev Inc.54