TRICARE Duplicate Claims System (DCS) - TRICARE Encounter Data (TED) Version
Chapter 4
Addendum B
Report Descriptions And Examples
Copyright: CPT only © 2006 American Medical
Association (or such other date of publication of CPT).
All Rights Reserved.
Revision:
|
Report Category:
|
Set Report
|
|
Report Menu Hierarchy And Format
Name:
|
REPORT => SET
REPORTS =>
BASIC
|
|
Printed Report Title:
|
Duplicate Claim System Sets
Grouped by Set Number
|
|
Report Description:
|
This report provides set-level
information regarding all of the sets loaded in the DCS. The fields
displayed on the report are: Institutional/Non-Institutional Indicator;
Set Number; Status; Set Match Type; Multi-Contractor Set? (Y/N);
Owner FI; Region; Initial Load Date; Current Load Date; Last Update
Date; Adjustments? (Y/N); Total Amount Identified For Recoupment;
Total Amount Actually Recouped; Total TED Adjustment Amount; and
Set Level User Defined Code.
|
|
Report Parameter Options:
|
Users may customize the report
by selecting: All “Standard” parameters (Claim Set Status, Adjustments,
Set Owner Type, Claim Type, Match Type, Date Type, Set Range, FI,
Region) plus Set Level User Defined Codes.
|
|
Report Notes:
|
The data used by this report
format is set level data.
|
|
Report Category:
|
Set Report
|
|
Report Menu Hierarchy And Format
Name:
|
REPORT => SET
REPORTS =>
BASIC BY USER CODE
|
|
Printed Report Title:
|
Duplicate Claim System Sets
Grouped by User Code
|
|
Report Description:
|
This report provides set-level
information regarding all of the sets loaded in the DCS grouped
by Set Level User Defined Codes. The fields displayed on the report are:
Institutional/Non-Institutional Indicator; Set Number; Status; Set
Match Type; Multi-Contractor Set? (Y/N); Owner FI; Region; Initial
Load Date; Current Load Date; Last Update Date; Adjustments? (Y/N);
Total Amount Identified For Recoupment; Total Amount Actually Recouped;
Total TED Adjustment Amount; and Set Level User Defined Code.
|
|
Report Parameter Options:
|
Users may customize the report
by selecting: All “Standard” parameters (Claim Set Status, Adjustments,
Set Owner Type, Claim Type, Match Type, Date Type, Set Range, FI,
Region) plus Set Level User Defined Codes.
|
|
Report Notes:
|
The data used by this report
format is set level data.
|
|
Report Category:
|
Set Report
|
|
Report Menu Hierarchy And Format
Name:
|
REPORT => SET
REPORTS =>
USER LOG REPORT
|
|
Printed Report Title:
|
User Log Grouped By Set Number
(Transaction History)
|
|
Report Description:
|
This report identifies the
users who made changes to a set and the dates on which the changes
occurred. The fields displayed on the report are: Set Number; Status;
Owner FI; Region; Initial Load Date; Current Load Date; Transaction
Date; User ID; Total Amount Identified For Recoupment; Total Amount
Actually Recouped; and Total TED Adjustment Amount. The report will
identify all of the sets meeting the criteria selected on the report
parameter screen and list all of the changes made to those sets
along with the associated User Ids. The system detects changes to:
the status of a set; the Owner FI; the Region; and the three total
dollar amount fields. Whenever a change to one or more of these
fields occurs, a “log” record is created and will appear on this
report along with the User ID associated with the change(s). The
report will not show log entries generated as a result of: sets
to which claims have been added during the monthly load process;
or sets that have been archived out of the active database to history. Users
may see entries with an “System” or “CLAIMADD” as the User ID. These
two User IDs are used by the DCS for set management purposes. These
User Ids may appear when the system makes a change to a set. The
report groups the data by Set Number in ascending order.
|
|
Report Parameter Options:
|
Users may customize the report
by selecting: All “Standard” parameters (Claim Set Status, Adjustments,
Set Owner Type, Claim Type, Match Type, Date Type, Set Range, FI,
Region) plus User IDs.
|
|
Report Notes:
|
The data used by this report
format is set level data.
|
|
Report Category:
|
Set Report
|
|
Report Menu Hierarchy And Format
Name:
|
REPORT => SET
REPORTS => EXPLANATION REPORT =>
NOTEPAD
|
|
Printed Report Title:
|
Explanations Notepad
|
|
Report Description:
|
This report provides a listing
of the notepad entries made on selected sets. The fields displayed
on this report are: Set Number; Status; Match Type; Owner FI; Region;
Initial Load Date; Current Load Date; and Notepad Entries.
|
|
Report Parameter Options:
|
Users may customize the report
by selecting: All “Standard” parameters (Claim Set Status, Adjustments,
Set Owner Type, Claim Type, Match Type, Date Type, Set Range, FI,
Region).
|
|
Report Notes:
|
The data used by this report
format is set level data.
|
|
Report Category:
|
Set Report
|
|
Report Menu Hierarchy And Format
Name:
|
REPORT => SET
REPORTS => EXPLANATION REPORT =>
VALIDATE
|
|
Printed Report Title:
|
Validate Status Explanations
|
|
Report Description:
|
This report provides a listing
of the explanations entered when sets are resolved to a Validate status.
The Duplicate Claims System requires that an explanation be entered
when a set is resolved to a Validate status. One
of the required Validate explanations describes
why the amount actually recouped and the paid amount of the TED
adjustments submitted do not equal the amount identified for recoupment.
The other required Validate explanation describes
why all of the identified line-items of a non-institutional actual
duplicate claim have not been adjusted. The fields displayed on
this report are: Set Number; Status; Match Type; Owner FI; Region;
Initial Load Date; Current Load Date; and Validate Explanations.
|
|
Report Parameter Options:
|
Users may customize the report
by selecting: All “Standard” parameters minus Claim Set Status (Adjustments,
Set Owner Type, Claim Type, Match Type, Date Type, Set Range, FI,
Region).
|
|
Report Notes:
|
The data used by this report
format is set level data.
|
|
Report Category:
|
Set Report
|
|
Report Menu Hierarchy And Format
Name:
|
REPORT => SET
REPORTS => EXPLANATION REPORT =>
MODIFY
|
|
Printed Report Title:
|
Modify FI Explanations
|
|
Report Description:
|
This report provides a listing
of the explanations entered when the Owner FI is changed on multi-contractor
sets. The Duplicate Claims System requires that an explanation be
entered when ownership of a multi-contractor set is changed from
one contractor to another. The explanation entered should indicate
who changed set ownership, who the change was discussed with at
the receiving contractor, the date the discussions and the change
took place, and why ownership was changed. The fields displayed
on the report are: Set Number; Status; Match Type; Owner FI; Region;
Initial Load Date; Current Load Date; and the Modify FI Explanations.
|
|
Report Parameter Options:
|
Users may customize the report
by selecting: All “Standard” parameters minus Owner Type (Claim
Set Status; Adjustments, Claim Type, Match Type, Date Type, Set
Range, FI, Region).
|
|
Report Notes:
|
The data used by this report
format is set level data.
|