Insert Subtitle Here
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HP Enterprise Services
Medicaid Information Technology System (MITS)
Electronic Document Management
System (EDMS)
Completion: New
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EDMS – Completion: New
Technical Courses
Orientation to FileNet System Administration
Orientation to Captiva System Administration
EDMS Catalog of Courses
Business Courses
Introduction to EDMS
Document Preparation, Scanning, and Manual IQC
Correction Processing – Completion: NEW
Quality Assurance – Completion: VERIFY
FileNet One Step Workflow
COLD Reports
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EDMS – Completion: New
1. Summarize the scanning process within EDMS
2. Describe the objective and the activities of each
step of the Completion: New process in detail,
including:
a) The types of scanned documents
b) Captiva’s role in verifying data, for both red
optical character recognition (OCR) type forms
and black ‘Key From Image’ (KFI) forms
c) The types of validation within each type of
document
d) How to verify data fields and complete this
verification step
EDMS – Completion: New
Course Objectives
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EDMS – Completion: New
Agenda
1. Introduction
2. Background – What is Being Scanned?
3. Documents and Batches
4. The Completion: New Process
Introduction
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EDMS – Completion: New
Term Definition
Captiva Commercial off-the-shelf (COTS) software that manages the
scanner, from interpreting the scanned documents through
storing the resulting images on the FileNet data repository
with index values. Captiva can be programmed to recognize
certain documents (such as claim forms).
OCR Optical character recognition, which is the Captiva software’s
ability to ‘read’ black typed data off red forms and eliminate
the need for data entry.
FileNet The database in which EDMS stores all MITS application
data received for storage.
EDMS Related Definitions
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EDMS – Completion: New
EDMS – A Bird’s Eye View …
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EDMS – Completion: New
1) Inbound mail is received
2) Documents are sorted, batched, and scanned
3) Manual IQC operators research any unscannable
documents and try to resolve the problem
4) Completion: New operators manually key fields
flagged by Captiva software as being in error, as well
as all verification fields for claim form ADA 2006
5) Completion: Verify operators key in all critical information
as a final QA step
6) Scanned document images are stored in FileNet
7) Workflow processes are initiated where necessary
What is the Full EDMS Process?
Bold is within the scope of this training
Background
What Is Being Scanned?
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EDMS – Completion: New
Agenda
1. Introduction
2. Background – What is Being Scanned?
3. Documents and Batches
4. The Completion: New Process
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EDMS – Completion: New
• To create electronic images of paper documents
related to Claims, Claim Adjustments, provider
enrollment (PE) requests, prior authorization (PA)
requests, and other OHP related ‘transactions’
What is the goal of scanning?
• Each document has one or more keys or indexes such
as Provider, Recipient, internal control number (ICN),
and other values
• These index values will ‘link’ these documents to
certain providers, claims, etc., and be accessible
correctly in interChange
How does EDMS store these documents?
Background – What Is Being Scanned?
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EDMS – Completion: New
How does Completion: New fit into the
process?
• Every document that is scanned must go through the
Completion: New process.
• Captiva (the scanning software) validates critical fields
in every scanned document. Any that do not pass the
built-in validation edits are presented to the
Completion: New worker to key in.
• We shall examine the contents of batches of
documents first and then discuss the Completion: New
process in more detail.
Background – What Is Being Scanned?
Documents and Batches
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EDMS – Completion: New
Agenda
1. Introduction
2. Background – What is Being Scanned?
3. Documents and Batches
a. What is a document?
b. What is a batch?
c. Scanning and Quality Control
4. The Completion: New Process
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EDMS – Completion: New
What Is a Document?
A Document is a claim, a claim adjustment, a proprietary
document, or a cover sheet with attachments.
A document has two components:
1. A form (e.g., CMS 1500, 6766, 9401, cover sheet)
2. One or more attachments (almost always present)
Claim
Document
Claim Adj.
Document
Cover Sheet
Document
Completion: New and Completion: Verify only involve
the forms – never the attachments.
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EDMS – Completion: New
1. Claims (CMS 1500, UB04, ADA 2006) – only
those with attachments
2. Claims adjustments (6766, 6767, 6768)
3. Proprietary forms (9400, 9401, 9402, 9405)
4. Paper attachments sent by the provider to
support claims, PEs, and PAs that the provider
uploaded via the Web Portal
With Go-Live, four types of documents will be
scanned. All are within the scope of the
Completion: New function.
What Is a Document?
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EDMS – Completion: New
There are three types of Claims:
A. CMS 1500 – Health Insurance Claim form
B. UB04 – Institutional Claims form
C. ADA 2006 – Dental Claim form
Optical character recognition (OCR) reads all
information off the red claim forms. Captiva is
programmed to find the key fields on each red form.
For black forms, data entry (‘Key From Image’ or
KFI) is done to capture the important information.
1. Claims – with Attachments
What Is a Document?
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EDMS – Completion: New
123456789
Ima Sick 11 24 47 x
123 Happy Lane
Happy Town ID
83000
04 01 10 04 03 10 3 12345 aa 12 1234.00
987654321 1234.00
Signature on file
When a red form is
scanned, the
scanner’s ‘red drop’
feature drops the
form’s red ink,
leaving just the
black text in the
scanned image.
That black text is all
that is read and
stored in EDMS.
What Is a Document?
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Examples of RED and BLACK claim forms
What Is a Document?
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1. Claims – with Attachments (continued)
What Is a Document?
Possible types of Claim attachments:
A. COB (Coordination of Benefits) and/or OI
(Other Insurance) forms – these forms replace
Medicaid form 6780, which will no longer be
accepted as of Go-Live
Special Note: The COB and OI forms are discussed in this training
but may not be scanned as of Go-Live. An ODJFS decision is
pending to limit these forms to portal upload only.
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1. Claims – with Attachments (continued)
What Is a Document?
More Possible types of Claim attachments:
B. 6653 forms (for claims over 365 days old) *
C. HAS forms (Hysterectomy, Abortion, and
Sterilization consent forms) *
D. Any other documents that may accompany a
claim
*
6653 and HAS forms should not be mailed in without a
claim
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EDMS – Completion: New
2. Claim Adjustment forms (6766, 6767, 6768)
3. Proprietary forms (9400, 9401, 9402, 9405)
4. Paper Attachments Sent By Provider
• To fix edit errors detected by Captiva (red forms)
• For full data entry of predetermined data fields
(black forms)
What Is a Document?
All four types of documents mentioned above may
require some keying by the Completion: New worker
in the following situations:
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EDMS – Completion: New
Definition:
1. A group of ‘like’ documents grouped together into
batches after the inbound mail is opened and sorted.
2. Captiva software is configured to scan documents in
batches.
3. Up to 50 documents, of one or more pages each,
will comprise a batch.
What Is a Batch?
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Below are the different types of batches and
their contents.
What Is a Batch?
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EDMS Cover Sheets and Document Dividers
• To understand more about the contents of
batches, we need to first learn about EDMS Cover
Sheets and Document Dividers.
• All batched documents, except for one type
discussed later, must have either EDMS cover
sheets or a document dividers that separate each
document in the batch.
• We will first look at the EDMS Cover Sheet, which
will affect the Completion: New process, and then
at the Document Divider.
What Is a Batch?
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EDMS – Completion: New
EDMS Cover Sheet
• The EDMS Cover Sheet is a
standard, fixed format page
that Captiva uses to identify
the type of document and
the provider, recipient, etc.,
that the document pertains
to.
• It also indicates to Captiva
that a new document is
beginning in the current
batch.
What Is a Batch?
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EDMS Cover Sheet (top half)
Radio buttons
indicate the
type of
document
that is being
scanned.
Only ‘Provider’,
‘Prior Authori-
zation’, and
‘Supporting
documents for
claim’ are valid
at Go-Live. All
other doc types
will be
returned.
What Is a Batch?
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EDMS – Completion: New
Prior
Authorization
documents
have sub-
categories to
further define
the
document.
Used only
when the PA
radio button
is selected.
EDMS Cover Sheet (top half)
.
What Is a Batch?
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EDMS – Completion: New
The bottom
half of the
Cover Sheet is
populated
with one or
more key /
index values,
pertaining to
the type of
document
scanned.
These values
normally are
be typed, but
could be hand
written.
EDMS Cover Sheet (bottom half)
What Is a Batch?
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EDMS – Completion: New
The barcode is
always at the
bottom of the
cover sheet.
It contains all
the data that
Captiva needs
to capture the
document type
and the key /
index values.
EDMS Cover Sheet (bottom half)
What Is a Batch?
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What documents to be scanned at Go-Live
require an EDMS cover sheet?
9 Supporting documents for claims
9 Provider enrollment attachments
9 Prior authorization attachments
What documents do not require (and
cannot have) an EDMS covers sheet?
What Is a Batch?
X Claims (CMS 1500, UB04, ADA 2006)
X Claims Adjustment forms (6766, 6767, 6768)
X Proprietary forms (9400, 9401, 9402, 9405)
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Document Dividers
• The document divider (doc divider) is
a standard page inserted between
documents in most batches that do
not use EDMS cover sheets.
• When a batch of several documents is
scanned, it tells Captiva where each
document ends and the next one
starts.
What Is a Batch?
• Like the EDMS cover sheet, the doc divider acts as a
separator page between documents in a batch.
Unlike the cover sheet, however, the doc divider is
not stored in FileNet with the document.
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EDMS Cover sheets and Document Dividers
•
In every batch of scanned documents
(except the 6768 form), every document
needs one or the other form preceding it:
- EDMS cover sheet, or
- Document divider
What Is a Batch?
• The 6768 is a single page form with no
attachments; it needs no separator page
such as an EDMS cover sheet or doc
divider. 6768s are in their own batch.
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EDMS cover sheet is required for:
• Supporting documents for claims
• Provider enrollment attachments
• Prior authorization attachments
Document divider is required for:
What Is a Batch?
• Claims (CMS 1500, UB04, ADA 2006)
• Claims adjustment forms (6766, 6767)
• Proprietary forms (9400, 9401, 9402, 9405)
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Batches with Cover Sheets:
Batches with Document Dividers:
. . . etc.
. . . etc.
What Is a Batch?
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What Is a Batch?
Examples of Claim documents, in a Batch:
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. . .
6766, 6767, 6768, or 9400 series documents
(possibly with attachments), in a Batch
What Is a Batch?
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What exactly is generated from scanning?
• Images are created – of every page in the batch,
including the EDMS cover sheet and doc dividers.
• Key/index data are read by Captiva and saved. This
data is captured from:
o EDMS cover sheets (attachments for PA, PE, and
Claims). Captiva reads this information from the 2D
Barcode (PDF 417).
o Red forms (CMS 1500 and UB04 claims, and the
COB and OI forms that accompany some claims) –
Captiva reads this information using OCR.
Scanning and Quality Control
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What scanned information is subject to
Completion: New and Completion: Verify?
• The key/index data that Captiva captured from the
EDMS cover sheets and the red forms.
• Other predetermined information from the claims,
claims adjustment, and proprietary forms.
Scanning and Quality Control
The images generated from scanning are not subject to
the Completion: New and Completion: Verify processes.
They are stored as is in EDMS, for viewing in
interChange. One exception: the Doc Divider images are
not stored in EDMS.
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What does quality control mean in terms of
scanned data?
• Verify that required fields are present
• Validate certain fields for length and format
(numeric, alphanumeric)
Scanning and Quality Control
NOTE: No lookup will be done to see
whether a key field (such as a Provider ID,
Recipient Number, or Application Tracking
Number) exists within MITS.
The Completion: New Process
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Agenda
1. Introduction
2. Background – What is Being Scanned?
3. Documents and Batches
4. The Completion: New Process
a. Definition
b. Rules
c. Role of Completion: New Worker
d. Using the Index Field & Values screen
e. Next steps
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Definition of Completion: New
The Completion: New Process
Two activities occur within the Completion: New
process of EDMS:
• Manual keying of data fields that Captiva has
flagged as missing or invalid, per predefined rules
for those fields – examples:
- Document Type missing (on an EDMS cover sheet)
- Provider Number is empty (required)
- Field B, defined as numeric, contains “John Smith”
• Fully keying in all data fields, as prompted, for the
ADA 2006 claim form (black form) and any other
black claim form (instead of red)
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Logging In
The Completion: New worker must first be logged in
to the Captiva RDC server:
1. The worker logs into the Captiva Remote
Desktop Server (RDC) – refer to the
handout for step by step details.
2. The worker clicks on the Completion:
New icon.
3. The worker logs on via Single Sign-On
with an ID and password.
The Completion: New Process
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EDMS – Completion: New
The Completion: New Process
The FormWare Completion panel is displayed. This is a
split screen, showing part of the scanned image in the
top half and the extracted data in the bottom half.
As long as the
worker stays
logged on,
Captiva
automatically
displays all
scanned
documents as
it processes
batches.
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EDMS – Completion: New
The Completion: New Process
Regarding the Formware Completion panel:
As batches emerge from scanning or from Manual IQC,
their documents will automatically be presented in
Completion: New.
For red forms, only the data and not the red form is
scanned and saved. The Formware Completion panel,
however, shows the form merged with the data for the
worker’s benefit in validating the scanned data.
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The Completion: New Process
Captiva automatically and rapidly reviews all scanned
documents on the worker’s PC screen, and only stops
when it encounters a questionable or invalid field.
Example: a cover sheet with a missing document type.
Black claim
forms also
have to be
keyed in by
the worker,
as prompted
by Captiva.
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The Completion: New Process
Rules for Keying Fields
When an invalid or missing field is found by Captiva,
it prompts the Completion: New worker to key in that
data field.
If the worker keys in the same value Captiva flagged
as being in error, Captiva will accept it, despite the
edit ‘error’. The Completion: Verify worker will have
one more chance to change the field, in the next step
of the process.
No matter what the Completion: New worker keys in,
pressing Shift-Enter will cause Captiva to accept the
keyed value, even if the keyed value still violates the
edit Captiva is applying.
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The Completion: New Process
The ADA 2006 Dental
claim form is a black
form, which means
Captiva cannot read
information from it via the
OCR process.
In Completion: New, the
worker must key in many
data fields for each ADA
form in the batch. The
panel will prompt the
worker for each field it
needs.
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The Completion: New Process
• A document image that was scanned in error or
is otherwise invalid can be flagged for rejection,
which means the document is flagged for
rejection from the batch. The worker can press
CTRL+F6 to flag the document for removal.
Captiva advances to the next document within
the batch.
• The Completion: Verify worker makes the final
decision on removing the document. If removal is
confirmed, that document is not stored on
FileNet.
What can the Completion: New worker do,
besides correcting or entering data in fields?
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The Completion: New Process
Examples of Completion: NEW ‘Fixes’
We shall look at examples of some common field
validations that Captiva will request of the worker.
• If the worker determines that the field was
misread by Captiva, he/she can key over the
field that Captiva displays.
• If, however, the worker determines the field to
have been read correctly by Captiva, even if it
failed a field edit, it can be accepted as is.
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The Completion: New Process
Cover sheet: Invalid NPI Number
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EDMS – Completion: New
The Completion: New Process
CMS 1500: Invalid Date of Service
Error message:
DATE IS OLDER
THAN 3 YEARS
(09/19/06)
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EDMS – Completion: New
The Completion: New Process
CMS 1500: Scan Results Are Faint
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EDMS – Completion: New
The Completion: New Process
CMS 1500: Sum of Charges Is Wrong
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EDMS – Completion: New
The Completion: New Process
CMS 1500: Field Value Is Invalid
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EDMS – Completion: New
The Completion: New Process
Frequently used keyboard shortcuts for the
Completion: New process
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EDMS – Completion: New
Once a batch moves successfully through the
scanning and Completion: New processes:
1. The batch continues to the Completion: Verify step,
where all key/index data is keyed by the operator, as
a final step to ensure quality.
2. Whatever the Completion: Verify worker keys in will
be what ends up in FileNet – they make the final
decision on all questionable fields or images.
3. When the Completion: Verify worker is done keying
in the information, the document is accepted for
storage in EDMS.
What Happens Next in EDMS Scanning?
Questions
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Columbus, OH 43215
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