CROWNWeb EDI Training.

Report
February 2013
Presented By: CROWN Data Discrepancy Support (CDDS)
The analyses upon which this publication is based were performed under Contract Number HHSM-500-2010-00067C, 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
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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
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File Submission
Type
EDI
Data
Collection
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
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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
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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
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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
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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
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Facility Mappings
(cont.)
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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
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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
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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
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EDI
Process
Flow
Diagram
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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.
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Admit/Discharge Mappings (cont.)
 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)
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Admission
Processing
Flow Diagram
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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.
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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
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Treatment
Processing
Flow Diagram
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Fields that cannot be updated with EDI
Updating Elements For Existing Patients within CROWNWeb
Schema Type
Name
If
Element or populated,
Attribute can value be
Name
updated?
PatientIdentifier
PatientIdentifier
PatientIdentifier
lastName
firstName
hicnum
No
No
No
PatientIdentifier
ssn
No
PatientIdentifier crownPatientId
PatientIdentifier
gender
PatientIdentifier
dob
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Notes
Cannot update this patient
identifier via batch. Can
add data if field is NULL
No
No
No
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Processing Results to EDI Submitters
 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
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Errors Overview
 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.
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Error Levels
 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-cvcenumeration-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.
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Error Levels (cont.)
 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.
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Error Levels (cont.)
 Record-level Error (Two categories )

High Level – processing stops for that patient. Validation moves
to the next record in the file, if one exists
 100 - Patient has possible matches
 401 - 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.
 11211 - Admit Date cannot be a future date.
 11296 - Race has been entered. Ethnicity is Required.
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Global Patient Error Trends
Rank Patient
Error
Description
1
13492
2
11225
3
204
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
Admission process cancelled, Patient already admitted to the current facility.
4
100
Patient could not be processed due to possible matches
5
11186
Mailing Address is required.
6
11185
7
11222
8
11216
9
13497
10
11207
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}).
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Global Patient Error Trends (cont.)
 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
Prev Admit Next Admit
Allowed
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Global Patient Error Trends (cont.)
 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
Prev Disc Next Admit
Allowed
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Discharges Allowed
Discharges
Allowed
Table
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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.
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Global Patient Error Trends (cont.)
 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.
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Global Patient Error Trends (cont.)
 11207: 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.
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Global Patient Error Trends (cont.)
 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.
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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
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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.
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Near Match Report Overview (cont.)
 Resolution Process
 The following diagram is a High-level Patient Processing
workflow
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Near Match
Report
Overview
(cont.)
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Global Patient Error Trends (cont.)
 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 Date.
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Global Patient Error Trends (cont.)
 13492: Medicare Enrollment Effective Date already
exists for Medicare Enrollment Status.
 13497: 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.
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Global Patient Error Trends (cont.)
 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.
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Global Patient Error Trends (cont.)
 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.
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Global Patient Error Trends (cont.)
 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.
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Global Clinical Error Trends
Rank Patient Error
Description
1
401
2
12721
3
20045
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.
4
20037
Vaccination data is required for HD or PD clinical submissions.
5
20057
6
12860
7
604
{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}.
8
13429
9
400
10
12631
Could not find a unique patient with the given orgPatientId
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.
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Global Clinical Error Trends (cont.)
 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.
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Global Clinical Error Trends (cont.)
 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.
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Global Clinical Error Trends (cont.)
 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.
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Global Clinical Error Trends (cont.)
 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.
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Global Clinical Error Trends (cont.)
 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.
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Global Clinical Error Trends (cont.)
 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.
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Global Clinical Error Trends (cont.)
 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.
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Global Clinical Error Trends (cont.)
 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.
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Global Clinical Error Trends (cont.)
 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.
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Global Clinical Error Trends (cont.)
 12631: Missing Clinic Weight (PD clinical submission)
 Resolution: Include the Clinic Weight element and value in the
patient’s PD clinical submission and resubmit.
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Questions?
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