Human Review Elements (Autocoding 2.0)
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This feature is only available at facilities that run Autocoding 2.0. If you are not sure whether your organization uses Autocoding 2.0, or you would like more information, email [email protected].
After Autocoding 2.0 processes a case, the case can carry Human Review Elements (HREs). Find them in a tab in the Case Information panel.
| Type | What it means |
|---|---|
| HARDSTOP | Information is missing or conflicting, and the problem would cause a payer rejection or denial. Resolve it before the claim is payer-ready. |
| COMPLIANCE | A regulatory or compliance concern. Route it to your compliance process. |
| FINANCIAL | A potential payment impact: a possible missed charge, or a charge the documentation may not support. |
| INFORMATIONAL |
| Something noteworthy, for example an action Autocoding completed. No action is required. |
| OTHER | An internal system event, for example an external service failure. An automated check did not complete. |
In the default Claim Maker configuration, a HARDSTOP element prevents Autocoding 2.0 from applying codes automatically. You may still receive Autocoding predictions, but Claim Maker does not apply them until the element is addressed. COMPLIANCE and FINANCIAL elements flag the case for the matching team and do not block automatic coding by themselves. Your administrators can change how each type is handled.
Each element contains a documentation link. Click it to navigate to the referenced page inside the Complete Record.
When you address an element, mark it as resolved. The dropdown offers several other statuses to choose from.
Unaddressed elements do not prevent you from exporting Code Complete cases.