Decoding Claim Maker Alert Emails

If you receive emails with Claim Maker Alerts attached, use this section to understand what the alert means and how to respond.

Note: these daily batch and document update emails are separate from Autocoding 2.0 Human Review Elements, which appear on the case inside Claim Maker. Do not expect review elements in these emails.

As batches are updated with additional documents or cases each day, we send out a daily email outlining everything that was updated. The updates sent out only apply to updates made to existing batches. The email arrives from [email protected] and will look like this:

The CSV file (seen in the image above) is sent via email when batches are updated with new cases or documents.

View Sample File

This file contains the facility name, the billing cycle role affected, the batch ID, and an explanation of what was updated, as well as whether a new batch was created because we received documents for an already processed batch.

Example notification content

The following notification is received. The info below is from one row in the CSV document. What is it telling the user, and how should they respond?

• facility: TEST FACILITY
• concerned_roles: MedicalCoderAdmin, RevenueCycleReconciler
• date_of_service: the batch date of service, in MM/DD/YYYY form
• event_description: Duplicate Batch Created for DOS: New Case Documentation Received
• batch_id: 190
• batch_state: New
• case_id: -9999
• case_state: New
• case_state_reason: OK
• created_batch_id: 190
• created_case_id: 4725

First, we know a new batch with the same date of service as an existing "closed" batch (either Completed or Charges Entered) was created. Furthermore, we know that the original batch did NOT have an existing case corresponding to the new documentation set, because "created_case_id" is populated while "case_id" is blank (aka -9999). The reconciler should review the case(s) in the new batch and, if valid, release the batch for coding.

See other examples in the test file (view above).