QA Alert Flag

A QA Alert Flag is a notification system designed to highlight specific audit findings or to randomly select a set of Dates of Service (DOS) for Quality Assurance (QA) review. These alerts enable supervisors and managers to customize and adjust the QA review process according to the needs of individual auditors.  

The following steps enable QA Alert Flags:

• Navigate to the Admin Manage Users.
• To enable the QA Alert Flag for existing users, select the desired user or click the Edit icon in the Action column. An Edit User window will be displayed.

Note:

• Ensure the QA Alert function is enabled for both the auditor and the individual conducting the QA review for comprehensive oversight and accuracy.
• The user can also enable a QA Alert Flag while adding any new user.

• Enable the QA Acceptance Alerts and choose one of the desired alert types from the drop-down:

• A Percentage of all DOS: The system will randomly select a defined percentage of Dates of Service (DOS) for QA review, as specified in the auditor's settings. This feature allows users to adjust QA review based on the auditor's performance.
  • The user can adjust the percentage using a percentage dial.

• Only selected Error Types: The system will display real-time alerts for the QA reviewer when the audited DOS meets one of the following criteria:
  • Over-coded: When an auditor identifies over-coding in a Date of Service (DOS), a red alert will be raised to ensure immediate attention and correction.
  • Under-coding: When under-coding is identified within a Date of Service (DOS), a yellow alert will be raised for prompt review.
  • Additional: When additional codes are added to a DOS, a green alert will be displayed for verification and validation.
  • Incorrect: When an auditor detects incorrect codes, an orange alert is raised to prevent errors and ensure accurate coding.

• Once the desired options are selected, click on the Save.
• Navigate to the Audit My Work Queue Audit Work Queue. The Audit Work Queue window will be displayed.
• Select the desired task, and the Date of Service Work Queue List window will be displayed.
• Choose the desired task and click on the Resume/Start Audit hyperlink in the Action field. The Audit Worksheet window will appear to complete the DOS. 
• Complete all the DOS, click Save & Submit, then select the Complete Claim button to mark the DOS as completed.
• Click on Close Send to QA from the Audit Work Queue list. The QA alert flag will be reflected only for QA in the QA work Queue window, with the number of alerts according to the alert configuration, and the DOS Work Queue window will display the type of QA alerts, if any mismatch or correction is required.

Clear QA Acceptance Alert Flag

The QA Reviewer can review the shared DOS and clear the alert during the review process.

To clear the QA Acceptance Flag, follow these steps:

• Log in to the Healthicity Audit Manager with the QA Reviewer credentials.
• Navigate to the Audit View My QA Audits or navigate to the Audit My Work Queue QA Work Queue. The QA Work Queue window will be displayed.
• Click on the desired provider name. The DOS Work Queue window will be displayed to review the DOS.
• To proceed, click on the Resume/Start Audit hyperlink in the Action field. This action will display the Audit Worksheet window.
• Go to the desired code area where corrections are required. Make a desired correction and click on the Run Edit button.
• Once all necessary changes are made, click on Save & Submit to save the DOS details.
• Click Complete and close the window. This will clear the QA alert flag.

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