Create Projects - Import Claims and Assign Audits

The claims uploaded into the system are automatically pre-populated into the audit worksheet, eliminating the need for manual data entry and saving significant time. In just a few steps, claims can be uploaded and assigned to the appropriate audit within the system.

Follow the steps below to get started:

• Navigate to the Audit Create Projects. The Create Projects screen will be displayed.
• Navigate to the Action menu and select Import Claims and Assign Audits. The Import Claims and Assign Audits window will be displayed.
• Navigate to the individual section and follow the further instructions:
  • Creating the Claims Upload File
  • Importing the Claims Upload File
  • Tips and Common Issue Resolutions

Creating the Claims Upload File

Follow the steps below to create the claims upload file:

• Click Download Auditee List, and verify that all auditees are loaded into the system before importing claims. Review the downloaded file to confirm they are present in the system. If they are not in the system, add them via the Manage Lists page before proceeding.
• Download the Audit Data File and enter your claim data into the downloaded Audit Data File. Required fields are marked with an asterisk (*).

Note:

• To simplify data loading, you can create custom templates for different audit types, such as professional, outpatient, inpatient, and DRG. To do this, copy the basic file, rename it for easy identification, and remove any unnecessary columns for that audit type.
• The Audit Data File includes all possible fields for auditing HCFA 1500, UB-04, or CDT forms over 200 data fields. This comprehensive file enables your IT or Reporting department to generate a single extract or report containing all the data needed for auditing.
• The only modification allowed in the Audit Data File is deleting columns. Do not rename or rearrange columns, as this will cause upload errors.
• Save the .csv file on your local machine.

Importing the Claims Upload File

Follow the steps below for importing the claims upload file:

• Select the desired project from the Audit Project dropdown list. If the desired project is not listed, you can create a new one using the icon in the field.
• Click the Upload Document area, then browse and select the saved file. If there are any errors, they will be displayed below the submit button after you import the file.
• Choose the desired Due Date.
• Select the desired Auditor and QA Reviewer using the appropriate fields.
• Select the desired Sub Status detail. 
• Click on Submit to import the claim file.Notes: 
  • After clicking Submit, Audit Manager processes the file, displaying it in the table with an Upload Status of In Process while validating data, including column headers and DOS.
  • If no errors are found, the Upload Status will display Complete. If errors are detected, it will display Cancelled. Errors found.

Follow these steps to view errors in your file:

• Click the download icon next to the errors file and open it in Excel.
• Scroll to the far-right column labeled Validation Errors to review error messages for affected rows. Expand the column for better readability.

Note: Most errors occur in the first few columns. To reduce scrolling, temporarily hide unnecessary columns. Just remember to unhide them before re-uploading.

• Fix all errors in the data. For best results, correct the errors and copy the updated data into a new template.
• Save the corrected file with a new name and proceed with the above steps to import the file.

Tips and Common Issue Resolutions

• Ensure auditees in the Auditees Data File match their corresponding entries in the Audit Data File. Records that do not match cannot be uploaded. Extra characters or spaces may cause upload failures.
• If an Auditee ID is unavailable, you can use the Auditee Name. However, once an Auditee ID is assigned, it must be used for claims import.
• Before uploading claims data, the system checks for errors to ensure only valid data is uploaded. Error messages appear in the last column, explaining the necessary corrections for each row.
• If an error occurs but the download file icon does not appear, try clearing your browser’s cache, closing and reopening the browser, and logging back into Audit Manager. This often resolves the issue.

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