Add or edit modeled definition

NOTE: You must obtain licenses to use both the 3M and Axion Revenue Modeling (ARM) options. When using 3M, an entity is related to a 3M-authorized site name. When using ARM, you can select any available contract.

Use the grouping and reimbursement modeled definition to group and manage what-if reimbursement scenarios.

1. From the Enterprise Decision Support home page, in the Grouping and reimbursement section, or tab dropdown, select Modeled.

   The Manage modeled reimbursement page shows all saved definitions, consisting of:

   • Name

   • Calculation method used (3M, ARM, or both)

   • Modified date

   • Batched – You may include model definitions in the import process. Modeled definitions that are batched can process against new or updated encounters as part of the EDS import.

   • Status:

     • Success

     • New

     • Pending (queued to run)

     • In Progress (processing)

     • Canceling

     • Canceled (you stopped the job)

     • Failed

   • Actions:

     • Process

     • Edit – If you select a definition, a pane appears on the right to show entity and payer details without using Edit. You cannot edit definitions that are Pending or In Progress.

     • Copy – Use any definition as the basis for another definition by copying it and updating its rules.

     • Cancel – Stop a Pending or In Progress job.

       NOTE: If the job is In Progress, you must reprocess any previously grouped or reimbursed encounters as results may be lost.

     • Delete – You cannot delete a definition if it is Pending or In Progress state.

2. On the Manage modeled reimbursement page, select Create.

   Provide a title for the definition so it is meaningful when viewed on the managed page. Then, determine whether to use 3M or Axiom Revenue Modeling (ARM) to model encounters:

   • 3M – When 3M is enabled, you can select only entities and schedule set up with 3M Grouper Plus Content Services (GPCS).

     Authorized sites are set up in 3M GPCS’s Access Manager by Syntellis in accordance with the customer's license agreement. The list of available schedules comes from the 3M GPCS instance for that entity (3M-authorized site).

     You create schedules in 3M for the grouping and reimbursement types you license with 3M. Those schedules are then referenced in the system for use in the definitions.

     The reference is the unique User Key 1 and User Key 2 combinations that are created in the 3M Schedule Manager. 3M determines which specific schedule to use by user keys and beginning and ending dates.

     EDS automatically updates from GPCS nightly. If new user key combinations are created and needed immediately, click Refresh under the schedule dropdown.

   

   User key 1 and 2 combination of MSDRG-MSDRG. MSDRG appears once in an EDS selection. When encounters using MSDRG-MSDRG are passed to 3M, 3M determines which schedule to use for the encounters.

   

   An example of this schedule list appears in the following Calculation Method image. The unique User Key combinations appear for the given entity.

   

   Results of the model may be stored in one of ten model result destinations.

   

   • ARM – When ARM is enabled, select a contract from the dropdown to direct encounters for reimbursement calculation. The list displays as Simulation: Contract. You can process encounters against any contract in any simulation regardless of payer code associated with the encounter.

   Use Filter Wizard

   Use the Filter Wizard to define the encounter data set to model filtering on any encounter data element.