User Manual CRAD Help Guide 022019 V2
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Communications Relational Assurance Database (CRAD) User Manual/Help Guide Version 1.0 02/20/2019 Contract Number: HHSM-500-2017-00022 CMS XLC Table of Contents Table of Contents 1. Introduction ............................................................................................................ 4 2. Overview ................................................................................................................. 5 3. Getting Started ....................................................................................................... 6 3.1 Set-up Considerations ...................................................................................... 6 3.2 User Access (Via Front-End Interface).............................................................. 6 3.3 Accessing the System ....................................................................................... 6 3.3.1 Login ........................................................................................................... 6 3.3.2 Description of the Home Page After Login .................................................. 8 3.3.3 Navigation ................................................................................................... 8 4. Using the System ................................................................................................. 10 4.1 Scorecard ....................................................................................................... 10 4.2 Add Scorecard ................................................................................................ 11 4.3 Reports ........................................................................................................... 14 4.3.1 Report Result Screen ............................................................................... 15 4.3.2 List of Reports........................................................................................... 16 4.4 CSR List .......................................................................................................... 17 4.5 Rebuttal List .................................................................................................... 20 4.6 User Management .......................................................................................... 22 4.6.1 Create Users............................................................................................. 22 4.6.2 List of users .............................................................................................. 23 4.7 My Account ..................................................................................................... 24 4.8 Support ........................................................................................................... 25 Appendix A: Acronyms ............................................................................................... 26 List of Figures Figure 1: Welcome Screen .............................................................................................. 7 Figure 2: Home Page ...................................................................................................... 8 Figure 3: List of Scorecards........................................................................................... 11 Figure 4: Save and Update Scorecards......................................................................... 14 Figure 5: Search Report Screen .................................................................................... 15 Figure 6: Reports Result Screen ................................................................................... 16 Figure 7: CSR List Template ......................................................................................... 18 Figure 8: CSR List 1 ...................................................................................................... 18 Figure 9: CSR List 2 ...................................................................................................... 19 Figure 20 UM Version10: 1.0 CSR List 3 .................................................................................................... ii CRAD CMS XLC Table of Contents Figure 11: List of Rebuttals ........................................................................................... 21 Figure 12: Save/Update Rebuttal .................................................................................. 22 Figure 13: Create User .................................................................................................. 23 Figure 14: List of Users ................................................................................................. 24 Figure 15: My Account .................................................................................................. 25 List of Tables Table 1 - User /Role Accesses ........................................................................................ 6 Table 2: Acronyms ........................................................................................................ 26 UM Version 1.0 ii CRAD February 2019 _________________________________________________________________________________________________ 1. Introduction CMS oversees the performance of 16 MAC Jurisdiction contracts and a network of 16 Provider Contact Centers (PCCs) that administer provider customer service by responding to provider inquiries in support of the Provider Customer Service Program (PCSP). This includes: • Quality monitoring of calls from Medicare providers to Medicare Administrative Contractor (MAC) Customer Service Representatives (CSRs). • Developing, implementing, and using a Communications Relational Assurance Database (CRAD) to record and store QAM information and generate user-defined reports. The CRAD shall have the capability to produce and aggregate QAM information as defined by users for analysis and review by CMS and the MACs. Help Guide Version 1.0 4 CRAD Version 1.0 February 2019 _________________________________________________________________________________________________ 2. Overview The Communications Relational Assurance Database (CRAD) is a web application that supports the business processes related to the evaluation of Medicare Administrative Contractor (MAC) Customer Service Representatives’ (CSRs) responses to provider inquiries. The CRAD is built to record and store QAM Scorecard results and produce reports for CMS and the MACs. The CRAD has the functionality of the current QAD and PQM Portal, including the ability to accommodate any future changes to MACs and MAC jurisdictions as directed by the CMS Contracting Officer’s Representative (COR). Help Guide Version 1.0 5 CRAD Version 1.0 February 2019 _________________________________________________________________________________________________ 3. Getting Started The following sections describe processes and procedures for accessing the CRAD System. 3.1 Set-up Considerations CMS screens are designed to be viewed at a minimum screen resolution of 800 x 600. To optimize your access to the CRAD, the screen resolution should be set to 1024 x 768 or higher. Access to the Internet is required as the CRAD is a web-based application. The following Internet browsers are compatible for the CRAD: 1. 2. 3.2 • • • • • • Internet Explorer, version 8.0 or higher Chrome User Access (Via Front-End Interface) Administrator: Views and modifies all CRAD components and data. Quality Manager: Views and modifies all components and data of the CRAD as they relate specifically to QAM. CMS User: Views all components of the CRAD as they relate specifically to QAM. May also modify data for specific components. MAC Administrator: View Home, view Scorecard, view My Account, view Resources, view and upload CSR List, Add Rebuttals and Add users in the User Management. Quality Monitor: Views and modifies Scorecard of the CRAD as they relate specifically to QAM. Has full modify access for the Scorecard forms. MAC User: View Home, view Scorecard, view My Account, view Resources, view and upload CSR List, add Rebuttals. No 3.3 3.3.1 ▪ ▪ User/Role 1 Administrator 2 3 4 Quality Manager CMS User MAC Administrator Quality Monitor MAC User 5 6 Table 1 - User /Role Accesses Accesses Home, Scorecard, Reports, CSR, Rebuttals, User Management, My Account, Resources Home, Scorecard, Reports, Rebuttals, My Account, Resources Home, Reports, CSR, Rebuttals, My Account, Resources Home, Scorecard, CSR, Rebuttals, User Management, My Account, Resources Home, Scorecard, My Account, Resources Home, Scorecard, CSR, Rebuttals, My Account, Resources Accessing the System Login Users will login with a unique username and password created by the System Administrator. The Login page displays information about the system. Help Guide Version 1.0 6 CRAD Version 1.0 February 2019 _________________________________________________________________________________________________ Figure 1: Welcome Screen Help Guide Version 1.0 7 CRAD Version 1.0 February 2019 _________________________________________________________________________________________________ 3.3.2 Description of the Home Page After Login Figure 2: Home Page The Home Page displays the following Help Guide Version 1.0 8 CRAD Version 1.0 February 2019 _________________________________________________________________________________________________ ▪ Username, Logout button, Screen Magnifier Icon and Session Timeout display at the top right corner. ▪ Display of Home, Scorecard, Reports, CSR, Rebuttal, User Management, My Account and Resources Menu. ▪ Hyperlinks to Home, Privacy, Security and Disclaimer at the bottom right corner. 3.3.3 Navigation Upon successful login, the Home Page displays the following menu items ▪ Home ▪ Scorecard: CRAD stores all completed Scorecards created for the QAM program. It displays a list of all saved Scorecards and give all valid users the ability to view the completed Scorecards. The Scorecard display list contains navigation tools to allow users to access all completed scorecards based on their role. ▪ Reports: The CRAD creates Scorecard, rebuttal, compliance and non-compliance reports. Users select and create reports from the backend database. ▪ CSR: The CRAD menu option CSR allow users to: ➢ Download the CSR List template for use when creating the CSR List for upload ➢ Upload a new CSR List ➢ Verify no changes to CSR List on file ➢ Generate CSR List report ➢ Rebuttal: The CRAD allow users to create a rebuttal to a failed Scorecard. The CRAD will also enable users to edit and view rebuttals created and saved to CRAD. ▪ User Management: The CRAD menu user management allow users to: ➢ Create new users ➢ Edit users saved to the CRAD ➢ View users saved to the CRAD ➢ Activate and Inactivate users ▪ My Account: All Users will be able to view the information in their personal my account page ▪ Resources: All Users will be able to view the helpful resources presented via the resource menu. Help Guide Version 1.0 9 CRAD Version 1.0 February 2019 _________________________________________________________________________________________________ 4. Using the System 4.1 Scorecard 1. This page shows different Scorecard search filters. Users can filter their search by selecting one of the following: ▪ Select MAC gives user the option to choose a range of 1 to all MACs. ➢ Select Jurisdiction gives user the option to choose a range of 1 to all MAC ▪ Select Status gives user the option to choose All, Pass, or Fail. ▪ Selecting QM ID gives user options to search by Quality Monitor ID. Quality Monitor ID is a randomly generated ID by the CRAD. ▪ Select Scorecard Type gives user the option to choose All, Scoreable, Non-Scoreable, or Does Not Count. ▪ Select From Date to choose the start date of the Scorecard to be viewed. ▪ Select To Date to choose the end date of the Scorecard to be viewed. ▪ Select Filter button to filter results. ▪ Select Reset button to reset field. ▪ Select Add Scorecard button to add new Scorecard. ▪ After the result has been filtered, the list of Scorecards is displayed below the page showing the selected fields. From this, User can: ➢ Copy the result displayed in the current page. ➢ Open/Save in Excel or PDF format. If a user clicks on view in Excel or PDF accidentally, the system will provide an option to cancel what was clicked. ▪ ▪ Also, the system will enable user to click on the Next button to go to the next page if the result to be viewed is more than one page. ▪ The system will also enable user to click on Previous button to go back to the previous page. ▪ User will be able to view results by clicking on any of the fields displayed (MAC, Jurisdiction, MAC Call Reference ID, QAM Name/ID, QM Start Date/Time, Scorecard Type, Status and Actions). User can also search field via the Search box. ▪ The system allows user to see the number of entries that was filtered at the bottom left of the page. Help Guide Version 1.0 10 CRAD Version 1.0 February 2019 _________________________________________________________________________________________________ Figure 3: List of Scorecards 4.2 Add Scorecard To add Scorecards, Users are required to fill the following information ▪ QAM Information Except the Scorecard Type, rest of the fields are not editable. Information is populated automatically. ➢ ➢ ➢ ➢ ▪ ▪ QM Name/QM ID Select Scorecard Type (Scoreable, Non-Scoreable, Does Not Count) Select QM Start Date/Time Select QM End Date/Time QAM Contact Information ➢ Call Monitoring Date ➢ MAC ➢ MAC Jurisdiction ➢ Program Selected: LOB Selected QAM Call and CSR Information ➢ Call Time (The actual time the call was made) ➢ Call Duration (Length of call) ➢ CSR Full Name (The CSR that received the call) ➢ CSR Levels - CSR level 1,2 ➢ Call Language (English or Spanish) ➢ MAC Call Reference ID Help Guide Version 1.0 11 CRAD Version 1.0 February 2019 _________________________________________________________________________________________________ ▪ ▪ ▪ ▪ ▪ ▪ o The CRAD will auto-populate the fields of the MAC Call Reference ID field as users select information needed for this reference number selected o The format for the field is: (JurisdictionCSR1stInitialLastNameYearMonthDay_Time). ➢ Call Category: ➢ Call Sub-Category which differs based on the Call Category selected. Select the Call Subcategory according to the Call category. Knowledge skills ➢ If a User selects “Yes” then the cursor moves to the next question. ➢ If a User selects “No” for Provision of Accurate Information, User will be required to provide Accuracy Call Failure Reason and Accuracy Call Failure Time. ➢ If a User selects “No” for Provision of Complete Information, User will be required to provide Completeness Call Failure Reason and Completeness Call Failure Time. Adherence To Privacy ➢ If a User selects “Yes,” then the cursor moves to the next question. ➢ If a User selects “No” for Adherence To Privacy procedures, User will be required to provide Privacy Call Failure Reason and Privacy Call Failure Time which is available via a dropdown for users to choose from Customer Skills ➢ If a User selects “No” for Customer Skills, User will be required to provide Customer Skills Call Failure Reason and Customer Skills Call Failure Time which is available via a dropdown for users to choose. Call Result ➢ This will be auto generated based on the above selected field User will be required to write Call Failure Reason Comments in the first text box and if needed, additional comments can be added in the second text box. After all these fields have been correctly filled and selected, User will select Save button to save what has been inputted. Select Close button to close the Page. Help Guide Version 1.0 12 CRAD Version 1.0 February 2019 _________________________________________________________________________________________________ Help Guide Version 1.0 13 CRAD Version 1.0 February 2019 _________________________________________________________________________________________________ Figure 4: Save and Update Scorecards 4.3 ▪ ▪ ▪ ▪ ▪ Reports User will be able to generate Scorecard, Compliance or Rebuttal Reports by selecting these fields via dropdowns ➢ MAC ➢ Jurisdiction ➢ Program ➢ PCC/Location ➢ From Date ➢ To Date ➢ Scorecard Radio button ➢ Compliance Radio button ➢ Rebuttal Radio button ➢ Scorecard Type ➢ Call Result After the appropriate fields have been selected, User will select Generate Report to view the Report. User can also select the Reset button to clear field. View contractor Information via the dropdown on the Report Menu, clicking on this dropdown will enable user to either Open, Save or Cancel the document to be opened. This document will be opened in a separate window on the computer. The document can also be saved on the user preferred location on the computer. Help Guide Version 1.0 14 CRAD Version 1.0 February 2019 _________________________________________________________________________________________________ Figure 5: Search Report Screen 4.3.1 ▪ ▪ ▪ ▪ ▪ Report Result Screen Click on back button to return to search report screen page. Results can be downloaded in Excel and PDF format. Results can also be copied from the CRAD. If a user clicks on any of the export options, the system will provide an option to Open, Save or Cancel. Select any of the three options. Help Guide Version 1.0 15 CRAD Version 1.0 February 2019 _________________________________________________________________________________________________ Figure 6: Reports Result Screen 4.3.2 List of Reports 1. Scoreable, Non-Scoreable, Does Not Count Records (Both Pass and Fail) Displays Scoreable, Non-Scoreable and Does Not Count records with both pass and fail status. Generated based on selection criteria and dates. 2. Scoreable, Non-Scoreable, Does Not Count Records (Pass) Displays Scoreable, Non-Scoreable and Does Not Count report with only pass records. Generated based on selection criteria and dates. 3. Scoreable, Non-Scoreable, Does Not Count Records (Fail) Displays Scoreable, Non-Scoreable, Does Not Count report with only fail records. Generated based on selection criteria and dates. 4. Scoreable (Both Pass and Fail Records) Scoreable report with both the pass and fail records. Generated based on selection criteria and dates. 5. Scoreable (Only Pass Records) Scoreable report with only pass records. Generated based on selection criteria and dates. 6. Scoreable (Only Fail Records) Scoreable report with only fail records. Generated based on selection criteria and dates. 7. Non-Scoreable Records Non-Scoreable report with only non-scoreable records. Generated based on selection criteria and dates. 8. Does Not Count Records Does not count type report with only does not count records. Generated based on selection Help Guide Version 1.0 16 CRAD Version 1.0 February 2019 _________________________________________________________________________________________________ criteria and dates. 9. QASP (Both Pass and Fail Records) QASP reports are aggregated Scorecard reports generated for pass and failed statues. User will be able to generate the report based on varied selection criteria’s and dates. 10. Compliance Report (All) Compliance report is generated for CSR Lists. Compliance is flagged to all the MAC’s CSR Lists based on the date uploaded to the CRAD. 11. Non - Compliance Report Non-Compliance report is generated for CSR Lists. Non-Compliance is flagged to all the MAC’s CSR Lists if the MAC uploads CSR Lists to CRAD after 5th day of each month. 12. Rebuttal Report (All) Multiple types of rebuttal reports are generated based on different filter criteria and dates. Completed, Pending and all is one of the filter criteria to generate the report. 13. Rebuttal Category Report Multiple rebuttal category reports are generated based on different filter criteria, dates and categories. 4.4 CSR List CSR Menu allow user to perform the following: ▪ CSR menu option allows Users to ➢ Download the “Sample CSR Template” for uploading the CSR List to CRAD. MAC users should always use the CRAD “Sample CSR Template” for loading the CSR user data. ➢ Upload a new CSR List – CSR information loaded into the CRAD provided template can be uploaded from MAC users computer using “Upload CSR List” button in the CSR List screen. MAC user should upload the CSR List by 5th of each month. ➢ Compliance & Non-Compliance: o Compliance: MAC users who uploaded the data by 5 th of each month are tagged as “compliant” in CRAD database. o Non-Compliance: MAC users who upload the CSR Lists data after 5th or who don’t upload the CSR Lists data for that month are tagged as “non-compliant” in CRAD database. ➢ ‘Keep Current List’ checkbox: If the CSR List doesn’t change from last month, MAC users can select “Keep Current List” to notify CRAD to add the last month CSR Lists data to the current month CSR Lists data o Compliance: MAC users who check the “Keep Current List” checkbox by 5 th of each month are tagged as “compliant” in CRAD database. o Non-Compliance: MAC users who don’t check the “Keep Current List” checkbox after 5th are tagged as “non-compliant” in CRAD database. Note: MAC users should either upload the CSR Lists to the CRAD or select “Keep Current List” check box to be compliant with QAM policies. Help Guide Version 1.0 17 CRAD Version 1.0 February 2019 _________________________________________________________________________________________________ ▪ The CSR List Template is as follows: Figure 7: CSR List Template ▪ ▪ ▪ ▪ Select Download Sample CSR Template to download and view CSR List template or to save a copy of the template on your computer To upload a new CSR List, click on the Browse button and it will take User to the actual location where documents are saved. User can select the folder that contains the CSR List to be uploaded. See Fig:8 below The system will ask if User really wants to keep current list by a pop-up confirmation tab. See Fig:9 below Selects the file to be uploaded. See Figure:8 below Figure 8: CSR List 1 Help Guide Version 1.0 18 CRAD Version 1.0 February 2019 _________________________________________________________________________________________________ Figure 9: CSR List 2 ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Select Value for the MAC. Select Value for the Jurisdiction. Select Upload File button. User can search CSR via these filters: o From Date o To Date o MAC o Jurisdiction User can click Search CSR button after entering all the values. User can click Previous and Next to go to the next page or return to the previous page Select Copy button to copy the CSR List already uploaded Select CSV button to view and save in CSV format Select Excel button to view and save in Excel format Select PDF button to view and save in PDF format Select Print to print the list Help Guide Version 1.0 19 CRAD Version 1.0 February 2019 _________________________________________________________________________________________________ Figure 10: CSR List 3 4.5 Rebuttal List ▪ List of Rebuttals ➢ Select Values from the MAC field. ➢ Jurisdiction which is based on the MAC already selected. ➢ Select From Date and To Date. ➢ Click Filter to search the list of Rebuttals. ➢ Click Reset to clear all fields. ➢ Click Add Rebuttals to add new Rebuttal. ▪ The Rebuttal page shows the list of Rebuttals that has been generated. Rebuttal List columns displays: ➢ MAC ➢ MAC Call Reference ID ➢ QM Name/ID ➢ PCC / Location: The RAD shall display the PCC Name identified when Rebuttal created ➢ Date Posted: The RAD shall display the Timestamp for when the Rebuttal was saved to the RAD ➢ Response Time: Business days elapsed between Date Posted and most current update to Rebuttal. ➢ Reporting Month (Monitoring Period for Failed Scorecard) ➢ Status: The RAD shall display the status of the Rebuttal as follows: o Pending o Completed ➢ Result: The RAD shall display the current result of the Rebuttal as follows: o Pending Help Guide Version 1.0 20 CRAD Version 1.0 February 2019 _________________________________________________________________________________________________ ➢ ➢ ➢ ➢ o Scoring Modified o Scoring Unchanged o CMS Elevated Actions o View o Edit Select Copy button to copy and paste the current displayed page. Select Excel button to view and save in Excel format. Select PDF button to view and save in PDF format. Figure 11: List of Rebuttals ▪ Select Add Rebuttal to add new Rebuttal ➢ Select MAC Call Reference ID and the following fields will be populated o CSR Full Name o Call Time o Call Monitoring Date o Call Category o LOB o QM Name/ID ➢ Select PCC/Location ➢ Select PCC Contact Person ▪ Select the Attachments checkbox to verify that PHI/PII information is not included in the attachment before uploading. ▪ To upload a document to the Rebuttal form, click on the Browse button and it will take User to the actual location where documents are saved. From here, select the folder that contains the attachment to be uploaded. Help Guide Version 1.0 21 CRAD Version 1.0 February 2019 _________________________________________________________________________________________________ Figure 12: Save/Update Rebuttal ▪ Select Save button to save what has been inputted and select Close button to close the Page. ▪ When the Rebuttal is created and saved, the system takes user to List of Rebuttals page. See fig:11. 4.6 ▪ 4.6.1 ▪ ▪ User Management When a User clicks on User Management button, it shows a dropdown that displays ➢ Create Users ➢ List of Users Create Users To create new User, click on Create Users and fill the following fields ➢ Username / Email Address ➢ Password ➢ Confirm your password ➢ First Name ➢ Middle Name ➢ Last Name ➢ Organization ➢ Role If MAC is selected as an Organization, additional fields will be required ➢ MAC ➢ Jurisdiction ➢ PCC/ Location Help Guide Version 1.0 22 CRAD Version 1.0 February 2019 _________________________________________________________________________________________________ ▪ ▪ Select Create to create user Select Close to close the page Figure 13: Create User 4.6.2 ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ List of users The CRAD updates the List of Users when new Users are entered/created. View Users by clicking on List of Users button. Search for a specific User by the Last Name or Role or Organization. Click Search to get the list of users. Click Add User, to create User. Double click on Active or Inactive under User Access to make a user ‘Inactive’ or ‘Active’. The CRAD shall automatically change Users status from Active to Inactive after 60 days of inactivity. The CRAD shall not allow deletion of users saved to CRAD but the users will be archived after 6 months of inactivity. Help Guide Version 1.0 23 CRAD Version 1.0 February 2019 _________________________________________________________________________________________________ Figure 14: List of Users 4.7 My Account This page shows the user’s account information in the following order ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ User name / Email Address Change Password First Name Middle Name Last Name Organization Role MAC Jurisdiction PCC/Location Help Guide Version 1.0 24 CRAD Version 1.0 February 2019 _________________________________________________________________________________________________ Figure 15: My Account 4.8 Support All inquiries should be forwarded to qamadmin@archsystemsinc.com. We will get back to you in a timely manner. Help Guide Version 1.0 25 CRAD Version 1.0 February 2019 _________________________________________________________________________________________________ Appendix A: Acronyms Table 2: Acronyms Acronym Literal Translation Definition CMS Centers for Medicare and Medicaid Services CMS is a Federal agency within the United States Department of Health and Human Services that administers the Medicare program and works in partnership with state governments to administer Medicaid, the State Children’s Health Insurance Program, and health insurance portability standards. PDF Portable Document Format A file format used to represent documents in a manner independent of application software, hardware, and operating system. MAC Medicare Administrative Contractor A Medicare Administrative Contractor (MAC) is a private health care insurer that has been awarded a geographic jurisdiction to process Medicare Part A and Part B (A/B) medical claims or Durable Medical Equipment (DME) claims for Medicare Fee-ForService (FFS) beneficiaries. CMS relies on a network of MACs to serve as the primary operational contact between the Medicare FFS program and the health care providers enrolled in the program. MACs are multi-state, regional contractors responsible for administering both Medicare Part A and Medicare Part B claims. Help Guide Version 1.0 26 CRAD Version 1.0
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