User Manual CRAD Help Guide 022019 V2

User Manual:

Open the PDF directly: View PDF PDF.
Page Count: 26

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
UM Version 1.0
ii
CRAD
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 10: CSR List 3 .................................................................................................... 20
CMS XLC
Table of Contents
UM Version 1.0
ii
CRAD
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
4
CRAD Version 1.0
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.
5
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).
6
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.
Internet Explorer, version 8.0 or higher
2.
Chrome
3.2 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.
Table 1 - User /Role Accesses
No
User/Role
Accesses
1
Administrator
Home, Scorecard, Reports, CSR, Rebuttals, User Management, My Account,
Resources
2
Quality Manager
Home, Scorecard, Reports, Rebuttals, My Account, Resources
3
CMS User
Home, Reports, CSR, Rebuttals, My Account, Resources
4
MAC
Administrator
Home, Scorecard, CSR, Rebuttals, User Management, My Account, Resources
5
Quality Monitor
Home, Scorecard, My Account, Resources
6
MAC User
Home, Scorecard, CSR, Rebuttals, My Account, Resources
3.3 Accessing the System
3.3.1
Login
▪ Users will login with a unique username and password created by the System Administrator.
▪ The Login page displays information about the system.
7
CRAD Version 1.0
February 2019
_________________________________________________________________________________________________
Figure 1: Welcome Screen
8
CRAD Version 1.0
February 2019
_________________________________________________________________________________________________
3.3.2
Description of the Home Page After Login
The Home Page displays the following
Figure 2: Home Page
9
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.
10
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.
11
CRAD Version 1.0
February 2019
_________________________________________________________________________________________________
4.2 Add Scorecard
Figure 3: List of Scorecards
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
12
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 Sub-
category 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.
13
CRAD Version 1.0
February 2019
_________________________________________________________________________________________________
14
CRAD Version 1.0
February 2019
_________________________________________________________________________________________________
4.3 Reports
Figure 4: Save and Update Scorecards
▪ 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.
15
CRAD Version 1.0
February 2019
_________________________________________________________________________________________________
4.3.1
Report Result Screen
Figure 5: Search Report 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.
16
CRAD Version 1.0
February 2019
_________________________________________________________________________________________________
4.3.2
List of Reports
Figure 6: Reports Result Screen
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
17
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 5th 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 5th 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.
18
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
19
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
20
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
21
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.
22
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 User Management
▪ When a User clicks on User Management button, it shows a dropdown that displays
➢ Create Users
➢ List of Users
4.6.1
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
23
CRAD Version 1.0
February 2019
_________________________________________________________________________________________________
▪ Select Create to create user
▪ Select Close to close the page
4.6.2
List of users
Figure 13: Create User
▪ 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.
24
CRAD Version 1.0
February 2019
_________________________________________________________________________________________________
4.7 My Account
Figure 14: List of Users
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
25
CRAD Version 1.0
February 2019
_________________________________________________________________________________________________
4.8 Support
Figure 15: My Account
All inquiries should be forwarded to qamadmin@archsystemsinc.com. We will get back to you
in a timely manner.
26
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-For-
Service (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.

Navigation menu