Knowledge Base

A prospective coding review process is intended to help clinicians prepare for upcoming patient encounters. The Curitics prospective review workflow enables coders to evaluate the member’s HCC code history, prescription drugs, hospital records, lab results, and physician notes.

Prospective Review Queue

• The prospective review queue functions very similarly to the “project-based” view of the member roster. The tabular interface will display all members where the coder is associated with the same project. The view includes the following columns:
  • EMPI
  • Member ID
  • First Name
  • Last Name
  • DOB
  • Client(s)
  • Project(s)
  • Prospective Review Status (new)
  • Actions
• The queue provides the ability to search by member first or last name
• The queue contains the following filters
  • Client
  • Project
  • Prospective Review Status
• The actions column contains a button labeled “Begin Review” enabling the user to navigate to the Prospective Coding Record view.

Prospective Review Record

• The prospective review record contains three main panels:
  • Add Additional Dx and Suspects
    • Users have the ability to:
      • Add additional ICD-10
      • Add comments to each code
      • Specify a type for each code
        • Type will be “Suspect” by default
  • Prospective Review Status
    • A panel enabling the user to update the prospective review status. Status options will include:
      • Pending
      • Documentation Added
      • In-Progress
      • Complete
  • Clinical Documentation
    • A panel composed of all relevant data elements within Curitics for the reviewer to access
      • Chronic Conditions (all known chronic conditions for the member)
      • Medication List (all known medications for the member)
      • Health Plan Gaps List (all known gaps for the member)
      • Documents (all documents available for the member with ability to upload additional)

Suspect conditions documented by way of prospective reviews will be made available to clinicians during subsequent encounters.