Cadence: Cadence Enterprise Scheduling makes it easy for users to schedule any

type of visit or procedures from anywhere in your organization. It also enhances

your ability to keep appropriate slots open, take patient preferences into account,
and deliver high-quality service that will distinguish your organization in todays
competitive healthcare marketplace. Cadence serves as an intelligent partner for
users, providing context-specific instructions, conflict checking, and solutions for
complicated appointment searches. Comprehensive rules based scheduling features
accommodate the needs of each clinician, room and piece of equipment, optimizing
the use of staff and capital resources throughout your organization.
ADT/Prelude: ADT/Prelude Enterprise Inpatient Registration improves bad utilization
and gives users the tools to manage hospital stays from pre-admission through
discharge. Clinicians can access an efficient census workspace that allows them to
view and update current information on patients in their care. Flexible work queues
help nurses and other staff members plan for upcoming ADT events (AdmissionDischarge-transfer), follow up on missing or inconsistent data, and assess
utilizations.
1) we tested bed management for inpatient.
2)we tested scenarios on Admission, discharge, transfer of patients.
3)Tested scenarios on outpatient being admitted as inpatient.
4)Tested scenarios on patient transferred from ED(emergency department ) to
Inpatient.
5)Inpatient transfered from one hospital location to another hospital location)
Epic has different modules
1)
2)
3)
4)
5)

cadencescheduling process, check- in and check-out.

Chronicle--- epics back-end --- data base.
ADT(admission, discharge, transfer) for In-patiant.
Resolute-- billing(hospital and professional)
Ambulatory-epic careused for outpatient.

Resolute contains two modules

1) hospital billing
2)professional billing
Resolute Hospital Billing. This includes:
Maintaining Hospital Accounts
Combining and Uncombining Hospital Accounts

Guarantor and Patient Inquiry

Editing Claims

Resolute Professional Billing. These include:

Writing off the self-pay balance once the insurance has paid its specified allowed
amount (a Not-Allowed Adjustment)
Transferring all or part of the balance to from insurance to self-pay
Transferring all or part of the balance from self-pay to insurance
Moving the remaining balance to the next responsible party
Resubmitting a claim to insurance
Writing off the self-pay balance
Writing off the insurance balance
Indicating that an insurance claim has been denied
Turning on or off the automatic self-pay write-off
Closing a claim reconciliation record

1) validated insurance claims and self pay claims.

2) Validated 837 and 835 claims using professional billing.
3) Worked on different interfaces in professional billing , interfaces like
a)

Statement Processing

b) Charge Review
c) Transaction enquiry
d) Account work queue
e) Self payment posting

You can see the interface in bellow diagram. -> arrow shoes interfaces.

4) Worked on different interfaces in Hospital billing , interfaces like

a) Account maintenance
b) Charge entry
c) Bach posting
You can see the interface in bellow diagram. -> arrow shoes interfaces.

Claims account summary:

EPIC Basics
Modules on Epic: Cadence, Resolute, In-Patient (ADT), Our-Patient (Ambulatory),
Prelude, Tapestry, Mychart
Tested Scheduling Activities in Cadence (Eg: Patient Check ins)
Tested Billing info in Resolute
Professional Billing (Out-Patient)
Hospital Billing (In-Patient)
Inpatient:
1) we tested bed management for inpatient.
2)we tested scenarios on Admission, discharge, transfer of patients.
3)Tested scenarios on outpatient being admitted as inpatient.
4)Tested scenarios on patient transferred from ED(emergency department ) to
Inpatient.
5)Inpatient transfered from one hospital location to another hospital location.

Out-Patient:
1)We tested office visits
2)Tested benefits inquiry
3) Tested Order entry scenarios

Prelude: Tested patient demographics, account and coverage info

Hyperspace: Every thing (Every module of Epic) is accessed from Hyperspace

Some general points:

Whenever we do a activity, an encounter is created which triggers HL7 Messages

which we
validate them in Bridges.

Various HL7 Messages: A01 - Admit patient, A02: Discharge patient, A03: Transfer
Patient
A04: Registration of patient, A11: Cancel of checkin, A31-Update registration info

Between EPIC and Ancillary system there will be a middleware (Kaiser used
Integration Broker(IB))
All the transformations and translations are validated in IB.

For eg: A Patient MRN number EPIC generates is "12" digits, but Anxillary system
has
"20 digits. So what the IB does is, it tranforms by adding 8 zeros and sends 20 digits
MRN number to Ancillary systems

Claims: When doing billing, A claim is generated which is 837 and it goes to Clearing
house and it sends back
835 remittance. We validated the 835 remittances in Buckets of Tapestry.

Tapestry: Tested premium billing, Tested capitation payments, Tested claim

accumulations

Mychart: used for reporting (Tested patient history questionnaire, Tested benefit
information feature)

Tested Membership, Provider and Claims applications in health care. Tested the EDI
X12 transactions and tested the mapping and also validated EDI file formats. Tested
the mapping and also validated EDI file formats. Tested membership web portals
and provider web portals.
In Membership application: Tested the functionality of Groups, sub groups,
subscribers, members address, DOB,SSN, eligibility and their association with class,
plan and products.
In Provider Application: Testting the agreement and contracts for professional
providers (Common Practitioners). Hospital providers (Facilities) Ancillary Providers
(Ambulatory/Inpatient Services) and Non-Participant Providers.
In Claims Application : Validation of medical and hospital claims. Loaded claims into
Epic Resolute (/legacy systems (mainframe systems)). Created different claims
based on test conditions. And run the mainframe batch jobs which will process the
claims based on the rules engine. Then we validate claim results(accept/denied)
whether the processed correctly or not).