Contract Manager

Contract Manager

Contract Manager Product Overview 

Contract Manager for claims allows automated data reporting against local contract requirements to make reimbursement claims quick and easy. Your Apex Contract Manager dashboard will be tailored to any locally commissioned services to seamlessly compile reports - all you need to do is review your activity and submit. With inbuilt data quality checks, Apex ensures you maximise your income by highlighting any areas that require review, such as missing coding or incomplete data.   

Key Features

  1. Easy Contract submission. Allows organisations to submit data, whether appointment or clinical entry, based on defined rules – whether local or national contracts – to a commissioning organisation at the click of a button. 
  2. Time-saving automation. Generate claims and invoice for services in a matter of minutes, rather than producing manual reports to support claims.  
  3. Tailored dashboards. We’ll customise them to any locally commissioned services to seamlessly compile reports - all you need to do is review your activity and submit. 
  4. Submission History tab allows you to see what claims have been approved by your ICB. Easily click to create an autocompleted invoice once your submission has been approved. 

Claiming via Contract Manager - Process Overview

  1. Apex receives pseudonomysed data from EMIS/SystmOne to populate the dashboards and reports. EMIS Extract/SystmOne Strategic reporting streams clinical data (including SNOMED coding); Contract Manager is then populated by the data we receive – we advise you allow at least 48 hours for this to run. You can find the date the data is representative from by clicking on the ‘Data Status’ box in the homepage. 
  2. Contract Manager aims to support data quality and allows you to submit your Claims based on activity detected in your clinical system. The requirements for the encounter to be included in the submission are outlined in the Definitions/Rules tab in the menu for each Contract. Consultation templates can be used to ensure the required coding is captured to allow the activity to be eligible for payment under your local LES/DES contract specifications.
  3. Throughout the month, it is advised that you check in on your current period activity in the ‘Monitoring’ tab. This will allow you to keep track of instances where activity is not coded in line with the requirements for claiming. The Results Drilldown will detail encounters both included as well as those that do not meet the contract requirements for payment.
  4. After the end of month, when the data has uploaded to show complete data, use the ‘Submissions' tab to review the complete activity breakdown in the Results Drilldown and any Potential Data Quality Issues. You can click on the downward arrow on the yellow ‘Data Quality’ bar to look at activity in detail. You may also choose to utilise the Code Analysis report to look at coding trends and figures.
  5. Once you have made your submission, you can view it in Submission History. Your ICB will review your claims after submission for approval. If a claim is declined, an explanation will be provided and the submission will be pushed back to you to review and resubmit. Once your submission is approved, the invoice can be processed as per local contract specifics. You can view previous claims and their status in the ‘Submission History’ tab.

Improving Data Quality for Submissions

If you find that activity has not been coded in line with contract specifications, you will need to amend the encounter to add the required coding. 

For the correct code set, please refer to the Definitions/Rules tab in Contract Manager. After making any changes in the clinical system, please allow 48 hours for the data to be representative. The last date that data was received will be shown in the ‘Data Status’ box on the homepage. 

Making a Submission 

After the end of month, use the ‘Submissions’ tab to review the complete activity breakdown and any Potential Data Quality Issues.

The Definitions/Rules tab will provide a breakdown of requirements for the encounter in EMIS/SystmOne to be detected by Apex and included in the Submissions. The specific SNOMED coding required will also be available for each contract in this tab. 
You may also choose to utilise the Code Analysis report to look at coding trends and figures. When all data quality issues have been addressed and you are happy that the figures shown represent activity complete, press Submit. 

Final Submission Checks 
Are you happy with the total figures shown in the ‘Make a Submission’ tab? 
Click Submit!
View your previous Submissions in the ‘Submission History’ tab.
Await Approval 
Wait for the Submission to be approved.  If a claim is declined, an explanation will be provided.

The Code Analysis Report 

The Code Analysis Report can be found in the Productivity & QI module in the main Apex menu on the left. This allows you to access a broad range of analytics and context based on coded care record entries, including encounter context, clinician-level utilisation and patient demographics. This may be a useful tool in identifying trends and data quality concerns and can be used to support Contract Manager submissions. 

Begin by clicking a code to analyse. Paste in the SNOMED CT Code as pictured and look up the term. Click ‘Add’. You can add a second code if required and search multiple together. Click ‘Ok’ and a report will be built based on usage of this code.

You can also choose whether you would like to include External data with the toggle at the top, bearing in mind that this activity may not be claimable but may show in EMIS/SystmOne searches. 

You can also click on the Job Category listed to see subgroups and individual session holders. This may help you spot if some are using an irrelevant template/forgetting to include the relevant coding. 

FAQs

How do I view activity for the current month? 
      This can be found by navigating to the ‘Monitoring’ tab.

How do I add new users/review user access?
      Navigate to Settings in the left-hand menu and into Users & Policy. Contact support if you have any issues with logging in.

When do I need to submit?
      Your ICB will confirm the expected timeline for submission, approval and payment. 

How often does Apex update? 
      Apex receives overnight imports from your clinical system. We advise allowing 48 hours for your changes in EMIS/SystmOne to be represented within Apex. 

My changes in EMIS/SystmOne haven’t uploaded in Apex – what should I do? 
      Ensure that Apex has had time to upload before checking for your changes. If the data has streamed and your changes are still not represented, contact Apex Support. 

Can I use searches in EMIS/SystmOne to find patients?
      Yes – but these should be used with caution as they do not filter out some forms of activity that are not claimable, such as external data. 

How do I reset my password?
      Click here to reset your password. If you have requested this and not received a password reset email (after checking junk folder), please contact Apex Support. 

What training is available? 
      Contact Apex Support if you would like further guidance on any aspect of the Apex system. If required, we can look into arranging training to answer queries in further detail. 

I disagree with the figures shown in Apex - what should I do? 
      Many discrepancies can be solved independently, with the steps below:
Go to the Source 
Review your data quality issues in EMIS/SystmOne as these cannot be edited from within Apex.

Check the Definitions/Rules 
The Definitions/Rules tab will provide a breakdown of requirements for the encounter in EMIS/SystmOne to be detected by Apex and included in the Submissions. 
Look for Trends in Data Quality
Utilise the Code Analysis report to ensure the correct codes are being used within a consultation. 

Contact Support 
When the above has been checked, contact The Apex Support Team by opening a ticket here. 

Please ensure all screenshots that are shared with Edenbridge Apex do not include patient identifiable data. 

Getting Apex Software? What to Expect...
Clinical and Consultation Data | Patient Interaction


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