Smart Health中文操作说明书

Smart Edits Frequently asked questionsOverviewSmart Edits is a claims optimization tool that UnitedHealthcare is using in the electronic data interchange (EDI) workflow to detect potential billing errors within a claim. Smart Edits are sent within 24 hours of a claim submission. For more information, visit /smartedits Frequently asked questionsWhat are Smart Edits?Smart Edits are an EDI capability that detects claims with potential errors within electronic claims. Smart Edits send a message back to the submitting care provider to explain why the claim was returned, provide direction on how to resolve and resubmit them via the 277CA clearinghouse rejection report. This is the same process by which Health Insurance Portability and Accountability Act (HIPAA) edit rejections are currently communicated to you.Why is UnitedHealthcare using them?When claims are submitted accurately and in compliance with the latest policies and regulations, it results in less rework and faster payments. Smart Edits are expected to make claims processing more collaborative between UnitedHealthcare and care providers.When did UnitedHealthcare begin using Smart Edits? In September 2017, we began using Smart Edits for 837P (professional claims) for a small number of our commercial plans. Now, Smart Edits are eligible to care providers for all lines of business. Click here to view a list of health plans and their Payer ID.Do I need any special software?No. Smart Edits are delivered using the industry standard 277CA clearinghouse rejection report. The messages are typically mapped from your software vendor so that edit messages appear on the same claim status reports you receive for HIPAA edits. You can always find Smart Edit messages on your raw EDI transaction data. Key pointsSmart Edits is a claims optimization tool to help you catch claims billing errors and correct them before they’re processed.When UnitedHealthcare receives a claim, a Smart Edit message is sent within 24 hours. If the information within your claim triggers a Smart Edit, you will see an edit message on your 277CA clearinghouse rejection report within 24 hours of submitting a claim. Advantages of Smart Edits include:•Easy-to-read alertsusing your existing clearinghouse or practice management system•No special software to download or contracts to sign •Expected to help reduce denied claims and rework for your staff, reduce the potential of medical record requests or future overpayment requests Smart Edits apply to commercial, Medicare Advantage and Medicaid plans with various Payer IDs. Please refer to our Payer ID list found at /smarteditsWhat are the types of Smart Edits, and what do I do with them?There are 4 types of Smart Edits: Return Edits, Rejection Edits, Documentation Edits and Informational Edits. The type of Smart Edit that you receive will define what specific action is needed from you.Return EditsA Return Edit is sent when the claim in question is likely to result in a denial if it continues into the claims processing system. The Return Edit could include a message about clinical code combinations using industry-sourced guidelines. For example, the Centers for Medicare & Medicaid Services’ National Correct Coding Initiatives (NCCI) rules or information about code sets and modifier validation.•What do I do with Return Edits? You can resolve and resubmit the claim within 5 calendar days, before your claim is automatically processed as originally submitted.•Example: “Per NCCI Guidelines, Procedure Code 43249 has an unbundle relationship with Procedure Code 43236. Review documentation to determine if use of a modifier is appropriate.”Rejection EditsA Rejection Edit will be sent when a claim is automatically returned before it’s processed and requires you to resubmit the claim. If no action is taken to correct the claim, it will not enter the UnitedHealthcare claims processing system.•What do I do with Rejection Edits? Resubmit the claim and include the information needed to processyour claim.•Example: “REJECT – CLIA ID XXXXXXXXXX does not meet the certification level for procedure code 87426. Claim has been rejected and will not be processed.”Documentation EditsA Documentation Edit alerts you when a submitted claim requires additional information before processing.This edit will describe what supporting documentation is required and the appropriate format, which you can then submit using TrackIt.•What do I do with Documentation Edits? Review the Smart Edit message to determine what supporting documentation is needed and submit using TrackIt.•Example: “Medical records may be required for procedure code 30465 with modifier AS and can beuploaded to the UnitedHealthcare Provider Portal at . For more information, go to /smartedits.”Informational EditsAn Informational Edit message notifies you of key information in the claim submission process or about upcoming events that require your attention. Informational Edits do not impact the specific claim submitted, as this is a line-level edit.•What do I do with Informational Edits? Please review the additional information to support our common goal of reducing claims errors.•Example: “INFORMATIONAL 96125 is identified as a component of another procedure on the sameservice date, where the use of a modifier is not appropriate. Please refer to National Correct Coding Initiative (NCCI) guidelines.”What is an informational banner?Claims receiving Smart Edits will have an informational banner placed at the claim level. The intent of the banner is to provide resources for further information on Smart Edits and the associated policies.If I received multiple reasons in a Smart Edit message that a claim contains errors, and I only correct one of them, what happens?One claim can result in multiple Smart Edits. In this case, the claim will be returned once but with multiple edits.If you have 2 Smart Edits on 1 claim, they will both be viewable on your 277CA clearinghouse rejection report.If you correct only 1, the claim will be returned again when you resubmit because you didn’t address the second edit. If you don’t address both edits within the claim, your claim will be returned for a second time. Please be aware that timely filing doesn’t reset on claims returned multiple t imes.Where can I get additional information about the Smart Edit messages?To see the list of active Smart Edits messages, go to /smartedits.S elect “Smart Edits Guide”under Resources.How much information is included in a Smart Edit message?Smart Edit messages communicate the specific problem that triggered the edit and suggest an action to fix the problem. For more detailed information, visit the Smart Edits Guide under Resources at/smartedits.What will UnitedHealthcare do to support practices who receive a higher number of Smart Edits?UnitedHealthcare will reach out to care providers more heavily impacted by Smart Edits. We will also provide updates through Network News and /smartedits.If you would like more specialized help with your Smart Edit messages, please coordinate with your UnitedHealthcare advocate or reach out to EDI Support.How will I know whether my claim was accepted or rejected by UnitedHealthcare? Use your 277CA clearinghouse rejection report to determine whether a claim was accepted or rejected.How will Smart Edits affect timely filing if I see an increase of rejections for claims I submit?Timely filing rules will apply, regardless of any front-end editing. Claims must pass Smart Edit requirements before they’re accepted by UnitedHealthcare. This is the same process that occurs today with HIPAA edits. Please review your electronic claim submission reports to prevent timely filing denials resulting from unaddressed claims.If I respond to a Smart Edits message, how does that affect the claim submission deadline?The claim will update the date of submission to when the claim is received by UnitedHealthcare.How do I bypass Smart Edits with lines on claims I know will not be reimbursed by UnitedHealthcare?For lines that are being submitted for relative value unit (RVU) tracking purposes rather than reimbursement, please bill these claim lines at $.03 or less. Lines billed with this amount will bypass Smart Edits.Need help?For more information on Smart Edits, visit /smartedits You can also contact EDI Support online at EDI Transaction Support form, by email at ****************** or by calling 800-842-1109.These Frequently Asked Questions (FAQs) based on accepted coding practices and guidelines as defined in the ICD-10-CM coding book and the Official Guidelines for Coding and Reporting (the “Code Book and Official Guidelines”). This information in these FAQs is to be used for informational purposes only and was current at the time it was written; however, the Code Book and Official Guidelines are the authoritative reference for accurate and complete coding. Remaining current with respect to the updates and changes to the Code Book and Official Guidelines is the sole responsibility of the healthcare provider.Enhanced precision and accuracy in the codes selected is the ultimate goal of the Smart Edits tool. The physician or other health care provider must submit adequate documentation to ensure that the claims are supported as billed. Documentation should include, for example, the presenting complaint, pertinent facts, findings and observations, history of past and present illnesses or conditions, examination or test results, treatment plans and outcomes. If the documentation in the medical record does not support a given code, a claim payment may be delayed or denied.”These FAQs contain proprietary information of United Healthcare Services, Inc. Altering, re-branding, public posting, re-publication or recording of these FAQs in any manner is prohibited without the prior written approval of United Healthcare Services.Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Health plan coverage provided by UnitedHealthcare of Arizona, Inc., UHC of California DBA UnitedHealthcare of California, UnitedHealthcare of Colorado, Inc., UnitedHealthcare of the Mid-Atlantic, Inc., MAMSI Life and Health Insurance Company, UnitedHealthcare of New York, Inc.,。

智能医疗系统操作手册第一章概述 (4)1.1 系统简介 (4)1.2 功能特点 (4)1.2.1 人工智能诊断 (4)1.2.2 病历管理 (4)1.2.3 个性化治疗方案推荐 (4)1.2.4 药物管理 (4)1.2.5 在线咨询 (4)1.2.6 数据分析 (4)1.2.7 信息安全 (4)1.2.8 多终端支持 (5)第二章系统安装与配置 (5)2.1 系统安装 (5)2.1.1 安装准备 (5)2.1.2 安装步骤 (5)2.2 系统配置 (5)2.2.1 基本配置 (5)2.2.2 网络配置 (5)2.2.3 硬件配置 (6)2.3 系统升级 (6)2.3.1 升级准备 (6)2.3.2 升级步骤 (6)2.3.3 升级注意事项 (6)第三章用户管理 (6)3.1 用户注册 (6)3.1.1 注册流程 (6)3.1.2 注册注意事项 (7)3.2 用户登录 (7)3.2.1 登录流程 (7)3.2.2 登录注意事项 (7)3.3 用户权限设置 (7)3.3.1 权限设置原则 (7)3.3.2 权限设置流程 (7)3.3.3 权限设置注意事项 (8)第四章患者信息管理 (8)4.1 患者信息录入 (8)4.1.1 录入界面 (8)4.1.2 录入内容 (8)4.1.3 录入操作 (8)4.2 患者信息查询 (8)4.2.1 查询界面 (8)4.3 患者信息修改 (9)4.3.1 修改界面 (9)4.3.2 修改操作 (9)第五章病历管理 (9)5.1 病历创建 (9)5.1.1 操作流程 (9)5.1.2 注意事项 (10)5.2 病历查询 (10)5.2.1 操作流程 (10)5.2.2 注意事项 (10)5.3 病历修改 (10)5.3.1 操作流程 (10)5.3.2 注意事项 (10)第六章检查项目管理 (10)6.1 检查项目录入 (10)6.1.1 用户登录智能医疗系统后，左侧菜单栏中的“检查项目管理”选项，进入检查项目管理界面。

智能健康管理系统操作手册第1章系统概述与安装 (3)1.1 系统简介 (3)1.2 系统安装与配置 (4)1.3 系统登录与退出 (4)第2章用户界面与基本操作 (5)2.1 界面布局 (5)2.2 基本操作指南 (5)2.2.1 登录与注册 (5)2.2.2 数据录入 (5)2.2.3 健康报告 (5)2.2.4 系统设置 (5)2.3 个性化设置 (5)第3章健康数据录入 (6)3.1 个人信息管理 (6)3.1.1 登录系统 (6)3.1.2 完善个人信息 (6)3.1.3 修改个人信息 (6)3.2 体征数据录入 (6)3.2.1 血压数据录入 (6)3.2.2 血糖数据录入 (6)3.2.3 心率数据录入 (7)3.3 运动数据录入 (7)3.3.1 添加运动记录 (7)3.3.2 查看运动历史 (7)3.4 饮食数据录入 (7)3.4.1 添加饮食记录 (7)3.4.2 查看饮食历史 (7)第4章数据分析与报告 (7)4.1 数据展示 (7)4.1.1 健康数据总览 (8)4.1.2 健康数据趋势 (8)4.1.3 数据对比分析 (8)4.2 健康状况分析 (8)4.2.1 健康风险评估 (8)4.2.2 健康指标分析 (8)4.2.3 生活习惯建议 (8)4.3 健康报告与导出 (8)4.3.1 健康报告 (8)4.3.2 报告导出 (8)4.3.3 报告分享 (9)第5章健康计划与目标设定 (9)5.1.1 确定个人健康状况 (9)5.1.2 设定具体、可衡量、可达成、相关性强、时限性的健康目标（SMART原则） (9)5.1.3 目标分类 (9)5.2 运动计划制定 (9)5.2.1 选择合适的运动类型 (9)5.2.2 设定运动频率和时长 (9)5.2.3 制定运动计划 (9)5.3 饮食计划制定 (9)5.3.1 计算每日热量需求 (9)5.3.2 平衡膳食结构 (9)5.3.3 制定饮食计划 (10)5.4 健康计划跟踪与调整 (10)5.4.1 定期记录和评估 (10)5.4.2 根据进展调整计划 (10)5.4.3 保持持续性和耐心 (10)第6章智能提醒与通知 (10)6.1 服药提醒 (10)6.1.1 功能介绍 (10)6.1.2 操作步骤 (10)6.2 运动提醒 (10)6.2.1 功能介绍 (10)6.2.2 操作步骤 (10)6.3 饮食提醒 (10)6.3.1 功能介绍 (11)6.3.2 操作步骤 (11)6.4 健康通知设置 (11)6.4.1 功能介绍 (11)6.4.2 操作步骤 (11)6.4.3 注意事项 (11)第7章健康知识与资讯 (11)7.1 健康知识库 (11)7.1.1 知识库概述 (11)7.1.2 知识库分类 (11)7.1.3 知识库使用 (12)7.2 健康资讯订阅 (12)7.2.1 订阅功能 (12)7.2.2 订阅分类 (12)7.2.3 订阅管理 (12)7.3 健康问答与互动 (12)7.3.1 问答功能 (12)7.3.2 问答分类 (12)7.3.3 互动交流 (13)第8章亲友管理与互动 (13)8.1.1 添加亲友信息 (13)8.1.2 编辑亲友信息 (13)8.1.3 删除亲友信息 (13)8.2 亲友健康数据查看 (14)8.2.1 查看亲友健康数据 (14)8.3 亲友健康提醒与关爱 (14)8.3.1 设置亲友健康提醒 (14)第9章数据安全与隐私保护 (14)9.1 数据安全策略 (14)9.1.1 数据加密 (14)9.1.2 数据备份 (14)9.1.3 防火墙与入侵检测 (14)9.2 隐私保护措施 (15)9.2.1 数据脱敏 (15)9.2.2 最小权限原则 (15)9.2.3 隐私政策合规性 (15)9.3 用户权限管理 (15)9.3.1 用户角色划分 (15)9.3.2 权限分配与审核 (15)9.3.3 权限变更与回收 (15)9.3.4 权限审计 (15)第10章系统维护与更新 (15)10.1 系统检查与优化 (15)10.1.1 系统自动检查 (15)10.1.2 系统手动检查 (16)10.1.3 系统优化建议 (16)10.2 系统更新与升级 (16)10.2.1 系统自动更新 (16)10.2.2 系统手动更新 (16)10.2.3 系统升级注意事项 (16)10.3 常见问题解答与售后服务 (16)10.3.1 常见问题解答 (16)10.3.2 售后服务 (17)第1章系统概述与安装1.1 系统简介智能健康管理系统是一款集成了现代信息技术、数据采集与分析、健康监测与评估等多功能于一体的健康管理软件。

智慧医疗健康监测设备使用手册第一章智慧医疗健康监测设备概述 (3)1.1 设备简介 (3)1.2 功能特点 (3)1.2.1 实时监测 (3)1.2.2 数据同步 (3)1.2.3 智能提醒 (3)1.2.4 个性化定制 (4)1.2.5 数据存储与云端同步 (4)1.2.6 专业服务 (4)1.2.7 简单易用 (4)1.2.8 安全可靠 (4)第二章设备安装与调试 (4)2.1 安装步骤 (4)2.1.1 开箱检查 (4)2.1.2 设备安装位置 (4)2.1.3 连接电源 (5)2.1.4 安装附件 (5)2.1.5 设备固定 (5)2.2.2 调试方法 (5)2.2.1 设备自检 (5)2.2.2 功能测试 (5)2.2.3 参数设置 (5)2.3 注意事项 (5)2.3.1 设备安装过程中，应保证设备与电源电压相符，避免设备损坏。

(5)2.3.2 设备安装位置应避免阳光直射、潮湿、强电磁干扰等环境，以保证设备正常工作。

(5)2.3.3 设备调试过程中，应按照设备使用说明进行操作，避免误操作导致设备损坏。

52.3.4 设备使用过程中，应定期检查设备运行状态，及时处理设备故障。

(5)2.3.5 设备维护保养过程中，应使用专业工具，避免损坏设备。

(6)第三章设备操作指南 (6)3.1 开机与关机 (6)3.1.1 开机操作 (6)3.1.2 关机操作 (6)3.2 主界面操作 (6)3.2.1 主界面布局 (6)3.2.2 主界面操作指南 (6)3.3 功能模块使用 (6)3.3.1 患者信息模块 (6)3.3.2 监测数据模块 (7)3.3.3 报警提示模块 (7)3.3.4 设置模块 (7)第四章心电监测 (7)4.1 心电监测原理 (7)4.2 心电监测操作 (7)4.2.1 准备工作 (7)4.2.2 操作步骤 (7)4.3 数据分析与解读 (8)4.3.1 心率 (8)4.3.2 心律 (8)4.3.3 ST段 (8)4.3.4 T波 (8)第五章血压监测 (8)5.1 血压监测原理 (8)5.2 血压监测操作 (9)5.3 数据分析与解读 (9)第六章血氧饱和度监测 (9)6.1 血氧饱和度监测原理 (9)6.2 血氧饱和度监测操作 (10)6.3 数据分析与解读 (10)第七章温度监测 (10)7.1 温度监测原理 (11)7.2 温度监测操作 (11)7.3 数据分析与解读 (11)第八章呼吸监测 (12)8.1 呼吸监测原理 (12)8.1.1 传感器原理 (12)8.1.2 信号处理原理 (12)8.1.3 数据传输原理 (12)8.2 呼吸监测操作 (12)8.2.1 设备准备 (12)8.2.2 设备佩戴 (12)8.2.3 数据监测 (12)8.3 数据分析与解读 (13)8.3.1 呼吸频率分析 (13)8.3.2 呼吸深度分析 (13)8.3.3 呼吸模式分析 (13)8.3.4 呼吸波形分析 (13)8.3.5 数据对比分析 (13)第九章设备维护与保养 (13)9.1 清洁与消毒 (13)9.1.1 清洁 (13)9.1.2 消毒 (13)9.2 定期检查与维护 (14)9.2.1 定期检查 (14)9.2.2 维护 (14)9.3 常见故障处理 (14)9.3.1 设备无法开机 (14)9.3.2 设备显示异常 (14)9.3.3 设备测量数据不准确 (14)第十章安全与隐私 (15)10.1 数据安全 (15)10.1.1 数据加密 (15)10.1.2 数据存储 (15)10.1.3 数据访问权限 (15)10.1.4 数据安全审计 (15)10.2 个人隐私保护 (15)10.2.1 隐私政策 (15)10.2.2 数据脱敏 (15)10.2.3 数据删除 (15)10.3 法律法规遵守 (15)10.3.1 法律法规遵循 (16)10.3.2 用户权益保护 (16)10.3.3 监管部门合规 (16)第一章智慧医疗健康监测设备概述1.1 设备简介智慧医疗健康监测设备是一款集成了现代信息技术、生物医学工程及物联网技术的智能监测系统。