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Bill audit evaluation

Evaluate audited bill services to determine nurse-review requirements, duplicate/physical-medicine counts, and service date ranges.

Field Value
Operation ID OP-SD-10
Trigger Bill audit workflow evaluates a bill's audited services.
Inputs Bill id, service collection
Outputs bool / int counts / service list
Primary components AuditQueryProvider
Entry point Data/SAIF.Data/Queries/AuditQueryProvider.cs

Steps

  1. IsNurseReviewRequired: returns true if any audited service's service code has IsNurseReviewRequired set (SD-BR-030). Data: CbpAuditedService (CBP_AUDITED_SERVICE), CbpServiceCode (CBP_SERVICE_CODE).
  2. GetNonDuplicateServiceCount: excludes services where OriginalBillCode = "D" (SD-BR-031).
  3. GetServices: a thru-date of DateTime.MinValue is treated as DateTime.MaxValue (SD-BR-032).
  4. GetPhysicalMedicineCount: counts physical-medicine services. Data: CBP_SERVICE_PHYSICAL_MEDICINE.

Process flow

The following diagram visualizes this operation's control flow.

flowchart TD
    Start(["Bill audit workflow evaluates a bill's audited services."]) --> S1["`AuditQueryProvider`"]
    S1 --> S2{"Rules satisfied?"}
    S2 -->|Yes| EndOk([Result returned])
    S2 -->|No| EndErr([Exception / empty result])

Failure and edge-case behavior

  • No audited services: IsNurseReviewRequired returns false.

Sources

  • Data/SAIF.Data/Queries/AuditQueryProvider.cs
  • Data/SAIF.Data/Queries/AuditQueryProvider.cs:34
  • Data/SAIF.Data/Queries/AuditQueryProvider.cs:39
  • Data/SAIF.Data/Queries/AuditQueryProvider.cs:44