Processing Reports

Coding gap processing reports.

Processing reports are made available to the payer 24-48 hours after the receipt of a payer-generated risk coding data file. For each inbound file, a response folder is generated with the following naming convention format: input-file-name_job-id_time-stamp.zip (for example: risk-gaps-inbound-oracle-11070922_32e18382-a020-4cca-aff7-c63a5fc27c35_1762538143510.zip).

Inside each input file folder there are two reports: a success report and a failure report. The success report details risk coding gaps that have been passed validation and submitted to provider workflow.

The error report contains the following details based on the data validations:

• Risk model reference errors: This error occurs during the calculation of risk adjustment scores when a clinical category cannot be mapped to the specified risk model. The system is attempting to process a measure report for a patient, but the provided category ID does not exist in Oracle reference datasets.
• Patient identity ambiguity (multiple matches): This error occurs when a request is made for a specific patient, but the system finds more than one record matching the provided criteria. FHIR operations (such as $evaluate-measure) require a 1:1 match to ensure data integrity. This error typically occurs when two or more patients share the same demographic information (name, DOB, gender).
• Malformed row errors: This error occurs when Oracle attempts to process the payer provided risk coding file and encounters structural inconsistencies. The system is unable to read the data because the physical structure of the file does not match the expected format. This is often a syntax error rather than a data error.

Below are sample error reports:

Figure 2-1 Data syntax error

Figure 2-2 Syntax error