Troubleshooting Resolving Ruleset Issues Impacting Visit Verification/Electronic Visit Verification

Issue:

Visit Verification rulesets are not applying correctly, resulting in incorrect reason codes or errors such as overlapping shifts or incorrect clock-out statuses.

Solution:

1. Verify ruleset activation

Ensure that the ruleset is activated and that its effective date is set correctly. Check the ruleset settings in your system to confirm that the correct version is active. Note that changes to rulesets may take up to 24 hours to become effective.

2. Run a verification test

Test the Visit Verification process with a problematic visit ID to confirm that the correct ruleset is applied. Ensure that the visit ID and other details match the expected ruleset criteria.

3. Check for errors

Review the verification results to identify any discrepancies or errors, such as incorrect reason codes or overlapping shifts. Ensure that the results align with the ruleset criteria.

4. Create a new ruleset

If the issue persists, create a new ruleset and link it to the relevant funder. Note that creating a new ruleset will not apply to past visits but will be effective for future visits. It may take up to 24 hours for the new ruleset to become effective.

5. Address past visit issues

If the issue involves past visits, be aware that they will use the ruleset active at the time of the visit's start date. Creating a new ruleset will not affect past visits but will be used for new ones.

For more detailed guidance, please review the following article: How do I create rule sets and link them to service codes, payors and branches?