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Run: UDS Patient Count Unduplication Reconciliation Worksheet

Reconcile unduplicated patient counts from EHR, billing, and site rollups in one worksheet before UDS submission. It helps you document the source of truth, ...

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Reconciliation Details

Reporting Period Start Date (required)

Start date for the UDS reporting period.

Reporting Period End Date (required)

End date for the UDS reporting period.

Reporting Cycle (required)

Select the reconciliation cycle.

Reconciliation Owner (required)

Name or team responsible for preparing the reconciliation.

Submission Date (required)

Date the worksheet is completed and submitted.

Source Totals

EHR Unduplicated Patient Count (required)

Aggregate unduplicated patient count from the EHR extract.

Billing Unduplicated Patient Count (required)

Aggregate unduplicated patient count from the billing system.

Multi-site Rollup Count (required)

Combined unduplicated count across all sites before duplicate adjustment.

Primary Source of Truth (required)

Select the source used as the primary reference for reconciliation.

Other Source Name (required)

Specify the alternate source used as the reference.

Duplicate Adjustment Review

Duplicate Adjustment Count (required)

Number of duplicate records removed from the rollup or source total.

Duplicate Driver Types (required)

Select all known causes contributing to duplicate counts.

Other Duplicate Driver (required)

Describe any duplicate driver not listed above.

Variance Reason Summary (required)

Briefly explain why the source totals differ and how the final adjustment was determined.

Final Count and Approval

Final Unduplicated Patient Count (required)

Final reconciled unduplicated patient count to be used for UDS reporting.

Count Verified Against Source Reports (required)

Confirm that the final count was checked against the source reports and supporting documentation.

Yes No N/A

Reviewer Name (required)

Name of the reviewer completing approval.

Review Date (required)

Date the reconciliation was reviewed.

Approval Notes

Optional notes from the reviewer, including any follow-up actions or exceptions.

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