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UF Health University of Florida
Office of Research College of Medicine
Clinical Research Hub Overview

R99 Tracking Log (legacy)

Purpose

  • This log only applies to legacy clincial research studies that are NOT tracking visits in OnCore.
  • The tracking log is used to identify and monitor the occurrence and payment data for all study-funded UF Health services in legacy studies.

Instructions

Row 1 – Study Title

  • Enter the title of the research study. This should match the proposal and IRB title.

Row 2 – Column C – Study Short Name

  • Enter the study’s short name as listed on the OCR submission.

Row 2 Column F – Subject Injury Terms

  • Enter the subject injury terms as outlined in the Informed Consent section labeled “What if you are injured because of the research study?”. This should match the terms that were given to the PI via the OCR Financial Language Assessment (FLA).

Row 3 Column C – P.I. Name

  • Enter the full name of the Principal Investigator.

Row 4 Column C – IRB #

  • Enter the IRB number for this study.

Row 5 Column C – R99 #

  • Enter the R99 number assigned to the study or N/A if there is not an R99 number.

Row 6 Column C – OCR/Proposal #

  • Enter the OCR log number (or proposal number).

Row 7 Column C – Project #

  • Enter the Project number from which the study-funded services should be paid.

Row 8 – Reminder

  • This line is used by the Research Administration and Compliance Office to provide a link to important policy information.

Row 9 – Column Sections

Row 9 Column L – Shands Hospital Account #

  • Enter the Shands Hospital Account number as it appears at the top of this study’s statement. Note: As of 12/08/14, there will only be one Shands account number for the life of the study.

Row 9 Column R – UFHP  Account #

  • Enter the UFHP Account number as it appears at the top of this study’s statement. Note: As of 12/08/14, there will only be one UFHP account number for the life of the study.

Row 10 – Header Row

  • Last Name: This is the last name of the study participant.
  • First Name: This is the first name of the study participant.
  • Participant Study ID (alias):  (optional) This is an alias number used to track participants within a study.
  • DOB: This is the study participant’s date of birth.
  • Medical Record #: This is the patient’s medical record number used by UF /Shands Health system to identify a patient.
  • Service Location: This is the name of the location where the study service is to be (or was) conducted (e.g. “Shands BMT Clinic”, “Quest Lab”, “UF CRC”)
  • CPT Code: This is the expected CPT Code(s) for a service. Refer to final technical and professional pricing sheets and the final billing grid to capture all applicable CPT codes for a listed service.
  • EAP Code: Enter the expected EAP Code(s) for the service. Refer to final technical pricing sheets and the final billing grid to capture all applicable EAP codes for a listed service.
  • Service Name: This is the name or a description of the study service being tracked.
  • Service Timepoint on Billing Grid: This is the description of the study service timepoint as referenced as listed on the billing grid. (e.g. “screening”, Visit 3”, “day 24”).
  • Service Date: This is the study visit date or the date the study service was performed.
  • Research Rate Estimate (technical fees): This is the estimated Research Rate for the technical charge for this study service as provided by Shands on the final Technical Pricing sheet. For other vendors (e.g. Quest Lab), use the negotiated research price provided to you by that vendor.
  • Statement Date (technical fees):  This is the date on a statement received from the Research Billing Office or an outside vendor for technical charges.
  • Statement Print ID (technical fees):  This is the unique statement identifier from the top of the statement received from the Research Billing Office or an outside vendor for technical charges.
  • Amount Paid (technical fees): This is the amount paid for the technical portion of a study service.
  • Date Paid (technical fees): This is the date that the payment voucher is created in PeopleSoft or a P-card payment is made for this technical charge.
  • Voucher # (technical fees): This is the payment voucher number as assigned in PeopleSoft for payment of a technical fee invoice. If a P-card is used for payment, the voucher number used to pay the P-card charges should be entered.
  • Research Rate Estimate (professional fees): This is the estimated Research Rate for the professional charge for this study service as provided by UFHP on the final Professional Pricing sheet. For other vendors (e.g. Quest Lab), use the negotiated research price provided to you by that vendor.
  • Statement Date (professional fees):  This is the date on a statement received from the Research Billing Office or an outside vendor for professional charges.
  • Statement Print ID (professional fees):  This is the unique statement identifier from the top of the professional fee statement received from the Research Billing Office or an outside vendor for technical charges.
  • Amount Paid (professional fees): This is the amount paid for the professional portion of a study service.
  • Date Paid (professional fees): This is the date that the payment voucher is created in PeopleSoft or a P-card payment is made for this professional charge.
  • Voucher # (professional fees): This is the payment voucher number as assigned in PeopleSoft for payment of a professional fee invoice. If a P-card is used for payment, the voucher number used to pay the P-card charges should be entered.
  • Verified No Pro Fee for Simple Labs or No Reads: Enter date that the tracking team was able to verify that no UFHP professional fees were accidently generated for simple, machine read Shands labs (pro fee should be waived), or for a service that will be ordered with a reading exception (“No Read” by the service provider is needed.) “No Reads” should be indicated on the final billing grid.

Comments/Notes: (optional) This column may be used to provide any additional information for explanation or documentation purposes.

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