RCM Workflow Configuration

A user-driven tasking feature is introduced for the revenue cycle management system. Though currently limited to the Collection Manager, this feature will soon be expanded to all important billing modules. The configuration allows the creation of similar functional user groups (known as “Teams”) and the setting up of predefined workflow rules that would essentially drive the provisioning/allocation of a user’s daily tasks /user worklists. The benefits of this new feature are the following:

* Clearly defined work allocation with time expiration based on the configured rules.

* Work automation-   No human intervention is required for the daily provisioning of work.


RCM workflow configuration is set up through Advanced Setup-> Billing Options(see Image 1). Click on ‘Configure’ to move to the Rule setup screen.

Image 1

Rule Listing Screen

On clicking ‘Configure’ in the Billing Options page, the user is taken to the RCM Workflow Configuration screen where all the existing rules are listed. These rules can be edited using icon provided at the right end(Image 2).

Image 2

To view the teams, click on on the top right hand corner in Image 2. Teams Screen opens up where all the teams are listed.

Team Setup Screen

You can add new teams using button. A team should have at least one user.

Image 4

* Note: Functionality related to the fields Esc. Days, supervisor and Administrator will be implemented in future releases.

Rule Creation Screen

To create a rule, click on button on the top-right hand corner of Image 2; The rule creation screen pops up(Image 3).

Image 3

Fields in Rule Set Up Screen

Field Description
Rule Name Name of the Rule; Provide a unique name
Rule Code Unique code for the rule
Teams Select Teams to be part of this rule; This is a multi-select drop-down.
Legal Entity If rule is based on specific LEs, select the LEs. This is a multi-select drop-down  
Provider If rule is based on providers; Select the providers here; This is a multi-select drop-down  
Payer ID Multi-select drop-down; select the payer IDs for the rule
Payer Name Multi-select drop-down; select the payer names for the rule
Payer Type If the rule is to be based on payer types; select them; Multi-select drop-down 
Case Type If the rule is based on case types; select them; Multi-select drop-down 
Denial category If rule is based on certain denial categories, select them
Rank If rule is based on claim rankings; select the required ranks here
Claim Age If rule is based on claim age; select the range here giving the ‘From’ and ‘To’ days
UTL If Untimely Filing Limit is included; provide the range here
Resp. Threshold If response limit threshold is part of the rule, provide the range here
Bill Amount If rule is based on the bill amount, provide the range here

New RCM workflow in Collections Manager:

When a user logs into Collections Manager, the system will load only those claims assigned to the team of which the user is a part of.

Even so, the assigned to Filter will be defaulted to ‘ALL’ in the following scenarios:

a. If the user is not part of any team.

b. If user is assigned a team which is not assigned any Active rules.

c. If the account has not configured the new RCM workflow.

RCM Audit Log

RCM workflow configuration,  Teams set up and adding users to teams are made available for audit and details can be viewed under the following Modules inside Audit Viewer:

RCM Workflow configuration, Teams, Team Users.