The Work Queue Home Screen

Image 1

About Work Queue

The work queue is primarily used as a workflow management tool to follow up on claims and charges. The work queue has charges and claims categorized according to different Key performance indicators(KPIs) defined by the practice.
The workflow management in the Work Queue can be either manual or automated.
In manual mode, claims arriving in the Work Queue are manually assigned to another user. In automated mode, the claims are categorized and pre-assigned to different user teams according to different rules set by the practice. This is achieved through our newly introduced RCM workflow configuration. (To learn more on RCM Workflow configuration and its benefits, click here.)

Workflow inside the Work Queue

1. The hierarchical display of claims in the left pane of the Work Queue is as follows: Priority → Rule → KPI Category → KPI

2. If RCM workflow automation is done, Work Queue will load those claims that have been allocated to the user’s team(s) when the Work Queue opens. A bucket named ‘Unallocated’ will display those claims that does not belong to any rule. In manual mode, when the screen opens up, all unassigned claims will be listed in the unallocated bucket.

3. Click on any KPI on the left pane to list the related claims on the right.

4. Click on a claim/charge to open the Next Action screen to follow up on the claim.

5. Change the Work Queue status from NEW to any other appropriate status. e.g. PENDING. Set the appropriate sub status as well.

6. Work on the claim and enter appropriate follow-up notes, or reassign the claim to another user in the system using the ‘Next Action’ screen.

7. The assignees can see the claims under the appropriate statuses the next time they open the Work Queue.

Key Highlights of our Work Queue Module

A. The enhanced Work Queue screen has a dashboard section for a quick view of the various KPIs and displays the count of items under each KPI on the left pane (Image 1).

B. New work queue statuses can be added from the billing lookup screen.
To add a new status, go to All Lookups->Billing Lookups, select WORKQUEUE_STATUS, click on and enter the required information, and hit save to have the new status added to the list.

C. Collection Manager activity can be tracked from within the Work Queue module without the user having to move out of the Work Queue screen. For this, the Follow-up Hx tab of Collections Manager is brought into the Next Action screen beside the Action Hx tab.

Categories In the Work Queue

Categories in the Work Queue screen are pulled from the H2 Operational (Drill Down) Dashboard setup screen (Image 2). To access the H2 setup, click the icon on the top right part of the H2 report. For each KPI listed in the settings screen, an option  ‘Mark as Work Queue Item’ is provided to pull the KPI into the Work Queue.

Image 2

Some Important Categories in Work Queue
Category Sub Categories Comments
Underpayments    All paid claims where the amount is less than the fee schedule rate. Closed lines that are underpaid are also included
Rank based KPI Priority 1, Priority 2, Priority 3, Priority 4 and Priority 5 For more details, click here
Need More Info Queue Denial codes, No-response categories, etc. Need More Info Queue and all the sub categories are pulled from the Collection Manager
Patient Charges in New Status over 30 days
Patient Collections All lines in Status BILL_TO_PT, BILL_TO_GR and IN_COLLECTION
Denials Subcategories are:

Denials with No Activity Past 4 days

Claims that had been denied more than once

Collection Denials  such as CO-45, CO-225, PR-50, PR-96, etc.

Rejections Payer Rejects
Expirations Claims that are 45 days away from response limit threshold
Statement Patients with balances and no statement sent over 60 days

Table 1

Search Criteria Section

The Work Queue has various search fields that help filter the tasks. Click on button to view all search parameters; refer to Image 3.

The search section also has a CSV export option to export all worklists and their claims. Click here to view fields in the WorkQueue CSV.

Image 3

Search Criteria Description
Queue Status All/NEW/Pending. All items first fall in the NEW status.
Queue Sub Status Drop-down includes values such as Incorrect Patient information, Incorrect Insurance Info, etc.
Agent Name The user who assigns the task.
Assigned To The assignee for the task.
Legal Entity Select a legal entity from the drop-down to display tasks in that LE.
Provider Select a Rendering provider to filter based on the rendering Provider
Payer Type in the first few letters and select an appropriate Payer Name from the drop-down that appears.
Aged between: DOS/LCD/LFD Claims can be filtered according to days from DOS, LCD(Last Claim Date), and Last Follow-up Date.
Date between: DOS/ Claim Date Filter the tasks according to whether their DOS and/or claim date fall in the given date range.
Workqueue Listing

Click on any category on the left pane to list the corresponding items on the right. Image 4 displays the claims related to the Payer Reject category.

Image 4

Patient Name is a hyperlink to the Patient demographics, and DOS is a hyperlink to the Charge Master. Click on any other field to move to the Next Action screen.

Note: The button at the bottom of the main screen (see Image 4) is a convenient way to edit or assign tasks related to multiple items in the work queue list in one go. Check the boxes corresponding to the items required, and then click on button. Changes made would then be reflected in all the selected items. Users can push claims from the WorkQueue screen to the “Need More Info Queue” using the “Next Action” option. These claims will appear in the assignee user’s “Need More Info Queue” in the Interoffice messaging screen. In the Work Queue screen, any assigned claims will also appear in a separate “Need More Info Queue” list.

Next Action Screen

Click anywhere on the claim line (see Image 4) except the patient name and DOS to open the Next Action screen with details of the invoked encounter; see Image 5.

Image 5

The different sections of the Next Action Screen are numbered (as highlighted in Image 5) and explained below.

1. Patient and Claim details:  The header section contains Patient demographics and claim details. The claim# on the header is a hyperlink to the claim form. The header also has some recently added fields, such as the MR# of the patient, tax ID, rendering provider, and service location. The fields in the header have been rearranged.

2. Encounter lines and their details: Encounter line details can be found here.

3. Links: Help in navigating to other pages such as patient demographics, case, insurance, Charge Master, ledger, eligibility, and document management.

4. Claim History and Previous Notes: This section has five tabs: Line Activities, Denial Hx, Action Hx, Follow-Up Hx, and Claim Status Hx.

The line activities tab logs all the line-level activities related to the task.

Denial history provides the details of previous denials (if any) for the task.

Action Hx history provides a history of follow-up activities done on the task.

Follow-Up Hx This is the collection manager’s activity history.

Claim status history provides a history of previous claims generated on the present claim and their details.

5. Action notes and status section: This section lets you update action notes, status, and sub-status. We can also tag status and sub-status for future follow-up. Work queue status and sub status mentioned here are not related to collection status and sub status. Tasks can also be assigned from here by selecting a user from the Assigned To drop-down, the task gets loaded in the ‘Need More Info Queue’ of the recipient’s inbox. If you also need to send an email regarding the work item, check the box Send Email Notification when saving the item.

Each work status can be linked to one or more work queue sub-statuses. Selecting a status in the Work Queue screen will bring up a specific set of sub-statuses preset from the Billing Lookups. To link Work Queue status and sub status, go to Advanced Setup ->All Lookups->Billing Lookups. Select the Work Queue sub-status on the left pane. For each sub-status, choose one or more statuses from the Work Queue Status column, which is a multi-select combo box (see Image 7).

Time Frame for Sub Statuses:

Users can now preset the claims follow-up time frame (days) from the work queue’s sub-status lookup and specify the days for each sub-status. Each sub-status can be linked to a specified follow-up time frame. The claims with the sub-status will reappear only after this time frame. This feature will relieve users from setting reminders individually for each claim.

The sub-status and the time frame can be set up from the Advanced Setup ->All Lookups -> WORKQUEUE_SUBSTATUS. Click on the sub-status that needs to be updated and enter the days to remind in the field, “Reminder Days”. This defaults the reminder days in the work queue for all claims for that sub-status where the days have been preset; however, users can override the days in the work queue screen.