The work queue is primarily used as a workflow management tool to assign tasks to users related to claims/charges belonging to the following main categories. These tasks can be monitored and priorities can be set for them.

In its entirety, Work queue aids the practice to take corrective action and follow-up on claims/charges that fall in the following categories.

1. Payer Rejected Claims

2. Clearinghouse Rejected Claims

3. Claims pushed from Collection Manager- These can include denied claims and no-response claims. They are displayed here under the respective categories as in the Collection Manager.

4. Unbilled Charges- These include charges that are still in the NEW status and not yet billed to any insurance/patient.

5. Unbilled visits- This category includes visits for which charges are yet to be created.

Tasks related to the above categories can be assigned to users and monitored. Image 1 is the work queue home screen.

Image 1

Search Criteria Section

Work queue has various search fields which help to filter the tasks based on the requirements. Click on button to view all search parameters; refer Image 2.

Image 2

Search Criteria Description
Queue Status All/NEW/Pending. All claims first fall in the NEW status.
Queue Sub Status Drop-down includes values such as Incorrect Patient Info, Incorrect Insurance Info, etc.
Agent Name The user who assigns the task.
Assigned To The assignee for the task.
Line Sub Status Current line sub status of the encounter line
Case Type Cash, Work Injury, Auto Injury, Private/Group Health Insurance, etc.
Patient Name of the patient
Show Reminders  Show tasks for which reminders have been set along with the other tasks. 
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 Rendering Provider
Amt > To filter claims with amount more than the specified value
Payer Type in the first few letters and select an appropriate Payer Name from the drop-down that appears.
INS. Level Primary/Secondary/Tertiary
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.

Table 1

Search Result

According to the search criteria provided, the results are displayed as in Image 3.

Image 3

To view the claims in any category, click anywhere on the category line, and the corresponding tasks(claims) are listed as shown in Image 4.

Image 4

Multiple tasks (claims) can be selected in the selected category (through the multi-select option) for adding a work queue note and to record the activity for all the selected tasks; see Image 4.

Assigning Tasks to other users

Click on the button (highlighted in Image 4) to open a popup window to add the information; refer to Image 4a. The info entered in the popup will apply to all the selected tasks.

Image 4a

Senders can push claims to the queue that need to be reviewed by either their supervisor or any other user. The button can also be used to achieve this. Select user from the Assigned To drop-down. The task gets populated in the Need More Info Queue of the assignee as in Image 4b.

Image 4b

The ‘Need more Info Queue’ displays work assigned information such as – Patient Name, Message, DOS, Age since DOS, Last Followup Date and the sender (username). Users receiving the task can hover the mouse over the Message field to view the entire message as a tool-tip or can click the Reply icon to reply to the message.

Reply opens up the Next Action screen to add notes and/or reassign the item. Remind Me in option gives users the ability to temporarily hide the item for a desired period of time. Also, patient documents can be uploaded through the patient’s document management by clicking on the Attach Document link (Image 4c). 

Image 4c

Claims Listing

The Work Queue details include the Claim Status code of the Clearinghouse and Payer as shown in Image 5. The status fields are available for all claims except for the unbilled charges and visits category. Image 5 displays the clearinghouse rejection code of a CH-rejected claim.

Image 5

Next Action Screen

Click anywhere on the claim line to open the encounter line for follow up. Next Action screen will pop up with details of the invoked encounter; see Image 6.

Image 6

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

1. Patient and Claim details: Patient demographics and claim details can be found in this section.

2. Encounter lines and its details: Encounter line details can be found in this section.

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

4. Claim History and previous notes: This section has four tabs- Line activities, Denial Hx, Action Hx, and Claim status Hx. 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. 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. Status and sub status mentioned here are work queue status and sub status and are not related to collection status and sub status. Tasks can also be assigned from here by selecting a user from  Assigned To drop-down; the task gets loaded in the ‘Need More Info Queue’ of the recipient inbox. If you also need to send an email regarding the work item, check the Box Send Email Notification when saving the item.