The work queue is primarily used as a workflow management tool to assign tasks to users related to the claims/charges or other items in the Work Queue list. These tasks can be monitored and priorities can be set for them. Work queue aids the practice to take corrective action and follow-up on these items.

A. Our enhanced Work queue screen has a dashboard section for quick view of the various KPIs and displays the count of items under each KPI.

B. The dashboard screen will show the categories on the left pane and a pie-chart representation of the categories on the right; see Image 1.

C. When the work queue opens up, it will show the tasks related to the user logged in.

Image 1

Categories In WorkQueue

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 on the top right part of the H2 report. The H2 report Set Up screen can also be used to assign specific items in the Work Queue to users. If a category is assigned to a user, all claims/items for that category will automatically fall into the user’s worklist/ownership and the user can view their tasks when they open the work queue.

Table 1 displays some of the important categories in Work Queue.

Category Sub Categories Comments
Rank based KPI Rank 1, Rank 2, Rank 3, Rank 4 and Rank 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 Claims denied more than once
Rejections Payer Rejects
Expirations Claims that are 45 days away from response limit threshold
Denials Claims denied more than once
Statement Patients with balances and no statement sent over 60 days

Table 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 3.

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 Info, 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 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

Image 4

A. Click on any category on the left and the corresponding items gets listed on the right. Image 4 displays the claims related to the Payer Reject category.

B. Patient Name is a hyperlink that takes us to the Patient Demographics. DOS is a hyperlink that takes us to the Charge Master. Click on any other field takes us to the Next Action screen.

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 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: 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.

Note: The button at the bottom of the main screen is a convenient way to edit/ assign tasks of 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 get reflected in all the selected items. Users can push claims from the WorkQueue screen to “Need More Info Queue” using the “Next Action” option. These claims will show up in the assignee user’s “Need More Info Queue” in InterOffice messaging screen. In the workqueue screen, any of the assigned claims will also show up in a separate “Need More Info Queue” list.