Introduction

The work queue is primarily used as a workflow management tool to follow up on claims and charges. The claims are categorized and assigned to user teams. This assignment can either be manual or automated through RCM workflow configuration (to learn more on RCM Workflow configuration and its benefits, click here)

A. When Work Queue opens, it will load only claims that have been allocated to the user’s team(s).

B. 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.

C. 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.

D. 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.

Image 1

E. 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 info, and hit save to have the new status added to the list.

Categories In 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. The H2 Report setup 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 and items for that category will automatically fall into the user’s worklist or ownership, and the users can view their tasks when they open 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 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
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.

WorkQueue 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 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 show up in the assignee user’s “Need More Info Queue” in the Interoffice messaging screen. In the Work Queue screen, any of the assigned claims will also show up in a separate “Need More Info Queue” list.

Next Action Screen

Click anywhere on the claim line in Image 4 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: Patient demographics and claim details can be found in this section.

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  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.