Work Claims Overview

Working on open claims is the most critical step in the revenue cycle. An organization cannot recognize its revenue potential if open claims are not actively worked on. The RCM is built to make this process simple, easy to follow, and effective. Let's review the areas where claims can be worked within the RCM!

User Permissions

Admin-level user profiles can work claims without additional user permissions. Organization Users and Managing Organization Users will require Edit-level permissions under Insurance Claim Access in the user profile. To read more about user types and permissions, click here.

Management Center

The Management Center sorts open claims into two age-based buckets: Claims Follow-Up Overdue and Claims Follow-Up Today. Any open claims with a follow-up date before the present date will fall into the overdue bucket. Clicking either tile will redirect you to the Work Claims section of the Work Center. 

In the Work Center

The Work Center can work on multiple claims for multiple patients simultaneously. It offers 15 filters, 13 columns of information, and 7 actions, allowing users to search, refine, and work on various claims simultaneously. For more information on working claims from the Work Center, click here.

In the Patient Profile

In addition to the Work Center, claims can be worked on individually within the patient's profile. For more information on working claims at the patient level, click here. 

In the Work Claim Screen

The Work Claim screen enables users to manage and review claims on an individual basis. For more information on the Work Claim screen, click here.