Work Center Overview

The Work Center enables you to manage every stage of the billing lifecycle, from verifying benefits and authorizations to submitting claims, following up, and posting payments. Organizations that utilize Patient Billing will also use the Work Center to create patient billables, generate statements, and track failed or expiring credit card payments. 

Work Center Home

The Home tab in the Work Center is used to track assignments, such as claim follow-ups and upload practice-level documents.

• This area will show you a dashboard view of all VOB, U/R, and claims assigned to you. Clicking each tile opens the Work Center location where you can work on these assignments.
• This tab is specific to organizations with Patient Billing enabled and will display the assigned patient billable and statement follow-up tasks.
• A central place to upload all documents related to patients and payments, including EOBs, medical records, authorization letters, payer letters of request, and other general documents. All practices and billing organizations maintain file-sharing relationships and use third-party services to transfer files. This section of the RCM eliminates the need for a third-party service.

VOB

The VOB tab of the Work Center allows you to manage incoming VOBs and eligibility information. Let's review each section together.

• Once a patient's insurance information has been entered, the VOB subsection in the Work Center will begin the service level agreements process. You can filter by Show (VOB assignment), Practice, and Payer name.
  
  There are four different time buckets for the VOBs: 120+ Minutes, 31-120 Minutes, 0-30 Minutes, and Overdue. As time passes, the patients will pass through each of these buckets. The patient will be removed from this queue once a VOB has been marked complete in the Benefits tab.
• The Eligibility Status tab on the Work Center (under VOB and U/R) displays each patient with an active treatment episode. It groups them into three segments: Inactive Coverage, Coverage Needs Review, and Active Coverage based on the latest scheduled batch eligibility check results.
  

Utilization Management

The Utilization Management tab in Work Centers provides a section dedicated to managing utilization reviews at the organization level.

• Utilization plans that need attention can be filtered by one or more of the 8 available options.

  

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  Case Manager: Filter results by the case manager currently assigned to the plan
  Organization/Practice/Facility: Filter and refine results based on the location where the service will be rendered.
  Rendering Provider: Filter results based on the Rendering Provider selected within the plan.
  Insurance Payer: This filter generates results based on the payer referenced in the plan, regardless of primary/secondary/tertiary position.
  Episode U/R Status: Use this filter to refine results based on the current status (or lack thereof) of the patient's utilization plan. Available options include: Active, Expired, Expiring Soon, and No U/R Plan.
  U/R Plan Type: Filters results by the type of plan created. Available options include: Auth Required, Private Pay, and Standalone.

• Users can customize their view of this area using the Sort By drop-down or the View Columns feature.
• After the results have been generated, users can assign multiple U/R plans to the same case management simultaneously, download the results into an Excel document, or remove the entries from the Work Center altogether.
  

Insurance Claims

The Insurance Claims section of the Work Center allows you to create claims, manage rejections and corrections, and submit claims for processing.

• This tab helps organize your claim management workflow and automatically sorts claims by follow-up date
• This is where all treatments submitted from the Attendance Calendar will appear until the claims are created. For additional information on creating new claims, click here.
• The corrections generator is a system task that runs each night automatically and compares submitted claim data with data in the RCM. Any claims with data changes since the original submission will be flagged and placed in this tab for review. For additional information on creating corrections, click here.
• Submit or resubmit claims from this tab. Claims have not been sent to the payer if they are in this section. For additional information about submitting claims, click here. 
• All claims that fail the scrubbing process appear in this tab for review and resubmission. For more information about rejected/held claims, click here. 

Insurance Payments

The Insurance Payments section of the Work Center allows you to resolve issues with automatically posted ERA payments, manually post payments, and identify out-of-balance claims and collections. For more information on payments in the RCM, click here.

• This is where all payments not automatically mapped to claims are held for review. For additional information on matching insurance payments, click here. 
• This is where all manual payment postings start and where existing checks are found. For more information on how to manually post payments, click here. 
• This tab helps identify possible duplicate checks, mismatches between payment totals, line-item totals, and provider adjustment amounts. For more information about reviewing insurance payment collections, click here. 
• This tab will contain all claims flagged by the system with patient responsibility or balance totals that do not reconcile with charge amounts. To read more about out-of-balance insurance claims, click here.