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
- This area will show you a dashboard view of all VOB, U/R, and claims assigned to you. Clicking on each tile will open 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 pertaining to patients and payments such as 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 back and forth. This section of the RCM eliminates the need for a third-party service.
VOB and U/R
The VOB and U/R portion of the Work Center allows you to manage incoming VOBs and expiring authorization plans. 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 U/R tab allows you to create and track follow-up details of a utilization plan. Here, you can filter by Case Manager, Practice, Facility, Rendering Provider, Insurance Payer, and Episode U/R Status. Additionally, you can customize your view by clicking the View Columns button.
- 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.
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 automatically runs each night and compares the submitted claim data to the data present 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 and manually post payments.
- This is where all payments that have not been automatically mapped to claims are held for review. For additional information on matching insurance payments, click here.
- This is where all manual payment posting starts and existing checks are found. For more information 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.
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