Organization Dashboard

The Organization Dashboard allows you to monitor the health of your entire organization. It's our recommendation to work each individual tile to 0. 

To access the Organization Dashboard, navigate to the Management Center and click on the Dashboards tab.

Organization Dashboard Overview Video

VOB 

The Verification of Benefits tiles helps you manage the verification of benefits checks and ongoing eligibility.

• Overdue: The count of newly entered prospective or admitted patients that need to have their benefits verified. Per your organization's setup, the VOB is overdue and needs to be verified as soon as possible. Clicking on this tile takes you to the Work Center > VOB.
• 0-30 Minutes: There are newly entered prospective or admitted patients that need to have their benefits verified within the next 30 minutes or less. You still have time to verify benefits before this is considered overdue. Clicking on this tile takes you to the Work Center > VOB.
• 31-120 Minutes: There are newly entered prospective or admitted patients that need to have their benefits verified within 31 to 120 minutes or they will be marked as overdue. You still have time to verify benefits before this is considered overdue. Clicking on this tile takes you to the Work Center > VOB.
• 120+ Minutes: There are newly entered prospective or admitted patients that need to have their benefits verified within the next two hours. Depending on your organization's setup, you may have over two hours to complete the VOB. Clicking on this tile takes you to the Work Center > VOB.
• Inactive Coverage: When Batch Eligibility is enabled, this tile will display all patients that were flagged with inactive coverage after the last bulk eligibility check (this can be manual or scheduled). Clicking on this tile takes you to the Work Center > Eligibility Status. 
• Coverage Needs Review: When Batch Eligibility is enabled, this tile will display all patients that have coverage changes that require a review after the last bulk eligibility check (this can be manual or scheduled). Clicking on this tile takes you to the Work Center > Eligibility Status. 

Recommendation: Use the VOB Work Center queue to organize your workflow and keep up with incoming VOBs.

Utilization Review (U/R)

The Utilization Review (U/R) tiles help you stay on top of insurance authorizations both new and expiring.

 

• Patients Newly Admitted: There are patients without any utilization plans created. Clicking on this tile takes you to the Work Center > U/R tab.
• Patients U/R Incomplete/Expired: There are patients that do not have a U/R plan that covers current dates. This could mean that the patient has been discharged or that the patient needs more authorization for treatments. Clicking on this tile takes you to the Work Center > U/R tab. Use the links to the right of the U/R tab to make quick updates.
   
• Patients U/R Expiring Soon: There are patients that currently have authorization for treatments where the end date is approaching. This could mean that follow-up needs to happen, or the patient needs to be discharged. Regardless of the action, these U/R plans are accounted for with this tile. Clicking on this tile takes you to the Work Center > U/R tab.

Suggested U/R Management Steps

Use the following steps to follow up on outstanding and expiring authorizations.

1. Create a new utilization plan from the Work Center.
2. Set the Follow-Up date for each plan that needs to be worked on.
3. Sort the U/R Work Center by the Follow-Up column to see an ascending order of what needs to be followed up on.
4. Edit the Admit/Discharge information to remove the patient from this list, and make the Dashboard more accurate.

Claims Submission

The Claims Submission tiles are designed to help you create claims and manage corrections and rejections. 

• Patients New Claims Pending:  There are patients that have been marked as attended for services and submitted to the billing team for creation. These marked treatments are waiting to be created into claims. Clicking on this tile takes you to the Work Center > Insurance Claims > Create New Claims. 
  • Recommendation: Gather and submit all the attendance for the week and Submit Treatments to Billing. Create New Claims from Selected Treatments with the current list of claims. 
  • Note: If a patient has more than one claim that needs to be created, and only one is created, the dashboard will still say that there is one patient pending claim creation. 
• Patients Claim Corrections Pending: There are patients with claims that the system has flagged as having changed since the original claim submission. Every 24 hours, AveaOffice will run a sweep of the system and compare the submitted data with the data in AveaOffice. For example, if the Insurance ID for a patient was changed after the original claim was submitted, the system would recognize this and suggest corrections for us to resubmit. Click on this tile takes you to the Work Center > Insurance Claims > Create Corrected Claims.
  
  • Recommendation: Review the corrections by clicking on the (Compare) link to see what the suggestions are. The Claim Value column is the originally submitted values and the Current Value column is the suggested corrections. You will always see that the Claim Instance ID changed by one iteration (-1.2, -1.3, etc). Also, more likely than not, the bill type for the claim will also change to the 7 correction claim bill type. 
• Claims Rejected/Pending Review: Claims sent to the clearinghouse or payer were rejected for either lack of information or incorrect information. Examples of this could include: requirement for taxonomy code, subscriber not found, enrollment for payer not completed, and invalid birth date. Clicking on this tile takes you to the Work Center > Insurance Claims > Review Rejected/Held Claims.
  • Recommendation: Click on the Claim ID, which will take you to the Work Claim screen (Individual Claim Follow-Up). Click over to Processing Events to get the full details about the rejection or held status. If the issue is easily solvable by changing information in AveaOffice and resubmitting the claim, you can:
    • 1. Review Corrections
      2. Check for Corrections
      3. Resolve the claim 
    • If the issue is more complicated, like an enrollment or registration issue, you can work on that issue outside of AveaOffice, but also mark each claim with an issue tag, change the queue to an Issue queue, create a note stating the current issue and action steps, and set a follow-up date to ensure that you are following up in a timely fashion. 
    • When a claim is resubmitted, a note is automatically generated stating who resubmitted the claim. The rejection will be removed from the Rejected list after it is resubmitted.

• Claims Ready for Review/Submit: Claims have been created and are pending submission to the payer. Clicking on this tile takes you to the Work Center > Insurance Claims > Submit Claims.
  
  • Recommendation: Click Submit Claims for all claims that are ready to go out the door. This will get the process started by sending the claims to the clearinghouse to be scrubbed, and from there, we will either see rejections requesting additional information, name-matching for a payer that we have not submitted for previously, or the claims will go through to the payer smoothly.

Insurance Payments

Use the Insurance Payments tiles to manage payments that were not automatically matched to a patient or claim. These tiles will also alert you to payments that don't match or exceeded the charges.

• Insurance Payments in Review: ERA payments have reached Avea but need to be reviewed by your team before they can be matched to a patient/claim. Most payments are automatically matched to a patient/claims, but this section is for when the system needs help mapping a payment. Clicking on this tile takes you to the Work Center > Insurance Payments > Review Payments.
  • Review Payments: This section will flag any payment that is not straightforward. For example, recouped amounts and patient name mismatches are usually flagged for review. 
  • Recommendation:
    1. Review this list of payments daily.
    2. Mark as Legacy if the payment is not for an AveaOffice claim.
    3. Review the Reason for mismatching.
    4. Resolve the payment to resolve the mismatching issue, and edit the payment fields.
• Insurance Payment Collections in Review: ERA payment collections (bulk checks, ACH) have reached Avea but need to be reviewed by your team before they can be considered complete. Most payments have amounts matched to a patient/claims, but this Review Payment Collections section will flag any payment that is not straightforward. For example, billed amounts and paid amount mismatches for the line item vs the payment totals are usually flagged for review. Clicking on this tile takes you to the Work Center > Insurance Payments > Review Payment Collections.
  • Recommendation: 
    • Review this list of payment collections daily.
    • Review the Reason for mismatching. 
    • Click Edit to Resolve. 
    • If the amount is highlighted in red, click the ICN and edit the payment fields that are red. 
• Insurance Claims Totals Out of Balance: The balance on a posted claim is more than the charged amount, or patient responsibility exceeds the billed charges. This happens when the payer sends multiple ERAs for the same claim, accounting for the charges and adjustments numerous times, without sending offsetting ERAs. Clicking on this tile takes you to the Work Center > Insurance Payments > Insurance Claims Out of Balance.
  • Recommendation: 
    1. Review this list of unbalanced claims daily.  
    2. Review the reason, EOBs, and checks before applying a reversal.
    3. Only apply reversals in cases where an offsetting ERA was not received.

Claims Follow Up

The Claims Follow-Up tiles display outstanding claims that need to be followed-up on. 

• Claims Follow-Up Overdue: Claims that have been submitted over 30 days ago need to be followed up on. The follow-up date can be set in the Patient > Insurance Billing > Claims section for each claim. Clicking on this tile takes you to Work Center > Insurance Claims > Work Claims.
• Claims Follow-Up Today: This tile shows Claims that have a follow-up day of today are ready to be reviewed. Clicking on this tile takes you to the Work Center > Insurance Claims > Work Claims > Follow-Up Day as Today. 

Recommended Resolution: Call the payer, and check on the status of the claim. Make a note, change the follow-up date, add issues, and change the status. This is called the Workflow process and facilitates the accurate documentation of claim follow-up. 

Patient Billing

Use the Patient Billing tiles to help identify, bill, and collect patient responsibility. These tiles are only available for organizations that have Patient Billing enabled. Some are also only relevant if you have enabled credit card processing within Aea. 

• Patients New Billable Services Pending: Private-pay services have been recorded through the Attendance Calendar or on the Services tab within the Patient Profile and are ready for billing. Clicking on this tile takes you to the Work Center > Patient Billing > Create New Patient Billables.
  • Recommendation: Review daily and create and approve billables to ensure services rendered are included in the next statement generation.
• Patients Corrections Pending: A claim change has occurred that changes Patient Responsibility. Clicking on this tile takes you to the Work Center > Patient Billing > Create Corrected Patient Billables. 
  • Recommendation: Review daily and resolve corrections to ensure the next statement generation accurately reflects any changes to patient responsibility.
• Patient Billables Ready for Review/Approval: A private pay service has been created or an insurance claim with patient responsibility has been closed and is ready for approval. Clicking on this tile takes you to the Work Center > Patient Billing > Approve Patient Billables.
  • Recommendation: Review daily and approve billables so they may be included in the next statement generation.
• Note: A Managing Org Admin can request Avea Support to modify organization settings to auto-approve billables and corrections. Email [e-mail] for more information.
• Patient Credit Cards Expired/Expiring Soon: The count of patients with cards expiring this month or have expired. Clicking ont his tile takes you to the Work Center > Patient Billing > Patient Payments.
  • Recommendation: Review daily and follow-up with guarantors to update the existing card on file or to collect a new payment method for ongoing payment plans.
• Failed Credit Card Payments: The count of patients with payments that have failed. Clicking on this tile takes you to the Work Center > Patient Billing > Patient Payments.
  • Recommendation: Review daily and follow-up with guarantors to update the existing card on file or to collect a new payment method for ongoing payment plans.

Statements Follow-up

The Statements Follow-Up tiles help you stay on top of patient payment collections. These tiles are only available for organizations that have Patient Billing enabled.

• Patients Follow-Up Overdue: Count of all patient statements with a follow-up date prior to today's date. Clicking on this tile takes you to the Work Center > Patient Billing > Work Statements.
  • Recommendation: Establish a daily or weekly cadence to follow-up with guarantors and determine the next steps for each patient statement; most importantly, update the follow-up date accordingly to manage your workflow.
• Patients Follow-Up Today: Count of all patient statements with a follow-up date of today's date. Clicking on this tile takes you to the Work Center > Patient Billing > Work Statements.
  • Recommendation: Establish a daily routine of patient statement follow-up to establish a record of collections efforts and ensure maximum collection percentage.