Queues, Statuses, and Issues

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Queues, Statuses, and Issues, also known as QSIs, allow users to triage open claims in a quick and identifiable manner. Let's review QSIs together! 

User Permissions 

Admin-level user profiles can assign and update QSIs without additional user permissions. Organization Users and Managing Organization Users will require Edit-level permissions under Insurance Claim Access in the user profile. For further reading on user types and permissions, click here. 

Configuration

QSI's can be customized by a Managing Organization Admin within the Managing Organization Admin > Configuration section. For further reading on configuration best practices, click here. 

Queues

In the RCM, queues provide a process to manage and schedule claim-related tasks. These queues allow you to organize claims into categories, identifying specific actions that need to be taken, such as who to follow up with or what is causing delays in the claim process.

When a claim has been submitted to the payer, the system automatically assigns it to a Default Claim Queue with a Default Follow-Up Date established within the Managing Organization Admin. For information on how to create and update claim queues and their defaults, click here. 

Queue Reassignment Workflows

    1. In the Work Center, click Insurance Claims.
    2. In the Work Claims section, update the dropdowns to instruct the system which claims to display.
       
    3. Click Update to refresh the screen.
       
    4. Select the Claim(s) whose queue you wish to update.
       
    5. Next, click Bulk Update Workflow/Notes.
       
    6. Click Claim Queue and update the queue to which you want to assign the claim(s).
       
    7. Finally, click Save to complete the process.
       
    1. In the Treatment Episodes section of the patient profile, click the Claims quick link.
       
    2. In the Claims section, locate the claim(s) whose queue you wish to change and update the Queue dropdown to the desired queue.
    3. To update multiple claims at once, select the desired claims and click Bulk Update Workflow/Notes/Issues.
    4. Click Claim Queue and update the dropdown.
    5. Finally, select Submit to complete the process.
       
    1. In the Work Claim screen, click Workflow.
    2. Next, select Edit.
       
    3. Update the Queue dropdown.
    4. Click Save to complete the process.
       

Statuses

In the RCM, statuses are assigned to open claims to provide users with information about the claim's current situation. When a claim has been submitted to the payer, the system automatically apply a Default Claim Status established within the Managing Organization Admin > Configuration > Account Settings section. For information on how to create and update claim statuses and their defaults, click here. 

Status Update Workflows

    1. In the Work Center, click Insurance Claims.
    2. In the Work Claims section, update the dropdowns to instruct the system which claims to display.
       
    3. Click Update to refresh the screen.
       
    4. Select the Claim(s) whose status you wish to update.
       
    5. Next, click Bulk Update Workflow/Notes.
       
    6. Click Claim Status and update the status you want to assign the claim(s).
    7. Finally, click Save to complete the process.
    1. In the Treatment Episodes section of the patient profile, click the Claims quick link.
       
    2. In the Claims section, locate the claim(s) whose status you wish to change and update the Status dropdown to the desired status.
    3. To update multiple claims at once, select the desired claims and click Bulk Update Workflow/Notes/Issues.
    4. Click Claim Status and update the dropdown.
    5. Finally, select Submit to complete the process.
       
    1. In the Work Claim screen, click Workflow.
    2. Next, select Edit.
       
    3. Update the Status dropdown.
    4. Click Save to complete the process.
       

Issues

Issues are assigned to claims to help users quickly identify why the claim was resubmitted (or delayed) without referencing the claim notes. These issues can be reported on, allowing management to understand the types of issues the organization is running into and provide an opportunity to solve problems. For information on how to create issue sources and types, click here.

    1. Open the claim.
    2. Click Issues.
    3. Next, click Create Claim Issue.
    4. In the window, update the Source dropdown.
    5. Next, update the Type.
    6. To add additional details, update the Other Description field. 
    7. Click Create to complete the process.
       
    1. In the Patient's section, click on the Claims quick link.
       
    2. Next, locate the claim you wish to tag.
       
    3. Click Issues to add an issue to the claim, then skip to step 7.
    4. To add the same issue to multiple claims, select the claims you wish to tag.
       
    5. Next, click Bulk Update/Workflow/Notes/Issues.
    6. Click Add Issues.
    7. To add a new issue, first update the Issue Source.
    8. Next, update the Issue Type.
    9. Add additional details in the Other Description field when applicable. 
       
    10. If the issue is recurring, select Existing Issue to copy the source and type from the previous claims.
       
    11. Select Submit to complete the process. 
  • For instructions on processing corrections and tagging them with an issue, click here. 

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