Work Claims in the Work Center

Claims can be worked on in bulk by navigating to the Work Center > Insurance Claims > Work Claims section of the RCM. Let's review how to work claims together in this section! 

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. For further reading on user types and permissions, click here. 

Section Overview

Let's break this section overview into three parts: Filters, Actions, and Definitions.

• 

  Name	Definition
  Organization/Practice/Facility	Filter open claims by their associated Organization/Practice/Facility
  Claims	Filter claims based on their assignment status e.g. Open, Unassigned; Open, All; Open, Assigned to Me
  HCPCS/CPT	Filter claims by the procedure code
  Insurance Payer	Filter claims by the current sequence payer
  Service	Filter claims by the service rendered
  Insurance Payer Status	Filter claims by the current payer status of the claim e.g. Accepted, Denied, Pending.
  Group By	Determines how to group the filtered claims in the grey sections
  Sort By	Determines the listed descending order of the filtered claims in the grey sections
  Queue	Filter claims by the current system-assigned status
  Assigned to	Filters show claims based on the user assigned to follow-up
  Date Type	Filter claims by the Follow-up Date or Date of Service
  Follow-Up Start/End	Determines the date range of the listed claims

• 

  Name	Definition
  Update	This button generates a list of open claims using the parameters established by the filters.
  Disc Icon	This feature is used to create a template from the current filter settings.
  Download As Excel	This feature is used to download the list of open to an Excel spreadsheet.
  Bulk Update Workflow/Notes/Issues	This feature is used to simultaneously update the Claim Queue, Claim Status, Assigned User, Follow-Up Date, Notes, and Claim State of one or more claims.
  Claim ID	Clicking this quicklink will redirect the user to the Work Claim screen of the individual claim.
  Patient	Clicking this quicklink will redirect the user to the Patient > Treatment Episode > Insurance Billing > Claims section of the RCM.

• 

  Name	Definition
  Subtotals	This is the sum of total claims, patients, and charges. The Group By filter will drive the subtotals.
  Claim ID	This is the RCM-assigned claim number.
  Patient	This is the patient's first and last name.
  Subscriber ID	This is the subscriber ID found within the patient's insurance set.
  Status	This is the current payer status of the claim.
  Service(s)	This is the name(s) of the service(s) on the claim.
  DOS Start and DOS End	This is the first DOS and last DOS on the claim
  Charges	This is the sum of all charges on the claim and does not account for expected rates.
  Follow-Up	This is the most recent follow-up date set for the claim
  Last Action Date	This is the last date any work was done on the claim
  Days Outstanding	This is the number of days the claim has been open
  Queue	This is who the claim is currently assigned to for follow-up
  Assigned To	This displays notes made by a user.

Workflow

Let's review how to work claims from within the Work Center! 

• 1. In the Work Claims section, click to update any desired filter dropdowns.
      
  2. Next, update the Follow-Up Start and Follow-Up End date.
     
  3. Click Update.
     
  4. Click Download as Excel to generate an Excel list of filtered claims.
     
  5. Click the box next to the Claim ID to update the claim.
     
  6. Next, click Bulk Update Workflow/Notes.
  7. Under Update, select one or more of the following box(es):
     1. Claim Queue: This will update the claim(s) queue.
     2. Claim Status: This will update the system status of the claim(s).
     3. Assigned User: This will assign the claim(s) to a specific user.
     4. Follow-Up Date: This will update the next follow-up of the claim(s).
     5. Note: This will add a note to the claim(s).
     6. Claim State: This will open or close the claim(s).
        
  8. Finally, click Save to complete the process.