Claim Worklist Dashboard

athenaCollector

You can use this page to work claims assigned to you in a custom claim worklist. You can also use the Reporting tab to report on claims in claim worklists to analyze productivity and work distribution across worklists, and allow worklist users to track their daily productivity.

 

On the Main Menu, click Claims and then click Claims Worklists. The View Claims Worklists appear in the Task Bar, with links to worklist categories. Click My Worklist. The Default Worklist and all the worklists of which you are a member appear in the Workspace

 

 

 

Your practice administrator should assign the following user roles to the appropriate personnel in your practice:

  • Claim Worklists: Admin — Grant this role to billing administrators who will create and manage teams and worklists. Users with this role can access the Claim Worklist Teams page and the Claim Worklists page.
  • Claim Worklists: Access All Worklists — Grant this role only to billing supervisors or superusers who need visibility into all of accounts receivable (AR). Users with this role can access the Claim Worklist Dashboard, the Claim Worklist Teams page, and the Claim Worklists page. Users with this role are assigned escalated claims if they are available in a specific worklist. These users can de-escalate a claim or assign it directly to another user.
  • Claim Worklists: Productivity Reporting — Grant this role to users, administrators, and supervisors who need visibility into productivity and management of claim worklists. To see the Reporting tab, you must grant this role in conjunction with either the Claim Worklists: Access All Worklists role or the Claim Worklists: Work Claims role.
  • Claim Worklists: Work Claims — Grant this role to users who edit claims as part of their daily work. Their usernames will appear in the list of eligible users (by practice) on the Claim Worklist Teams page. Users granted this role can access the Claim Worklist Dashboard and escalate claims out of their worklists. If a user is also a team lead, that user is assigned escalated claims.
  • Claim Worklists: Manager Access — Grant this role to billing managers responsible for managing billing staff or billing work. Users granted this role can access the following advanced Claim Inbox features:
    • View the Claim Worklists and Escalations tabs.
    • View all pended and escalated claims in their worklists (the default filter options show claims pended and escalated by that user).
    • Escalate claims to any user.
    • View and assign all claims in hold (feature available only to users with the Claim Worklists: Manager Access role or permission).
    • Reassign claims to users (feature available only to users with the Claim Worklists: Manager Access role or permission).
    • Apply kick codes to claims (feature available only to users with the Claim Worklists: Manager Access role or permission).

 

 

  1. Display the Claim Worklist Dashboard: On the Main Menu, click Claims and then click Claims Worklists. The View Claims Worklists appear in the Task Bar, with links to worklist categories. Click My Worklist. The Default Worklist and all the worklists of which you are a member appear in the Workspace.
    Note: Users with the Custom Claim Worklists: Access All Worklists role, such as billing managers, see all worklists for your practice.
  2. Click assign to assign a claim to yourself.
    The claim appears in the My Claims table.
  3. Click edit next to a claim in the My Claims table.
    The Claim Edit page appears.
  4. Work the claim.
  5. Click Return to Claim Worklist Dashboard at the top of the Claim Edit page.
    Important: If, when you return to the Claim Worklist Dashboard, a claim that you successfully resolved still appears in the My Claims table, do not release it. athenaOne runs a script every few minutes to move resolved claims from the My Claims table to the Worked Claims table. All claims that you resolved that day eventually appear in the Worked Claims table. athenaOne refreshes this list each night.
  6. Click the note icon in the Notes column to associate a note with the claim in the My Claims table.
    Important: This is not a claim note. This text does not appear on the claim; it persists only as long as the claim is in a worklist. It is meant to record information that you may need before you can properly work the claim. Notes carry over to other team members who are subsequently assigned that claim. However, these notes are not persistent, and should only be used by team members to communicate relevant information about the action required to resolve the underlying claim issue.
  7. Click Save to save the note.
  8. Click release next to a claim in the My Claims table to return it from assigned status to its original worklist.

 

  1. Display the Claim Worklist Dashboard: On the Main Menu, click Claims and then click Claims Worklists. The View Claims Worklists appear in the Task Bar, with links to worklist categories. Click My Worklist. The Default Worklist and all the worklists of which you are a member appear in the Workspace.
    Note: Users with the Custom Claim Worklists: Access All Worklists role, such as billing managers, see all worklists for your practice.

  2. Under My Claims, click pend next to the claim.

  3. Pend for — Enter the number of business days the claim will not be assignable.

  4. Return to me — Leave the box unchecked to return the claim to the worklist's assignable claims immediately when the pend period elapses. Check the box for athenaOne to return the claim to your worklist when the pend period elapses.
    Note: If you do not work or re-pend the claim immediately after it returns to your worklist, athenaOne sends the claim to the worklist's assignable claims list via an overnight script.

  5. Enter any notes in the text box.

  6. Click Pend.
    The claim moves from your list of assigned records and appears under My Pended Claims, in case you need to refer to or work the claim before the pend period elapses.
    Note: The claim is now counted in the Pended Claims column on your Claim Worklist Dashboard page and also appears in the Assigned to me column as a pended record.

 

  1. Display the Claim Worklist Dashboard: On the Main Menu, click Claims and then click Claims Worklists. The View Claims Worklists appear in the Task Bar, with links to worklist categories. Click My Worklist. The Default Worklist and all the worklists of which you are a member appear in the Workspace.
    Note: Users with the Custom Claim Worklists: Access All Worklists role, such as billing managers, see all worklists for your practice.
  2. Pended Claims — Click a linked number.
    The pended claims appear below it.
  3. Review the claims. Click the X icon at the upper right to close, or:
    1. Click un-pend to move the record out of pend status and either return it to the user who pended it or return it to the worklist's assignable claims, depending on whether or not the user who originally pended the claim checked the Return to me box.
    2. Click assign to me to move the record out of pend status and add it to your list of assigned claims.
    3. Click assign to me and go to claim to move the record out of pend status, add it to your list of assigned claims, and display the Claim Edit page for you to review and work the claim.
  4. Click Save.

 

  1. Display the Claim Worklist Dashboard: On the Main Menu, click Claims and then click Claims Worklists. The View Claims Worklists appear in the Task Bar, with links to worklist categories. Click My Worklist. The Default Worklist and all the worklists of which you are a member appear in the Workspace.
  2. Click escalate for the appropriate claim.
  3. You must add an internal note explaining why you're escalating the claim. Enter the note and click Escalate.
    Note: This is not a claim note and does not record on the claim; it persists only as long as the claim is in a worklist.
    The claim disappears from your worklist and is added to the Escalated Claims column.
  4. Continue to work other claims or assign additional claims to yourself. If you are not a team lead for a specific worklist and do not have the appropriate role for escalations, you are assigned only regular claims that have not been escalated. 

 

  1. Display the Claim Worklist Dashboard: On the Main Menu, click Claims and then click Claims Worklists. The View Claims Worklists appear in the Task Bar, with links to worklist categories. Click My Worklist. The Default Worklist and all the worklists of which you are a member appear in the Workspace.
    The number of escalated claims for a worklist appears in red in the Escalated Claims column.
  2. Click assign next to the worklist that contains escalated claims.
    If you are the team lead for that worklist or have the appropriate role for escalations, you are assigned escalated claims. If the number of escalated claims is fewer than the number of assigned claims per request for this worklist, you might also be assigned additional claims.
    The claim now includes the text Escalated by (user).

  3. You have several options to address the escalated claim.
    Note the reason for the escalation and consider whether the claim is in the correct worklist. It's possible a user escalated a claim because it was sent to the wrong team, or the worklist is incorrectly configured.

    • Click de-escalate if you believe this claim can be addressed by other users assigned to the worklist. The claim moves back to the general pool of claims. You must add a note when you de-escalate a claim; by default, any content in the Notes field is pre-populated.
    • Click reassign to assign a claim directly to another user. Enter the user to whom you are sending the claim and enter a note.
      The claim appears in that user's My Claims list and is no longer marked as an escalation.
    • Click edit to work the claim.
    • Click release if you cannot work, reassign, or de-escalate the claim to release it back to the worklist for another user to pull the escalation. The claim remains escalated.

 

 

You can report on claims assigned, worked, escalated, pended, and released at the worklist level and at the user level. You can also report on the number of claims that have been assigned or unassigned to a worklist during the reporting period.

  1. Display the Claim Worklist Dashboard: On the Main Menu, click Claims and then click Claims Worklists. The View Claims Worklists appear in the Task Bar, with links to worklist categories. Click My Worklist. The Default Worklist and all the worklists of which you are a member appear in the Workspace.
  2. Click the Reporting tab.
  3. Date — Enter a date range to view claims you worked during a specific date. Alternatively, click the calendar icon and select a date, or select a date range from the drop-down menu.
  4. Team — Click All to include all the teams of which you are a member, or click Selected and select the teams to include in the report.
  5. Click Filter.
    The search results appear below.
  6. Click the arrow for a worklist to expand the row and display subtotals by user.
  7. Click Download to Excel to download all of the worklist data for the reporting period.
    Each row in the Excel file represents a unit of worklist activity; the Action column at the far right indicates the type of activity.

 

  1. Display the Claim Worklist Dashboard: On the Main Menu, click Claims and then click Claims Worklists. The View Claims Worklists appear in the Task Bar, with links to worklist categories. Click My Worklist. The Default Worklist and all the worklists of which you are a member appear in the Workspace.
  2. Scroll down and click My Claims.
    Your daily totals appear above the table.
    Note: The "Claim history" section shows all the worklist records that were assigned to your username during the current day, and are no longer assigned to you. This list will reset every midnight.

 

 

 

With the Claim Worklists feature, you can manage your HOLD and MGRHOLD claim work queues. Use the Claim Worklists page to set up claim worklists and associate these worklists with claim worklist teams, to give you optimal control over your claim work queues.

 

If yours is an athenaEnterprise organization, you can establish claim worklists across multiple practices. The team function allows you to direct work to particular teams and to prevent other teams from easily accessing other non-assigned work. You can use the Claim Worklist Teams page to create the teams.

 

You can build workflow-specific queues of work to parse front-end scrubs from back-end denials and specify custom rules. You can:

  • Organize and sort the claims into very specific worklists.
  • Segment your claim work queues by workflow.
  • Create custom claim worklists across HOLD and MGRHOLD and then associate that work with a specific team.
  • Use the team feature to assign specific work to groups outside the current role architecture.

 

 

Claims can be escalated for several reasons:

  • The user does not know how to work the claim.
  • The claim should be in a different worklist.
  • The claim needs to be addressed by a user with different expertise, for example, a practice manager or billing manager.

To view escalations, a user must have the Claim Worklists: Access All Worklists or Claim Worklists: Manager Access user permission.

 

You can use the Claim Inbox page or the Claim Worklist Dashboard page to escalate claims out of a worklist. If you cannot work a claim because it is improperly categorized or you do not have the expertise to correct the claim, you can move that claim to another user using the tool, eliminating the need to phone or send email.

The claim escalation does not route claims to athenahealth. The escalated claim disappears from your My Claims list and appears under a new heading, indicating an escalation.

 

The escalation point of contact can work the claim, reassign the claim to another user, or de-escalate the claim back to its original worklist.

 

Escalated claims never leave their assigned worklist, and they remain in a general pool of claims available to many users. The key difference between an escalated claim and a regular claim is the order in which claims are assigned to users with different permissions. Users who are expected to address escalations are assigned escalations before any other claims (if present). All other users are never assigned escalations.

 

 

 

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