Claim Worklist Teams

athenaCollector

This page allows you to organize billing staff members into teams for working HOLD and MGRHOLD claim work queues. You can use the Claim Worklists page to create custom claim worklists for team members.

 

On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Claim Worklists, click Claim Worklist Teams

 

 

 

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 Teams page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Claim Worklists, click Claim Worklist Teams.
  2. Click Add new. Additional fields appear.
  3. Team name — Enter a name for the team.
  4. Select from users who have access to one of the following contexts: — This field appears for athenaEnterprise organizations. Select more than one context to build a team across multiple contexts.
  5. Team members — Select the members of the team.
    Note: Only users with the "Claim Worklists: Work Claims" permission appear in the list.
  6. Team lead (Optional) — Select one of your practice users with the "Manager Access" permission to act as team lead.
    Note: All users with the "Manager Access" permission will be available as an escalation contact within the Claim Inbox, even if they are not designated as the team lead. The team lead can be used for reporting purposes.
  7. Notes — Enter any notes about the team, e.g., "Back office team," or some other information not contained in the name of the team.
  8. Click Save.

 

 

 

Before you create claim worklists and teams, athenahealth recommends that you first create a list of current claim management workflows at your practice, noting the individual or team responsible for each workflow. This process will help clarify how custom worklists and teams should best be organized in your practice.

 

If your practice has multiple departments, you can use the worklist instructions and claim note highlighting features. You can add instructions that appear at the top of the Claim Edit and Claim Action pages by entering them on the Claim Worklists page. Using the highlighting feature, you can easily see what you must do to work the claim to remove it from the worklist. This feature is especially helpful when the claim is holding for more than one reason.

 

 

 

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.

 

 

Team name Enter a name for the team.
Select from users who have access to one of the following contexts: This field appears for athenaEnterprise organizations. Select more than one context to build a team across multiple contexts.
Team members

Select the members of the team.

Note: Only users with the "Claim Worklists: Work Claims" permission appear in the list.
Team lead

Use this optional field to select one of your practice users with the "Manager Access" permission to act as team lead.

Note: All users with the "Manager Access" permission will be available as an escalation contact within the Claim Inbox, even if they are not designated as the team lead. The team lead can be used for reporting purposes.
Notes Enter any notes about the team, e.g., "Back office team," or some other information not contained in the name of the team.

 

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