Ei Deep Dive User Training: Insurance A/R Workflow with non-MedEvolve PM system
In depth user training video highlighting the steps to manage claims using Effective Intelligence.
VIDEO SUMMARY
The insurance AR workflow module training video for a bolt-on PM client shows administrative view, work lists, claim details, customization options, and the process of working on accounts. It also covers the ability to add notes, tasks, and communicate with other departments.
(0:00)
Administrative View – Worklists by Rep
As you can see display here we're showing you what the administrative view looks like. You're going to be able to see your work list divided out by your representative to understand how many claims qualify for all the work lists that are assigned to them, the claims that they've worked today, any claims that have been placed in follow-up, meaning they've put a activity status, action code, follow-up date and a note on the account. We can also see the claim balance and the cash opportunity. If you want to see the detail in a little bit more of a granular methodology, you can click on the insurance AR by work list. What this is going to show you is the detailed work list they're assigned to each individual of the practice. You can see whether it's a denial work list or a regular work list.
(0:53)
Administrative View – Details on the Worklists
The number of claims that qualify for each work list, again, the number of claims that they've worked today, the number of claims that are in Follow-up as well as the balance and the cash opportunity. When you want to come in and look either deeper at the claim or when a representative is going into work the account, they simply will double click on their workless name in their view from the sign-on, and then it's going to pull up the actual current work list with the detail of all the claims that are there. The representative will need to work the claims in the order in which they're displayed. On the work list, you have a whole host of information here. You can see the account numbers, name insurance, payers, providers, dates of service file dates, visit entry dates. You can see claim amounts as you continue to scroll across.
(1:40)
Denial List Details
You can also see any denial ANSI codes, denied amounts, claim statuses, as well as financial locations, insurance categories, a whole host of things. All of these columns can be dragged and dropped into any order in which the end user would like to see them displayed on the table. You also can come here to the column chooser and you can remove any columns in which you don't want to see either. So this is all customizable based upon the end user's preference and how they would like to see the screen displayed. The changes do save based upon the web browser that the user is using as well. To start working the accounts, you can either double click on the top account number here or you can click on the action button tab at the top. The action tab is going to take you into the claim. I like to say this is where we start and stop all of our work on any claim.
(2:34)
Add Notes and Action Codes
If you scroll down to the bottom, you can see any notes that have either come across from the host PM system that we have worked to get an interface with or you can see any notes that have been made here within the workflow tool itself. So I like to say you start here so that you can come down, get an idea of what's happened and occurred with this account and the work that's been done on it to try to get it paid so far and you'll end here because these five columns and items here are going to be what you need to do and are required for every account. You will have to choose an activity status code, action code, which are all customizable to you and your organization follow up date and a note on the account. As you continue to come through, you can see the account tab is going to give you some additional information of basic demographics, dates of birth, age of the patient.
(3:28)
Insurance Information
You'll see insurance listed here. If there's a secondary insurance, it would be listed here where my mouse is kind of hovering and this blue teal dotted line that you see around the primary insurance that's denoting that you're working this claim for. A primary insurance had there been a secondary insurance and that dotted line box was around the secondary insurance, the end user would know that they're working the claim as a secondary claim. You can see the patient insurance information listed here. You can see demographic information. The other items that are down here on this screen are directly related to the medval PM and not to any bolt-on PMs. The claim information tab is going to give you the remaining detail on the claim. You can see diagnosis codes here and the pointers. You can also see again the insurance displayed here. You've got some additional information about the claim as you scroll down.
(4:26)
Transactions, payments posted, CPT codes
You can also see the transactions down here at the bottom. This will show any payments, charges, adjustments that are reflected on the account. You can see diagnosis, pointers, any modifiers that are added here, the units, et cetera. As you go down through here, this is how you can start to review the claim, see what you want to do here with a bolt-on client if there is any refiling of claims that need to be done, any reversals adjustments, payments posted, additional CPT codes or diagnosis codes that will need to be done in the host system. And then you would simply come back to the action clap tab where you're going to notate the account and then it will update everything in the nightly process when we get our new feed from the post PM system. Your activity code is going to be how you came about working the account. So for example, I went out to the insurance company's website to work this account and I am working it off my work list. I'm also going to choose my status code. So for this status code, it was denied due to medical records have been requested. Then I'm going to choose my action code and the action code is going to be the action that I'm going to take to attempt to get this claim paid. So I'm going to request medical records be sent in to see if we can overturn this denial.
(5:56)
Adding a task & internal communications
I come here to my follow-up date, I can click the plus sign and type the number of days that I'd like to push this claim out for Follow-up, I'll be able to type my note in here, requested medical records and then I can add a task because I'm not going to be the one that's going to pull these medical records so I can click the plus sign. I can add my task. It's going to go to my AR admin team. I'm going to be requesting medical records and I want this to be a high priority. I'm going to assign this to the medical records department so the first person available can choose that and get that information for me. I'm going to type in my contact, my comment, please pull medical records and submit to insurance company.
And now what this is going to do is it allows me to communicate with the medical records department and this communication is trackable. So meaning any leadership within workflow can understand that I needed assistance to take an action to get this claim paid. It's going to allow leadership to see in reporting the additional work effort that's being needed to get this claim paid because I'm having to go to an outside department in order to do this and I also can see and track how long this request has been out there, how long it takes them to close it, if there's any backlog, anything of that nature so that we can understand why there is a lengthier time to get a claim paid. Once I've created this task and I have filled in my activity status, action code, follow update and note, I'm simply going to click next and it will take me to the next account in the work list for me to work on the account. Also, if you haven't followed up or there's not, you've pushed the claim out too long, it will denote a box here and give you the warning sign for this so I can simply come back in and say that I want to click on today so that it knows what today is and then I can do my plus sign again and say 21 days and click okay and it will push that out for 21 days and allow me to then go ahead and go to the next account in the work list.