Claim Inbox: a new way of working holds Mallory Mahoney Manager, Product Innovation
Agenda Claim Inbox Overview Claim Inbox Basics Claim Inbox s Key Workflows & Features Key Takeaways Resources Q&A 2
Claim Inbox Overview
What is Claim Inbox? An alternative to Workflow Dashboard and other claim resolution workflows in athenanet A resource with new features and workflows to help billing teams work claims in hold more efficiently An additional layer on the front end that allows you to organize and prioritize claims A framework to reflect your practice s billing workflows through custom hold buckets A tool to help you reduce your DAR 4
Claim Inbox produced positive results from our 30 beta clients Overall increases in Inbox users average weekly productivity +12% claims +6% dollars We also received very positive feedback from our beta users: I love being able to put a note on multiple claims at once! We are seeing a decrease in our hold amount. This is a great tool. I like the Claim Inbox. I would rather see claims this way than have to assign and release claims. This is much easier for me since I monitor more than actually work claims. I really like the new look of the worklists. It combines the best of the old workflow with the new worklists.
7 Claim Inbox Basics
User Permissions Permission Claim Worklists: Admin Claim Worklists: Access All Worklists Claim Worklists: Productivity Reporting Claim Worklists: Work Claims Claim Worklists: Manager Access Description Grants access to the Claim Worklists admin pages which are used to configure worklists and teams Grants access to all worklists, regardless of whether the user is explicitly assigned to the worklist s team Grants access to user activity reporting through the Performance tab Grants access to see and work claims in the Claim Inbox by controlling the navigation link (New in 15.9) Grants access to advanced features of the Claim Inbox, such as the Apply kick code action, escalation contact, and the All Claims tab 8
Basics Custom claim worklists allow you to build workflow-specific queues for your claims in hold, and assign those queues to specific teams Every practice has a Default Team and a Default Worklist A worklist is made up of worklist records, which represent individual hold reasons on your claims A user may be included in many teams, and a team may be assigned to many worklists, but a worklist can only have one team assigned to it 9
Using Claim Inbox
Navigation Claims > Claim Worklists > Claim Inbox Tab Claim Worklists My Claims Pended Claims Escalations All Claims Performance Description High level overview of all worklists Claims assigned to you Claims pended by you Claims escalated by you All claims in selected worklist User productivity metrics 16
17 Assigning Claims
Assigning claims: Assign next 10 claims 1) Click the Assign next 10 claims link. A dropdown window will appear. 2) Select the worklist you would like to assign claims from. 1 2 18
Assigning Claims: Find unassigned claims 1 2 3 5 4 19
Assigning Claims: Hints, Tricks and Defaults 20 Hints You can assign up to 100 claims at a time The outstanding amount shown is a net amount (positive amounts less negative amounts) Tricks Click the checkbox in the column header to select all of the claims on the current page of the Unassigned Claims window Use the shift-click shortcut to select a range of claims in the Unassigned Claims window Default Configurations (change these in Claim Worklists Admin) There is no limit to how many claims you can have assigned at once Assigned claims will be released after 1 business day Payer and Hold Reason are the additional filters in the Unassigned Claims window Total Outstanding Amount is the sort value in the Unassigned Claims window
Organizing claims: Filters 1 2 3 21
Organizing Claims: Sort columns 1 3 2 22
23 Working Claims: Worklist statuses
24 Working Claims: Pended and escalated claims
25 Working Claims: Flagged claims
26 Working Claims: Bulk actions
27 Managing Work: Manager tabs
28 Managing work: Manager tabs
29 Reporting on Work: Performance tab
Reporting on Work: Performance metrics Metric Assigned Worked Escalated Pended Released Not Worked Inflow Outflow Description The number of times the user has been assigned a worklist record The number of times the user has changed the claim status of a worklist record (this will close the record) The number of times the user has escalated a worklist record The number of times the user has pended a worklist record The number of times the user has manually released a worklist record The number of times a worklist record was automatically released from the user due to an expired assignment duration (practice-configured) The number of worklist records that entered the worklist The number of worklist records that left the worklist 30
Custom Worklists: Edit the default worklist The default worklist will always be your lowest priority worklist. Claims that do not fall into a higher priority custom worklist will be captured here. Fields you can edit: Worklist team Maximum claims per user Pend duration Pend return Primary grouping Secondary grouping Sort by
33 Custom Worklists: Create a new worklist
34 Custom Worklists: Create a new worklist
Key Takeaways
Key takeaways An alternative to Workflow Dashboard and other claim resolution workflows in athenanet that can help you reduce DAR Assign user permissions to get your billing staff ready to take advantage of these new features and workflows Use the worklist actions assign, pend, & escalate to organize and track the work in your hold buckets Find and work groups claims together using filters and the bulk action dropdown Experiment with custom worklists to create buckets that reflect the billing workflows at your practice 36
Claim Inbox Resources Release Center See release notes and release demo video https://community.athenahealth.com/videos/1499 https://athenanet.athenahealth.com/1/1//postings/releasenotes/15.9/build159external /Content/ClaimInbox.htm Webinars Replays at: athenanet main menu > support > Resource Hub > Events & Training O-Help Search for Claim Inbox or Custom Worklists for additional information Claim Inbox Community Find additional training resources and documentation, suggest new features https://community.athenahealth.com/groups/beta-claim-worklist
Questions?
Thank You