Configuring Insurance Follow-Ups Flashcards
What makes up a Follow Up Record (FOL)?
FOL=CVG + ETR (Coverage plus a charge)
When is a FOL created?
A FOL is created when the claim is accepted
When is a FOL completed
When balance is $0.00
What actions complete a FOL?
NRP, Write-Off or Paid In Full
When working on Follow-Up WQs, which workspace should you start with? FU WQ Profile or FU WQ Maintenance?
FU WQ Profile
What does the property “Related FOL Records” do?
Allow you to keep a Follow-up records from the same invoice together when the follow-up records are routed.
What does the Group By Field indicate?
It indicates how you want the follow-up records in a WQ grouped for the user.
What options are in the “Group By” field?
Invoice, Account, Transaction and Visit (VITA)
What does the “Resolve reason codes after claim resubmit” field determine?
It determines whether the system automatically resolves follow-up records’ outstanding reason codes after an action of Resubmit.
What rule applies when determining the appropriate level for the build (WQ, profile, or both)?
Rule of specificity. A WQ is more specific than a profile.
The mapping section schedules automatic activities based on a ______________________ combination.
“days since”
Which batch job must be run to perform the Follow-Up WQ automatic activities?
Template 1184 -Follow Up WQ Automatic Activities
What is the difference in in the Automatic Activity Mapping Logic between Credit and Follow UP?
In Follow-Up, once a line has been performed on a record, no other line with the same Days and Since combo will be performed for that record.
Which is more specific, workqueue or profile?
WQ is more specific than the profile
How are activities performed in automatic mapping?
In order listed. More specific scenarios must always be listed before more general scenarios
How do you configure displays on the FU WQ and WQ Asst easily?
Using Application extensions.
For the HTML Display (Left Side) if left blank, which information will be displayed?
REason Code section and charge information are displayed.
For the HTML Display (Right side) if left blank, which information will be displayed?
the deferral info, Activity History and Payment Hx will be displayed.
True or False: A FOL will only be in one WQ at a time
True.
Why should you add a default catch-all WQ?
To ensure that all outstanding FOL will be looked at by the WQ routing section and possibly re-routed to a WQ of a higher priority if it qualifies.
Which one should be in a higher priority when routing WQs, No response or ones that have a payor response (denial, partial payments)
The one with a payor response should have a higher priority.
By giving payors time to respond after a FOL is generated, which tab on the WQ will it show up?
Deferred tab.
Why would you use the routing section of the profile?
To ensure that after a certain number of days specified, the claim will go to the highest WQ for which it can quialify.
EPIC recommendations for Follow-up
- Make simple rules that can be reused
- Consider using Related FOL REcord properties when building rules to keep follow-up records from the same invoice together.
- Automatic Activity mapping should be simple-causes fewer errors and is easier to troubleshoot.
- Denial WQs should be in higher priority than no response WQs.
- Use a default catch-all WQ.
Preventing Follow-up Record Completion setting as recommended by epic should be configured at: FU WQ Profile or FU WQ Maintenance?
Profile level.
