Configuring Insurance Follow-Ups

Question 1

What makes up a Follow Up Record (FOL)?

Answer 1

FOL=CVG + ETR (Coverage plus a charge)

Question 2

When is a FOL created?

Answer 2

A FOL is created when the claim is accepted

Question 3

When is a FOL completed

Answer 3

When balance is $0.00

Question 4

What actions complete a FOL?

Answer 4

NRP, Write-Off or Paid In Full

Question 5

When working on Follow-Up WQs, which workspace should you start with? FU WQ Profile or FU WQ Maintenance?

Answer 5

FU WQ Profile

Question 6

What does the property “Related FOL Records” do?

Answer 6

Allow you to keep a Follow-up records from the same invoice together when the follow-up records are routed.

Question 7

What does the Group By Field indicate?

Answer 7

It indicates how you want the follow-up records in a WQ grouped for the user.

Question 8

What options are in the “Group By” field?

Answer 8

Invoice, Account, Transaction and Visit (VITA)

Question 9

What does the “Resolve reason codes after claim resubmit” field determine?

Answer 9

It determines whether the system automatically resolves follow-up records’ outstanding reason codes after an action of Resubmit.

Question 10

What rule applies when determining the appropriate level for the build (WQ, profile, or both)?

Answer 10

Rule of specificity. A WQ is more specific than a profile.

Question 11

The mapping section schedules automatic activities based on a ______________________ combination.

Answer 11

“days since”

Question 12

Which batch job must be run to perform the Follow-Up WQ automatic activities?

Answer 12

Template 1184 -Follow Up WQ Automatic Activities

Question 13

What is the difference in in the Automatic Activity Mapping Logic between Credit and Follow UP?

Answer 13

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.

Question 14

Which is more specific, workqueue or profile?

Answer 14

WQ is more specific than the profile

Question 15

How are activities performed in automatic mapping?

Answer 15

In order listed. More specific scenarios must always be listed before more general scenarios

Question 16

How do you configure displays on the FU WQ and WQ Asst easily?

Answer 16

Using Application extensions.

Question 17

For the HTML Display (Left Side) if left blank, which information will be displayed?

Answer 17

REason Code section and charge information are displayed.

Question 18

For the HTML Display (Right side) if left blank, which information will be displayed?

Answer 18

the deferral info, Activity History and Payment Hx will be displayed.

Question 19

True or False: A FOL will only be in one WQ at a time

Answer 19

True.

Question 20

Why should you add a default catch-all WQ?

Answer 20

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.

Question 21

Which one should be in a higher priority when routing WQs, No response or ones that have a payor response (denial, partial payments)

Answer 21

The one with a payor response should have a higher priority.

Question 22

By giving payors time to respond after a FOL is generated, which tab on the WQ will it show up?

Answer 22

Deferred tab.

Question 23

Why would you use the routing section of the profile?

Answer 23

To ensure that after a certain number of days specified, the claim will go to the highest WQ for which it can quialify.

Question 24

EPIC recommendations for Follow-up

Answer 24

1. Make simple rules that can be reused
2. Consider using Related FOL REcord properties when building rules to keep follow-up records from the same invoice together.
3. Automatic Activity mapping should be simple-causes fewer errors and is easier to troubleshoot.
4. Denial WQs should be in higher priority than no response WQs.
5. Use a default catch-all WQ.

Question 25

Preventing Follow-up Record Completion setting as recommended by epic should be configured at: FU WQ Profile or FU WQ Maintenance?

Answer 25

Profile level.