Managing Claim Edit WQs

Question 1

Define Claim Edit AR? How would you identify Claim Edit AR?

Answer 1

Claim Edit AR is the volume of claims in a Claim Edit WQ.
You monitor the Claim Edit AR by viewing the AR snapshot section of the claims supervisor dashboard . The target amount is $$

Question 2

What report would you run to identify claim credentialing errors?

Answer 2

Claim Edit WQ Summary report

Target is # of errors

Question 3

Define Claim Edit Error-Trending

Answer 3

Volume of Claim errors over time

Question 4

Name two areas in which you can view Claim Edit Error trending?

Answer 4

Claim Edit WQ Summary report

WQ history report
you get to this report by selecting the claim edit WQ and choosing the report icon on the header

Question 5

Define Claim Volume and where can it be reported?

Answer 5

Claim volume identifies top claim errors, claim lag, insurance a/r without claim volume.
It can be located in the Revenue Management Report

Question 6

Define duplicate claim denials and where you can report them?

Answer 6

They are claims that are denied due to a payor receiving duplicate claims
The clarity report–of Denial and Reason/Remark code analysis report.
The target is the $$ amount

Question 7

Define Claim Edit WQ productivity report and where it can be found.

Answer 7

Claim edit activities by user, edit check, or error code with trending.
Located in the PB Claims KPI Reports section of the PB Claims Supervisor Dashboard. (allows you to monitor the user productivity operational metric.)
Should be monitor on a daily basis.

Question 8

What type of value should be recorded on the dashboard for the management metric of credentialing errors?

Answer 8

of errors