Managing Claims Flashcards
Name several claim metrics
Claim acceptance rates Claim Lag Number of claims submitted Insurance AR not on claims queue Pending Claims
Define claim acceptance rate
Is the % of claims accepted by the clearing house
Where is the claim acceptance rate located?
Claims Reconciliation Report
What is the date criteria of the claim acceptance rate?
Weekly
What is the target of the claim acceptance rate?
%
Define Claim Lag
Is the difference between charge post date and claim acceptance rate
Where can you locate the Claim Lag?
The PB Claims Supervisor Dashboard
What is the date criteria of the Claim Lag?
Daily
What is the target of the Claim Lag?
of days
Define Number of Days Submitted
Volume of claims submitted in a given period of time
Where can you locate Claims Submitted?
PB Claim Run Tracking report
What is the date criteria of claims submitted?
Weekly
Claims management and metrics reports to monitor can be located where?
In the Professional Claims Lead Operational Workbook (formerly known as the PB Revenue Cycle Readiness Profile) which may help you identify potential risks to your organization’s revenue cycle
Define pending claims
Charges assigned to a payor but not yet submitted on a claim.
Where can pending claims be located?
PB Claims Supervisor Dashboard-Pending Claims
What is the target amount for pending claims?
Dollar amount
Define Insurance AR not a claim queue
AR held up but not included on a claim.
Insurance balance but not a in the claims queue
An end user may change the value of the claim box from {Y] to [N]
Where can the mgmt. metric of Claim Lag be located?
The weekly charge post date to claim lag section of the PB Claims supervisor dashboard allows you to monitor the # of days it takes to send out claims. From the charge post date to the claims acceptance date.
Where can you locate to report the number of claims submitted over a period of time
Claim Run Tracking Report—(which can be run at the end of the week)–which can be run from the PB Claims Supervisor dashboard.
Where can claim volume (which is an operational metric) be located to be reported on?
The Claim Run Tracking Report (from the KPI reports dashboard component there is a drop down from the far right of the claim edit wq productivity report.
Define Claim Acceptance Rate
Claims accepted by the clearinghouse
Where can you report the Claim Acceptance Rate (2 places)
A report from the clearinghouse
Claim Reconciliation Report (if using CRD)
Target is the % of claims
What is the Follow Up WQ Summary Report used for?
Outstanding insurance AR breakdowns and unresolved denial breakdowns. (operational metric)
End users can save application reports from which tab?
General
My reports are also referred to?
Reporting Workbench
