Outstanding Claims

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Introduction: The Outstanding / Unpaid Claims screen lists claims for which remittance has not yet been received.

Filter: On clicking the Filter icon, the 'Outstanding Filter' pop-up is displayed. Once a filter value is applied, the Funnel icon on the Outstanding screen turns green.

Action Icons

Sort: It allows sorting of Outstanding Claims according to the sequence chosen on the 'Outstanding' pop-up. Sorting by Ascending/Descending for up to three columns is allowed.

Hide Columns: Select the checkbox to hide the columns on the screen.

Patient Detail: Click on the icon to update and view patient information.

Patient Insurance: Patient insurance is denoted by an Umbrella icon, which shows the insurances associated with a claim. A claim can have three associated insurances: Primary, Secondary, and Tertiary. Based on requirements, the user can assign or change Primary, Secondary, and Tertiary insurances. When an insurance is associated with any patient or claim, the Umbrella icon turns red. There can be multiple scenarios where the user needs to assign secondary and tertiary insurance after the claim is processed and sent to the Primary Insurance.

Track Status: It tracks the claim's status history, such as the number of times the claim was sent, rejected, and reopened. It displays the 'Track Status Notes' pop-up, which displays information under columns like 'Name', 'Change On', 'Track Date', 'Code', 'Status Name', 'Comment', and 'Message'. You can even print the track statuses using the 'Print' button on the 'Track Status Notes' pop-up.

Claim Ledger: It displays a list of all receipts, write-offs, and adjustments made by insurance or patients against this claim.

Statement for DOS: It displays the details of services rendered on a particular Date of Service (DOS).

Patient Billing Notes: It invokes a pop-up to display or add patient billing notes.

Claim Letter: It invokes the 'Claim Letter' pop-up.

Claim Notes: It is used to write notes about the claim for internal documentation purposes.

AR Calling: It displays the 'AR Calling' pop-up, which displays the details of the claims selected on the Outstanding Claims list. Details are displayed for 'Patient Details', 'Claim', 'Primary Insurance', and 'Secondary Insurance'. Users can print 'AR Calling' details for later reference or even for tracking purposes with insurance companies using the 'Print' button.

Patient A/C: It displays a billing report of the patient's account (highlighted by a blue band).

Encounter Details: On clicking the Encounter icon, the system takes the user directly to the current Claim Encounter details of the patient.

Assign To: Use this option to assign the selected claim to other PrognoCIS users; a message along with a date can be entered. This function applies ONLY to the selected row and is applied as a tooltip. To display the tooltip message of 'Assign To', hover your mouse over the link under the Loc column. Refresh the page to view the changes.

WriteOff ChargeNext: Using this option, the balance can be transferred to the next entity, such as Secondary/Tertiary Insurance or the patient, or it can be written off.

Resend Claim: It is possible to resend an already posted claim, if required, by clicking the 'Resend Claim' icon. Select claims that are not 'Self Pay' claims to resend.

The Outstanding Screen Can Be Customized Using Properties

There are five properties that enable users to customize columns (add, modify, or delete) on the AR/Follow-up → Outstanding Claims screen. These properties are:

claims.outstanding.fieldcount - This property helps control the number of columns displayed on the AR/Follow-up → Outstanding screen. The maximum value supported by this property is 17 and the default value for this property is also set to 17.

claims.outstanding.fields - This property will control the columns that will be displayed on the AR/Follow-up → Outstanding screen. Users need to enter the column names in a comma-separated format.

claims.outstanding.sort - This property controls the sorting order of the columns displayed on the Outstanding screen. When the property is set to 'Y', the sort order becomes visible on the screen. When set to 'N', the column sort option will not be visible to users. The default value of this property is set to 'Y'..

claims.outstanding.titles - Using this property, users can assign titles to the columns. The names of the columns should be in a comma-separated format.

claims.outstanding.widths - This property controls the width of each defined column displayed on the AR/Follow-up → Outstanding screen.

The Outstanding screen can be configured using these property values.

*claims.outstanding.titles*	Claim Id,Status,Location,Ins1,Ins2,Ins3, Date of service,Patient,Subscriber Id,Provider,Claim Send Date,Bill Amt,Pri Bal Amt, Sec Bal Amt, Ter Bal Amt, Emp Bal Amt, Pat Bal Amt,Collection balance, Denial Count, Assign Date, Days Since DOS, Days Since Sent, Action Comments, Done Comments, Exp Date, Follow-up Date,Since EOB,Had Denial,Had EOB,Had Aging Bucket,Assigned By,Action Required,Done Date,Action Taken,Followup -Date
*claims.outstanding.widths*	10,10,10,101,101,5,10,20,10,10,15,10,10
*claims.outstanding.sort*	NNNNNNNNNNNNNNNNNNNNNNNNN
*claims.outstanding.fields*	BLH_ID, BLH_ASSIGNED_STATUS, BLH_LOCATION, DBO_CLAIM_PRI_INS_NAME, DBO_CLAIM_SEC_INS_NAME,DBO_CLAIM_TER_INS_NAME, BLH_FROM_DATE, PT_DISPLAY_NAME, DBO_BLH_SUBSCRIBER_IDS, MED_DISPLAY_NAME, BLH_SEND_DATE, BLH_BILL_AMOUNT, DBO_BLH_BAL_AMT4PRI, DBO_BLH_BAL_AMT4SEC, DBO_BLH_BAL_AMT4TER, DBO_BLH_BAL_AMT4EMP, DBO_BLH_BAL_AMT4PAT, DBO_BLH_BAL_AMT4COL,dbo.fnBlh_deniedCount(BLH_ID), BLH_ASSIGNED_DATE, DBO_DAYS_SINCE_DOS, DBO_DAYS_SINCE_SENDDATE, DBO_ACTION_COMMENTS, DBO_DONE_COMMENTS, DBO_EXPECTED_DATE, BLH_ASSIGNED_FOLLOWUP_DATE,DBO_DAYS_SINCE_EOB, DBO_HAD_DENIAL, DBO_HAD_EOB, DBO_DOSAR_BUCKET,DBO_ASSIGN_BY ,DBO_ACTION_REQD,DBO_DONE_DATE,DBO_ACTION_TAKEN ,DBO_FOLLOW_UP_DATE
*claims.outstanding.fieldcount*	17

Following are the descriptions of the columns mentioned below:

Claim ID: All claims are listed here with their respective Claim IDs. Clicking the Claim ID hyperlink navigates the user to the Claim screen. A checkbox is present in front of all Claim IDs, which enables the user to select claims to execute actions using the Action icons. Use this column to take action (using the Action icons) on checked claims. This column is provided with a checkbox in the header. When this checkbox is checked, all rows displayed on the screen are selected by default. The total number of records displayed on the Outstanding Claims screen is 100. A maximum of 100 records can be selected. Users can deselect any of the claims explicitly by unchecking the checkbox against individual claims. By unchecking the master checkbox, all selected claims will be deselected.

Note: Outstanding Claims also displays Penalty Invoice Claims.

Status: Status is a concatenation of Assignment Status + Action Taken + Comments. When the status is Done, it is shown in green.

Location: This column displays the location code of the claims.

Ins 1: Displays the claim's primary insurance company name.

Ins 2: Displays the claim's secondary insurance company name.

Ins 3: Displays the claim's tertiary insurance company name.

Date of Service: This is the date of service on which the encounter occurred.

Patient: This column displays the name of the patient.

Subscriber ID: Displays the claim's insurance Subscriber IDs.

Provider: This column displays the name of the rendering doctor associated with the claim.

Claim Send Date: This is the date the claim was sent. This date can change based on whether the claim is reopened and resent, or only resent. For example, if Claim 5365 was initially sent on 13-09-2016, it will show the send date as 13-09-2016. If the user resends this claim on 19-09-2016, the system will update the send date to 19-09-2016.

Bill Amt: The total billed amount of the claim is shown under this column.

Pri Bal Amt: Displays the claim's balance amount with the Primary.

Sec Bal Amt: Displays the claim's balance amount with the Secondary.

Ter Bal Amt: Displays the claim's balance amount with the Tertiary.

Emp Bal Amt: Displays the claim's balance amount with the Employer.

Pat Bal Amt: Displays the claim's balance amount with the Patient.

Collection bal: Displays the claim's balance amount with the Collection Agency.

Denial Count: Displays the denial count.

Assign Date: This is the date on which a claim was assigned to the respective person in PrognoCIS. This date can change in the case of reassignment of claims.

Days Since DOS: Displays the number of days between the claim's date of service and the current date.

Days Since Sent: Displays the number of days between the claim's send date and the current date.

Action Comments: Displays the Task Action Comments.

Done Comments: Displays the Task Done Comments.

Exp Date: Displays the Task Expected Date

Follow-up Date: Displays the Task Follow-up Date

Since EOB: Displays the number of days between the first remittance received (DOC_DATE) and the current date

Had Denial: Displays whether the claim charges are denied in the remittance (Y) or not (N).

Had EOB: Displays whether the claim has a remittance present (Y) or not (N).

Had Aging Bucket: Displays the claim's aging bucket from the Date of Service (0-30, 31-60, 61-90, etc.).

Assigned By: Displays the name of the task assigner.

Action Required: Displays the action required for the task.

Done Date: Displays the Task Done Date

Action Taken: Displays the Task Action Taken

Followup-Date: Displays the Task Follow-up Date.

Columns on the Outstanding Screen Can Be Frozen Using Properties

In addition to modifying columns, users can also freeze columns (i.e., make them fixed). This can be done using the property claims.outstanding.fixedcolumncount, it is a system-level property and the value defined in the property determines the number of columns to be frozen on the AR/Follow-up → Outstanding screen. With this property, only the leftmost columns can be frozen, and the maximum number of columns that can be frozen is 3. By default, the value of this property is set to 1.

Legends: This button displays a list of status codes along with their details. It can be used as a reference to track the status codes displayed on the current page.

Task List: Clicking this button invokes a modal pop-up designed to list all tasks assigned from the filtered claims data. If no filter is applied, the Task List displays all assigned tasks present in PrognoCIS.

InsArgrpOS: Clicking this button invokes the aging breakup for Primary/Secondary/Tertiary insurances by AR Group.

Count: It displays the total number of outstanding claims displayed on the Outstanding Claims screen.

Total Charge/Bal: This field displays the total billed amount for claims and the total outstanding amount to be recovered from outstanding claims. It helps the Biller track these outstanding claims, as the unpaid amount is visible at a glance.

Print: It allows printing of the details of outstanding claims displayed on the Outstanding Claims screen.

Excel: It allows users to print the complete Outstanding screen in Excel format. There are two properties that help transfer data into Excel. If a user needs to add more columns to the Excel sheet that are not present on the Outstanding screen, those columns can be configured using the properties outstanding.more.xls.fields and outstanding.more.xls.titles.

Pagination: The Pagination hyperlink will be enabled only when there are more than 100 records.