Introduction: Outstanding / Unpaid claims lists the Claims against for which remittance is not yet received.
Filter: On click of Filter icon, it displays the pop up 'Outstanding Filter'. As filter value is applied the Funnel icon on Outstanding screen turns Green in color.
Action Icons
Sort:
It allows sorting of outstanding claims according to sequence chosen on pop up 'outstanding'.
Sorting by Ascending/ Descending up to three columns are allowed.
Hide Columns:
Select checkbox to hide the columns on the screen.
Patient Detail:
Click on the icon to update and view the Patient
information.
Patient Insurance:
Patient insurance is denoted by Umbrella icon,
which shows the insurances associated to a claim. Claim can have three
insurances associated Primary, Secondary and Tertiary. Based on requirement
user can assign or change Primary, Secondary and tertiary Insurances. When
Insurance is associated to any patient or Claims the umbrella icon turns red
. There can be multiple scenarios where user needs to assign
secondary and tertiary insurance after the claim is processed and sent to
Primary Insurance.
Track Status:
It tracks the claims' status history, as in, the number of times the claim got sent, rejected, and reopened. It displays the pop up 'Track Status Notes' which displays information under columns like 'Name', 'Change On', 'Track Date', 'Code', 'Status Name', 'Comment', 'Message'. You can even print the track statuses using button 'Print' on pop up 'Track Status Notes'.
Claim Ledger: It displays the list of all receipts/write-offs/adjustments made by insurance/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/add patient billing notes.
Claim Letter: It
invokes the Claim letter popup.
Claim Notes: It is used to write notes about the claim, for internal documentation purpose.
AR Calling:
It displays pop up 'AR Calling' which displays the details of the claims selected on Outstanding Claims list. The details are displayed about 'Patient Details', 'Claim', 'Primary Insurance' and 'Secondary Insurance'. User can print 'AR Calling' details for referring it later or even for tarcking purpose with Insurance Companies using button 'Print'.
Patient A/C: It displays a billing report of the patient (highlighted by a blue band) account.
Encounter Details:
On click of the Encounter icon, 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 user(s); a message along with date is allowed to be entered. The function applies ONLY to the row that is selected and is applied as a tool tip. To display the tool tip message of 'Assign To' hover your move over the Link under the column: Loc. Refresh the page to view the changes.
WriteOff ChargeNext:
Using this
option, balance can be transferred to next entity such as Secondary /
Tertiary Insurance or Patient or can be written off.
Resend Claim: It is possible to resend an already posted claim, if required when 'Resend Claim' icon is clicked. Select claims which are not 'Self Pay' claims to resend the claim.
Outstanding Screen can be Customized Using Property
There are five properties that enable users to customize columns (Add, Modify or delete) on AR/Follow up →Outstanding Claims screen. The properties are:-
claims.outstanding.fieldcount
- This property helps in controlling the number of columns displayed on
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 name of the columns in comma separated format.
- claims.outstanding.sort - This property control the sorting order of the columns displayed on the Outstanding Screen. When the property is set to ‘Y’ the sort order become visible on the screen. When set to ‘N’ the column sort option will not be visible to the users. Default value of this property is set to ‘Y’.
- claims.outstanding.titles - Using these property users can give titles to the columns. The names of the columns should be in comma separated format.
- claims.outstanding.widths - This property control the width of each defined column displayed on AR/Follow-up → Outstanding screen.
The
outstanding screen can be configured using the 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 description of the columns as mentioned below:
Claim Id: All the claims
are listed here with the respective Claim Ids. On click of Claim ID
Hyperlink, user is navigated to Claim screen. A check box is present in
front of all the claim ids, which enable user to select the claim for
executing any action using the actions icon. To this Column to take
action(From Action Icons) on Properly Check Box 'Checked' Claim/s.
Status: Status is a concatenation of Assignment Status + Action Taken +
Comments. When status is Done, it is shown in green color.
Location: The column
displays the location code of claims.
Ins 1: Display the
claims primary insurance company name
Ins 2: Display the
claims secondary insurance company name
Ins 3: Display the
claims tertiary insurance company name
Date of Service: It is date of service on which encounter happened.
Patient: This column
displays the name of the patient
Subscriber ID: Display the claim insurances Subscriber ids.
Provider: The column displays the name of the rendering
doctor associated with the claim.
Claim Send Date: It is the claim sent date. This date can change based on if Claim is reopened and resend or only resend. Ex:- If a Claim 5365 was earlier sent on 13 -09-2016 then it will show send date as 13-09-2016. Now if user resends this claim on 19-09-2016, then system will show send date 19-09-2016.
Bill Amt:
Total Billed amount of the Claim is shown under this Column.
Pri Bal Amt:
Display the Claims balance amount with the Primary
Sec Bal Amt:
Display the Claims balance amount with the Secondary
Ter Bal Amt:
Display the Claims balance amount with the Tertiary
Emp Bal Amt:
Display the Claims balance amount with the Employer
Pat Bal Amt: Display the Claims balance amount with the
Patient
Collection bal: Display the Claims 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 from PrognoCIS. The date can change in case of reassignment of
claim/s.
Days Since DOS: Display the days difference between the claims date of service to
current date
Days Since Sent: Display the days difference between the claims send date to current
date
Action Comments: Display the Task Action Comments
Done Comments: Display the Task Done Comments
Exp Date:
Display the
Task Expected Date
Follow-up Date: Display the Task Follow up Date
Since EOB: Display the days difference between the first remittance received
(DOC_DATE) to current date
Had Denial: Display the Claim charges are Denied from remittance (Y) or not (N).
Had EOB:
Displays the
Claim with remittance present (Y) or not (N).
Had Aging Bucket: Display the claims aging by from Date of
Service. (0-30 , 31-60, 61-90 etc)
Assigned By: Display the Task Assigner name
Action Required: Display the Action Required for Task
Done Date: Display the Task Done Date
Action Taken: Display the Task Action Taken
Columns on Outstanding Screen can be Frozen Using Property
In addition to modification of columns users can also freeze the column i.e. making then fixed. This can be done with the help of a property claims.outstanding.fixedcolumncount, it is a system level property and value defined in the property decides the number of columns to be frozen on the AR/Follow-up → Outstanding Screen. With this property only the left side columns can be frozen and the maximum numbers of columns that can be frozen are 3. By default the value of the property is defined as 1.
Task List:
Clicking on this button invokes a
model Pop up designed to list all the tasks which are assigned from the
filtered Claims data. If no filter is applied, then Tasks list will list all
the Assigned Tasks present in PrognoCIS.
Total Charge/Bal: This field displays total Billed amount to claims/ Total outstanding amount to be recovered from outstanding claims. It helps 'Biller' to track these outanding claims as amount unpaid is visible at a glance.
print:
It allows printing of details of oustanding claims displayed on Outstanding claims screen.
excel:
It allows to print
the complete Outstanding screen in Excel format. There are 2 properties that
helps in transferring data into excel. If user needs to add more columns in
Excel sheet, which are not present on Outstanding screen, then those columns
can be configured using properties
outstanding.more.xls.fields
and
outstanding.more.xls.titles.
Pagination: Pagination hyperlink will be enabled only when there are more than 100 records.