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Revenue Cycle Management
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4.2 Worklists (Insurance)

Suppliers

Inputs

Requirements
     
     
     
     
     
     

Primary Deliverables

Customers

Requirements

Outcomes
       
       
       
       
       
       

Measures

Dashboard (TBD)
   
   
   
   
   
   

(R)esponsible

(The Doers) - Those who do the work to achieve the task. There is at least one role with a participation type of Responsible.

(A)ccountable

(The Buck Stops Here) - The one ultimately answerable for correctness and thoroughness of the completed task.

(S)upport

Those who can provide resources or can play a supporting role in implementation.

(C)onsult

Those whose opinions are sought, typically subject matter experts. Two-way communication.

(I)nform

Those kept up to date on progress with whom there is one-way communication.

Timeframes to Next Follow-Up

  • Claim in process = 10 days
  • Appeal follow-up = 60 days after appeal
  • Sent to arbitration = 60 days
  • Denial = 3 days
  • Paid = 30 days

Notes should include:

  • What happened with claim?
  • What are you doing to get it paid?
  • How did you get information?
  • Adjuster name, phone number, fax number, reference number
Worklists (Insurance) Log in to MedEvolve (workflow website) See timeframes to next follow-up Notes should include...

 

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