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Followup Queue Definitions are defined by Queue Type, either Self (for Account followup) or Insurance (for Claims followup).
Note: Leaving the Minimum and Maximum values empty for a field will ignore the field during the queue selection process. You may leave both fields blank, or you may enter a minimum or a maximum. If you enter a minimum and not a maximum the system will automatically assume the maximum amount. If you enter a maximum and not a minimum system will automatically assume the minimum amount. For example, if you enter a minimum age of 60 and no maximum, the system will assume the maximum is 9999. If you enter a minimum subscriber of M, the system will assume the maximum is ZZZZZZ.
Plan Type
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Enter/Select Criteria for a specific Plan Type to be selected for this queue. Leaving this blank will select all Plan Types.
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Plan
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Enter/Select Criteria for a specifc Plan to be selected for this queue. Leaving this blank will select all Plans.
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Minimum Claim No
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Enter the minimum Claim number to be selected for this queue.
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Maximum Claim No
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Enter the maximum Claim number to be selected for this queue.
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Minimum Policy No
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Enter the minimum Policy number to be selected for this queue.
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Maximum Policy No
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Enter the maximum Policy number to be selected for this queue.
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Minimum Subscriber
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Enter the minimum Subscriber Name to be selected for this queue.
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Maximum Subscriber
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Enter the maximum Subscriber Name to be selected for this queue.
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Age Claims by Date
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If selecting claims by Age, indicate whether they should be aged from the Submitted date or from the Refiled date.
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Minimum Age (in Days)
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Enter the minimum Age at which the claims will be selected for this queue. This will either be the number of days from the date the claim was submitted or the number of days from the refile date, depending on what was specified in the parameter above.
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Maximum Age
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Enter the maximum Age at which the claims will be selected for this queue. This will either be the number of days from the date the claim was submitted or the number of days from the refile date, depending on what was specified in the parameter above.
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Minimum Amount
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Enter the Minimum Claim Amount of the claims to be sent to this queue.
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Maximum Amount
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Enter the Maximum Claim Amount of the claims to be sent to this queue.
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Medigap Claims
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Indicate whether Medigap claims should be Included or Excluded. The default is that they be Included.
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Paper/Electronic
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Indicate whether All claims should be included, or whether just Paper claims should be selected, just Electronic claims, or just Test claims.
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Broken Promises
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Select whether this Queue should Include or Exclude claims with a Broken Promise, or should ONLY include claims with Broken Promises.
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Held Claims
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Select whether this Queue should Include or Exclude claims with a HELD status, or should ONLY include Held claims.
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Disputed Claims
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Select whether this Queue should Include or Exclude Held claims with a DISPUTED status, or should ONLY include Disputed claims. If you wish to Include or Only Disputed, you must Include Held Claims, since Disputed claims are always held claims (although all held claims are not disputed claims). You cannot Exclude Held claims and Include Disputed claims.
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Payment Reason
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Select whether this Queue should Include or Exclude Held claims with a Payment Reason code on them, or should ONLY include Held claims with Payment Reasons. If you wish to Include or select Only claims with Payment Reasons, you must Include Held Claims. You cannot Exclude Held claims and Include Payment Reason claims.
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Level
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Select what Claim Levels should be included in this queue - primary, secondary, tertiary. The system defaults to all claim levels being selected.
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Additional Tabs are available adding DIVISION, FACILITY, LOCATION, PROVIDER, and SURGEON selection criteria. If you wish to build separate Queues by Division, Facility, Location, Provider, or Surgeon, access the separate tabs to indicate which one(s) you would like to include or exclude. If you wish to include accounts for all divisions, all facilities, all locations, all providers, and all surgeons leave these tabs blank.
When defining insurance queue criteria, a Plan Type or a Plan may be specified and is suggested. If you decide to build queues by Plan Type or Plan, you will need to be sure that queue criteria are created for each and every plan or plan type that needs to be seen in the Followup Queue. Because multiple criteria can be specified when creating a Queue it does make it easier in that you do not need a Queue for every plan or plan type. However, you will need to make sure that there is a criteria for each plan or plan type that goes into a Queue. For example, you could create one Queue that includes COMM, WC, and Champus claims in it. You just need to make sure that other Queues cover all the other remaining plan types that exist. Remember that if you ever add a new plan type in your practice, then you will also need to update your Followup Queue Definitions so that new plan type is included in the Followup and not overlooked.
SUGGESTION:
In order to ensure that claims do not "fall through the cracks" because of a Plan Type inadvertently not having been created that will catch those claims, you might want to set up a "catch all" queue for very delinquent claims that can be used as a spot check. For example, it could be set up to catch all claims over 120 days that are still open. Another "spot check" that could be used is the Claim Delinquency Report run periodically for very delinquent claims to ensure that these claims are being worked.
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