Automate Real-Time Claim Status with the Job Scheduler

Automate Real-Time Claim Status with the Job Scheduler

*Real Time Claim Status is a Premium Add-On Feature.

Real-Time Claim Status (RTCS) allows the System to automatically check Claim Status responses on a designated schedule.

  • This helps keep Claim Statuses up-to-date without requiring manual follow-up for every Claim.
  • The Job Schedule can check Claims after a defined number of days, update their status if the Payer reports Payment or Denial, and send Unresolved Claims to a Worklist for further review.
  • Set the number of days that the Payer Response is valid using the System Setting:


Job Scheduler Criteria

Admin > Job Scheduler > Add

  1. Run Function: Select Payer Claim Status from the dropdown.

  1. Current Claim Status: Select the starting Claim Status(es) to be checked by the job.
  • More than one Status can be selected.
  • The field defaults to PA.
  1. Role: Select an option from the dropdown if applicable.
  • All (Default)
  • Primary
  • Secondary
  • Tertiary
  1. You may want to run the Claim Status check for specific Insurance(s), Facility(s), Insurance Reporting Group(s), or Facility Reporting Group(s) (Optional)
  • Select options from the dropdowns on each field.
  1. Check After ____ Days: Enter the number of days that must pass after the Claim is submitted before the job begins checking the Status.
  • This determines when the Claim Status Job should begin.
  • Example: If the Payer(s) selected for this Job usually pay within 14 days, select 14 (Days) in the dropdown.
  • The Job will begin on the 15th day.
  • The Default is 15 Days.
  1. Send to Worklist, After: Determine how many days the Job should wait to send the Claim to a Worklist.
  • The Job will continue to check the Claim Status until it reaches the After Days threshold selected from the After dropdown list.
  • After the specified number of days, the Send to Worklist setting will be used to add the Claim to the Worklist selected in the dropdown.
  1. Update Claim Status if Paid/Allowed: Select the Claim Status for the Encounter after the RTCS response shows that the Claim has been adjudicated and Paid.
  • This does not include a $0.00 Allowed Amount.
  1. Update Claim Status if Denied: If the RTCS response shows that the Claim has been Adjudicated and Denied, the Encounter Claim Status will update to the option selected in the dropdown.

  1. Pattern: Set a schedule for how often the job should run.
  2. Range: Select the timeframe for the job to run.
  • Enter the Start Date.
  • Enter the Time for the job to run.
  • Select No End Date.
  1. Select Save [F2].

Examples

Example 1: Monitor Payer Accepted Claims

Scenario: Your billing team wants the System to check the Claim Status for Payer Accepted Claims on day 16 (after submission) and automatically update Paid and Denied Responses. Claims that are not resolved after 30 days should be sent to a Worklist.

Job Scheduler Configuration:

  • Run Function: Payer Claim Status
  • Current Claim Status: PA
  • Role: All
  • Insurances, Facilities, and Reporting Groups: All
  • Check After Days: 15
  • Send to Worklist After Days: 30
  • Update Claim Status if Paid/Allowed: Adjudicated Paid
  • Update Claim Status if Denied: Adjudicated Denied
  • Pattern: Daily
  • Range: Select a Start Date and Time with No End Date.

Expected Results: Beginning on day 15, the System checks the status of all Payer Accepted Claims. Paid and Denied Claims update automatically. Claims with no response by day 30 are added to the selected Worklist.

Example 2: Secondary Claims Only

Scenario: Your office wants to automate secondary follow-up but leave Primary Claim follow-up manual. Secondary Payers usually take longer to respond, so the team wants the system to begin checking after 20 full days have passed. This means the job begins on the 21st day. Unresolved claims should move to a worklist after 45 full days.

Job Scheduler Configuration:

  • Run Function: Payer Claim Status
  • Current Claim Status: PA
  • Role: Secondary
  • Insurances, Facilities, and Reporting Groups: All
  • Check After Days: 20
  • Send to Worklist After Days: 45
  • Update Claim Status if Paid/Allowed: Adjudicated Paid
  • Update Claim Status if Denied: Adjudicated Denied
  • Pattern: Daily (or Weekly)
  • Range: Select a Start Date and Time with No End Date.

Expected Results: Secondary claims are checked beginning on day 21. Paid and Denied responses update automatically. Claims with no response by day 46 are added to the secondary worklist.

Learn More

Job Scheduler Overview

Real-Time Claim Status

Charges System Settings


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