Unresolved Claims Report

Use this Report to work open (unresolved) or unpaid Claims.

• It is similar to the Interactive Aging Report, but on the Unresolved Claims Report, you can include Notes and Patient information.

• It is not an interactive report meaning there are no links to navigate to the Patient/Encounter Dashboard.

• Since it pulls the Insurance phone number from the Insurance Library, it can be used as a call list.

• This report can be set to automatically run using the Saved Report Filters panel.

• Send the results to a Worklist.
  

Filters

• Filter by fields: If any of these fields are left blank, the Report will pull "All".

• Insurance & Insurance Reporting Group

• Facility & Facility Reporting Group

• Billing: Billing Provider

• Provider and Referring Provider Reporting Groups

• Procedure Code and Procedure Code Reporting Groups

• Patient: Select a specific Patient or Patients.

• Tags: Report Encounters that have a specific Tag(s).

• Resolved Tags can be Excluded/Included or just report Resolved Tags Only.

• Balance >=/<=: Control the Balance amount that you pull on the Report.

• Check Boxes

• Include Diagnosis Codes: Useful when contacting the Insurance Company.

• Include Case Details

• Include Patient Details: Shows Insurance Details.

• Primary, Secondary, & Tertiary Insurances

• Insured

• Relationship to the Patient

• Policy # & Group #

• Include Notes: This will report any Billing Notes that have been added to the Encounter.

• Page Break by Insurance

• Role: Pull all Insurance Roles or pull by Primary, Secondary, or Tertiary

• Aging by:

• Bill Date (last date billed)

• Responsibility Date (when the Insurance became the responsible party).

• Post Date: Date the charge was posted.

• Date of Service: Date the Patient was seen.

• Aging From/Aging To: Choose any Aging category, such as, > 90 days and <= 120 days.

• Times Billed >=/<=: Equals the number of times an Encounter has had the Status of Printed (PRINT), Clearinghouse Accepted (CA), and/or Crossed from Primary (EPX).

• Date Span: Pre-select the date(s) to use for this report. Using a Date Span option allows the report parameters to be saved and reused to always report on the same time frame each instance the Report is run.

• Example: A report that always runs for Yesterday or Last 1 week or Previous Month no matter what the date is.

• DOS From/DOS To: Manually enter  dates.

• Send to Patient Worklist or Send to Encounter Worklist: A Patient or Encounter Worklist can be created to automatically send the results of the report.

• Best Practice: Do not complete (close) a Task on the Unresolved Claims Worklist before it has been paid.

• If the Task has been completed, and the Claim has not been paid, another Task will be created when the Unresolved Claims Report is run.

• To prevent this from occurring, add a Follow-up Date that is far enough out for the Claim to be paid.

• The Task will not show on the worklist again until that follow-up date is reached.

• If the Claim is paid, the Task will auto-complete.

• If the Claim is not paid, it will display when the follow-up date is reached.

• Sort by: Insurance ID or Insurance Name 

Including Patient Details vs not Including 

Including Notes

Diagnoses Included

Patient Details, Notes, and Diagnoses Included

Workflow

• Set up your Report and select a Worklist.

• Determine when you want this report to run.

• Set up the Unresolved Claims report to auto-run.

After the Report runs, it will display in the My Reports panel on the Reports Dashboard and the Encounters on the report will be in the Worklist.

My Reports

The Unresolved Claims report can be lengthy because of the information it contains, and it might not be practical to print it.

• Select View to open the Report

• On Demand: The report was run manually

• Scheduled: The report was created by the Job Scheduler.

Worklist

The Worklist makes it easier to work the Unresolved Claims. It has links to all the information that the User needs to call the Payer.

Select the Task number to work the Unresolved Claims.