Denials Workflow Management

Next to each denial is a Workflow Button. Clicking this button opens a detailed workflow page where you can track the progress of resolving the denial, assign tasks, and update the status of the workflow. 

The Denials Workflow Page allows you to track the steps needed to resolve denials. 

The workflow is initiated automatically when a denial is identified after EOB is received in the collections module. 

Workflow Steps

Each workflow includes several steps, such as:

• Denial Identified: The date and EOB details.
• Assign to: The individual responsible for resolving the denial is auto assigned (if configured) or can be manually assigned by selecting from the dropdown.
• Investigation Pending: Notes and attachments related to the  investigation should be added while moving the workflow.
• Investigation in Progress: Updates on the progress of resolving the denial should be added while moving the workflow.
• Resolved: Once the denial reason is resolved, the workflow should be marked as completed manually to signal that it is ready for resubmission.
• Close: Once the claim is resubmitted and you no longer need to see the active workflow, click on the Close button to remove it from the interface. This action will only close the workflow view, while all relevant data will remain in the Timeline for future reference.

Timeline View

• The module displays a timeline of all steps in the workflow, allowing users to track the history of the denial’s resolution.

Filters on Workflow Timeline

• Users can filter workflows based on denial categories to narrow down the timeline events to specific workflows.

Creating a New Workflow manually

• A workflow can be initiated from the workflow page. Users can select from predefined workflows, including:

  • Authorization Denial
  • Coding Denial
  • Eligibility Denial
  • Fee Schedule Denial
  • Timely Filing Denial
  • And more...