Using the Billing Queues

Initial flows through postprocess The Billing Queues are used to move dispatches through the billing process, from QA to paid. Each queue represents a certain billing task, and the queue contains all dispatches that require that task. This division of labor allows for multiple billers to work together, simultaneously or in tandem, without collisions and without any receivables falling through the cracks.

Before reading further, make sure you are familiar with the Postprocess Workflow, particularly the Bill-to and Payor fields and how they control the path each dispatch follows through billing. You should also understand how to use the Exception Flags to mark dispatches that have unusual problems.


Insurance Review Queue

Dispatches appear in this queue when they are:

This queue receives dispatches graduating from (or skipping) QA, and so it grows constantly; in most billing situations, this queue will be serviced every day.

The billing task for this queue is for the biller to consider each dispatch in the queue and decide whether to submit it to insurance, versus to send it directly to invoicing.

For this task, simply click the "[Not reviewed]" link for each row in the grid of waiting dispatches. The popover review form will appear. This form is loaded with all the essential datafields from the dispatch:

Insurance review form

In the upper-right corner are links to the more-detailed data, including the full run ticket and the full run report, in case the form does not contain all the information you need to make a determination.

At the bottom of the form, the biller registers their decision by selecting a payor. Some of the payor choices may be greyed-out according to the billing settings recorded by the dispatcher. If the billing settings are incorrect, then you can simply open the full run ticket (click its run ID at the top of the review form), correct the settings, then refresh the review form.

If you decide to claim the call against insurance, then tick the ☑ Insurance  radiobutton to set the Payor. Save your work by clicking the "✔ Send to Coding →" button. The call will then move to the Insurance Filing Queue. If you wish to immediately code the call, rather than allowing it to sit in the queue, then click the "✔ Go to Coding →" button instead.

If you decide to not claim the call against insurance, then click the desired Payor option: ☑ Facility  to send the call directly to the selected facility's invoice, ☑ Affiliate  to send the call to the selected affiliate's invoice, or ☑ Patient  to send the call to the patient's invoice. Save your work by clicking the "✔ Send to Invoicing →" button. In all three cases, the call will move to the appropriate Invoice Generator, to be included in the next round of invoices.

If you need to track down more information before making a decision, then you can park the call by clicking the "✔ Send to Parking Lot ↓" button. That button will save any changes you made to the billing notes and to the patient notes, but will not mark the call as ☑ Reviewed. Therefore, when you eventually unpark the call, it will return to the Insurance Review Queue, right where it was when you initially parked it.

Automatic payor selection

AngelTrack automatically sets the Payor field for any dispatch that has only a single bill-to option (insurance / facility / affiliate / patient / cash-pay) selected. The field will be set when the dispatch graduates from (or skips) QA. Therefore you will occasionally see calls in the queue that are awaiting review but already have ☑ Insurance  selected.


Insurance Filing Queue

Dispatches appear in this queue when they are:

From this list, the biller will perform the coding for each trip, and then batch them up for the clearinghouse, like this:

  1. Code each dispatch.
  2. From the Insurance Filing Queue, tick the ☑ checkboxes in the leftmost column of the grid, selecting items for inclusion in a claim batch. Once you've chosen the items for the batch, click "Batch the Checked Runs" from the "Bulk Operations" box. As you create each batch, AngelTrack automatically generate the necessary "Claim Filed" payment events. The underlying dispatches will then exit the Insurance Filing Queue, moving to  Awaiting payment . Your clearinghouse can handle batches containing a mixture of Medicare, Medicaid, and Private claims... but your batches will probably be easier to manage if they contain only a single type of carrier.
  3. If you've activated AngelTrack's clearinghouse uploader/downloader, then:
  4. Whereas if you do not use the clearinghouse uploader/downloader, then refer to the Clearinghouse Manual EDI Upload/Download Guide to learn how to do this manually.

To learn more about this process, read the Filing a Coded Claim Guide. To learn more about claim EDIs, read the EDI Primer.

Offloading data to an outside biller

The Insurance Filing Queue is not an appropriate place to offload billing data to an outside biller, because the queue excludes trips that were uninsurable and thus went straight to invoicing. The aforementioned can happen for two reasons:

All such trips will go straight to invoicing, skipping the rest of the insurance queues, and so they will never appear in the Insurance Filing Queue. We strongly recommend againstusing this queue for offloading calls for the above reasons.

To learn how and where to do that while guaranteeing that no receivables go missing, read the Detached Biller guide.

AngelTrack also has a billing API that an outside biller can use to pull run data, and likewise to push items to  Awaiting payment . If your biller would like to make use of this API, ask them to contact AngelTrack Support.

Manually recording a claim filed elsewhere

If there is a trip in the queue for which a claim was already filed outside of AngelTrack, and you just want to push the trip onward to  Awaiting payment , perform these steps:

  1. Tick the ☑ checkboxes in the leftmost column of the grid, selecting the trips you want.
  2. Look at the "Bulk Operations" box and choose the desired export format. Then click "Export Checked Runs" to download the data to your computer.
  3. Once the download is successful, click the "Record Claim Filed Events" to tell AngelTrack that the dispatches have been filed against insurance. This will create the "Claim Filed" payment events, and push the underlying dispatches out of Insurance Filing Queue and on to  Awaiting payment .

Insurance Transmission Queue

When you create an 837P batch of claims, it appears in this queue while waiting to be uploaded to your clearinghouse, and while waiting for any reply 999s and 277CAs to come back.

If using AngelTrack's automatic uploader/downloader

If active, AngelTrack's clearinghouse uploader/downloader will automatically transmit your batches from this queue to your clearinghouse, marking each one  Transmitted . It will also fetch all reply EDIs returned by the clearinghouse, depositing them into the "Incoming Replies" tab of the Insurance Transmission Queue.

You can use the queue's "Outgoing Batches" tab to monitor your batches as they go up and as EDI acknowledgements come back down. You will also use the queue's "Incoming Replies" tab to manually import any X12.835 EOBs that AngelTrack will not automatically import; it will not automatically import whenever an EOB contains denials or ambiguities.

If you intend to submit a claim batch on CMS-1500 paper claim forms instead of electronically, then immediately click the batch's 1500 icon to download your new batch as a .PDF, as this will mark the batch as  Accepted  so that AngelTrack will not upload it for you. To learn more, refer to the Filing a Paper Claim Guide.

If not using AngelTrack's automatic uploader/downloader

When AngelTrack's uploader/downloader is not active, you will use the Insurance Transmission Queue to do all of the following:

  1. Download a claim batch to your computer, either in electronic (X12.837P) format or as a CMS-1500 PDF for printing on paper claim forms.
  2. Mark a claim batch as "transmitted" after you manually upload the batch to your clearinghouse, or after you mail a CMS-1500 to a carrier.
  3. Import the X12.999 batch acknowledgements returned by your clearinghouse, or tell AngelTrack that the batch was accepted without an X12.999 coming back.
  4. Import the X12.277CA acknowledgements returned from carriers via your clearinghouse.
  5. Review previously-imported X12.999, X12.277CA, and X12.835 EDI documents, on the "Finished Replies" tab.

To learn more about using the Insurance Transmission Queue without the automatic uploader/downloader, refer to the Clearinghouse Manual EDI Upload/Download Guide.

To learn more about AngelTrack's features for managing your 837P batches, read the 837P Batch Management guide.


Insurance Appeal Queue

Dispatches appear in this queue when they are:

If you outsource your billing to a separate software application or to an outside biller, you may not receive notice of appealable denials. In that case, nothing will ever appear in this queue.

Note that a carrier may reverse and re-approve, in which case AngelTrack will see the re-approval as the most recent insurance event and so handle it in the normal way (file against secondary, or send to invoicing).

Tools for filing an appeal

The rows in the queue provide links to helpful pages filled with the information you will need when filing the appeal:

Recording the appeal or the decision to not appeal

Once the appeal is filed or abandoned, you must record it, so that the dispatch exits the queue.

You can do this right in the queue. Simply click the "[Not yet appealed]" link for the appropriate dispatch, and the appeals popover dialog will appear:

Appeals popover

The popover dialog gives you three choices, using the radiobuttons at the bottom:


Insurance Exception Queue

Dispatches that have been submitted to insurance, but are kicked back to 'Billing office' for reasons other than a denial or a failed claim, appear in this queue. In other words, the Insurance Exception Queue contains those dispatches that require unusual intervention -- something other than an ordinary appeal. As such, we strongly recommended this queue being serviced by your most experienced billing staff.

Dispatches appear in this queue when they are:

Note that dispatches will appear in this queue if a biller records an insurance claim or appeal, but does not push the dispatch forward to  Awaiting payment . In that situation AngelTrack does not understand why the dispatch is still at  Billing office , and so the call goes to the exception queue for manual intervention.

Handling reversals

All reversals appear in this queue, if they are not followed by re-approvals, because AngelTrack files all reversals as denials.

You must decide on a case-by-case basis how to handle them, by filing appeals, or by re-filing them as fresh claims, or by giving up and sending them to invoicing.


Special Handling Queue

This queue exists to help identify incorrect billing settings and situations, including:

Finding the reason why a dispatch is in Special Handling

To learn the reason why any particular dispatch is in this queue, open its Dispatch Edit page by clicking its run ID, and switch to the "Billing" tab. The field named "Workflow location" will display the dispatch's current location within the queues, and if the location is Special Handling Queue, it include more information. Additionally, you can review the call's billing notes for more insight as to why it appears here.


Parking

Parking is the act of pulling a dispatch completely out of the postprocess workflow, and letting it sit idle while you work on it.

Normally, dispatches sit idle while marked  Awaiting payment , because you are waiting on a third party. Parking, by contrast, is for keeping a dispatch at  Billing office  but not in any queue. Calls that are parked will not appear in any queue, and thus, will not be touched by other billers. You alone have custody of your parked dispatches. You can work them in your Parking Lot, and unpark them at any time.

Most billing queues include a parking control, to quickly check or modify the parking status of each dispatch. Here is the meaning of the different parking icons:

Unparked Parked, awake Parked, snoozing Parked, by someone else
Unparked Parked,
awake
Parked,
snoozing
Parked,
by another biller

Simply click the parking icon to change its status. Clicking on a dispatch that is unparked (i.e. moving through the postprocess workflow normally), or that is parked by someone else, will move it to your parking lot. Additional clicks will cycle through different snooze settings (14 days, 30 days) and then back to unparked again.

To learn more about parking, including the snooze feature, read the Parking guide.


Invoice Generators

Invoice Generators are used to process all dispatches that are ready for invoicing to facilities, affiliates, and patients. This means dispatches that are not billable to insurance, or were denied by insurance, or which have a copay still owing.

Invoice Generators act like queues, because they accumulate all dispatches that are awaiting invoicing. On the Billing home page, the links to the various Invoice Generators include an indication of how many dispatches are currently waiting there.

Flows through postprocess

Invoice Generators produce uncommitted invoices. "Uncommitted" means that the invoice has not yet been applied to the postprocess workflow. Committing an invoice has many effects on the workflow; included dispatches are moved from 'Billing office' to  Awaiting payment , and price quotes are set as specified.

A new invoice can include items already invoiced previously, if there is still a balance owing. A facility's or affiliate's current ledger balance can also appear as a credit or debit on its invoice.

To learn more about the Invoice Generators, read the Invoice Generator guide.


Where Does a Dispatch Go After Leaving the Queues?

Remember, the purpose of the queues is to organize all of the dispatches into categories, each category representing a certain task that needs doing. The categories can then be parcelled out to employers or to outside contractors (or both).

So, where do the dispatches go once the billing process is done?

When a dispatch is paid in full or written off, it moves to  Finished  (postprocess step 5). All billing activity is done, and it never again appears in any queue. (If necessary, it can be found using the Closed Dispatches grid or the Master Billing Queue, and pushed back for more billing.)

For all other receivables (i.e. everything with a balance still owing), each dispatch leaves queues when it is marked  Awaiting payment  (postprocess step 4). Being marked  Awaiting payment  means there is nothing left to do but wait.

When a payment event eventually occurs, retrieve the associated dispatch using the Record a Payment Event page. It has many filters for quickly pulling up the dispatch record you seek. When you've found the correct record, click the $ icon to open the "Record Payment Event" window and record the event.

As you do so, you will make the choice to either leave the dispatch where it is (still  Awaiting payment ), or push it back to the  Billing office  for more work. If you choose the latter, then the dispatch will reappear in the appropriate queue.

To learn more about recording payment events and pushing dispatches back to the  Billing office , read the Payment Event guide.


Special Queues

Of the aforementioned queues, a dispatch can only belong to one at a time as determined by the rules of the queues. If you are not sure where a dispatch is currently located, open its Dispatch Edit page and select the "Billing" tab. A field named "Workflow location" shows where the dispatch resides.

There are also special queues, which a dispatch may appear in in addition to its position within a regular queue.

Like the regular billing queues, the special queues can be assigned to an outside biller, who will login to your AngelTrack cloud server and remotely process everything waiting.

Master Billing Queue

The Master Billing Queue is a flexible, filterable list showing all of your unfinished receivables, regardless of their positions in the workflow. It even includes calls that are parked, regardless of which biller parked them.

Because it shows everything at  Billing office , this queue is the recommended place for offloading data to an outside biller, and so it has bulk-operations features to assist with that.

Due to its nature, we recommend against using Master Billing Queue for normal billing activities; the other queues are better used, because they provide protection against common mistakes.

Prior Authorization Queue

Upcoming dispatches, and those scheduled for today, and those which occurred recently, appear in the Prior Authorization Queue if they probably require prior authorization and/or a PCS form. AngelTrack makes this determination by looking at the service requested, the priority requested, the bill-to setting, and the patient's insurance.

It includes calls that are parked, regardless of which biller parked them.

Refer to the Prior Authorizations guide for details.

For those EMS companies who outsource their billing, it is common to assign responsibility for this queue to the outside biller. The outside biller can verify insurance coverage, get your nursing homes to get their PANs filed, find PCS forms from doctors, and so forth. Because all of that happens over the phone and fax, it can easily be done by an outside biller -- even if they are in another state.

Missing Demographics Queue

This queue contains patients whose records are missing essential billing information. Patients are included only if they have one or more dispatches that are:

Lieutenants and Captains have permission to use this queue, so that if desired, you can give them responsibility for collecting the missing information. The queue is organized by the patients' place of residence (i.e. it is organized by facility), so you can send an employee out to the facility to complete five or ten patient records in a single visit.

This queue does not include calls that are parked, because a very common reason for parking is missing demographics information.

Stale Receivables Queue

The Stale Receivables Queue shows all dispatches that have been awaiting payment -- with no recorded EOBs, denials, or invoice commits -- for more than 45 days (or whatever time period you specify using the date controls on the page). Dispatches in the queue may require action, such as a status check or a fresh round of invoices.

It includes calls that are parked, regardless of which biller parked them.

Dispatches will exit the queue when new payment activity is recorded, or when the postprocess status changes to something other than  Awaiting payment  (postprocess step 4).

You can change the default "staleness" interval from 45 days to whichever interval is appropriate for your operation. Visit the Preferences page under Settings to adjust it.

Check Register

The Check Register behaves like a queue, in the sense that it reports the number of financial transactions (checks, EFTs, credit card payments) that are flagged flag for review.

On the Billing Home page, the "Check Register" dashboard displays the number of flagged transactions... or else displays "-" if none are flagged.

To learn more, read the Check Register Guide.



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