Using the Billing Queues

Initial flows through postprocess The Billing Queues are used to move dispatches through the Billing process, from QA to final payoff. Each queue represents a certain billing task, and the queue contains all dispatches that require that task. This division of labor allows for multiple dispatchers 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 is fed with dispatches graduating from (or skipping) QA, and so it grows constantly. It should be serviced every day.

The Biller's task is 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 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 do one of the following, depending on how your billing department is set up:

Option 1: File claims using AngelTrack

  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 creates the "Claim Filed" payment events automatically. 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. From the Insurance Transmission Queue, click the 837 suitcase to retrieve the claim batch's EDI, and then upload the EDI to your clearinghouse. After upload, then click the ☑ Mark as transmitted button to tell AngelTrack you've done so.
  4. In a day or two, your clearinghouse will return a 999 EDI, acknowledging your upload. Once you receive it, return to the Insurance Transmission Queue and give the EDI to AngelTrack by clicking the + button in the "999 Reply From Clearinghouse" column. Or, click the + icon to tell AngelTrack that the clearinghouse has accepted the batch and you do not intend to give AngelTrack a 999 for it.

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

Option 2: File claims using other software

  1. If exporting as 837P, code each dispatch first.
  2. From the Insurance Filing Queue, tick the ☑ checkboxes in the leftmost column of the grid, selecting items for export. Once you've made your selections, 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 .

*All competent EMS billing software can import run data as NEMSIS 3 XML. If your billing software does not support this format, nor 837P claim batches, then you must export the run reports as PDF, and have an utterly miserable time keypunching them into your billing software by hand. (Why aren't you using AngelTrack to file your claims?)

Option 3: Export Runs to Outside Biller

  1. From the Insurance Filing Queue, tick the ☑ checkboxes in the leftmost column of the grid, selecting items for export. Once you've made your selections, look at the "Bulk Operations" box and choose the export format your biller prefers. Then click "Export Checked Runs" to download the data to your computer; from there, you will transmit the data to your biller by whichever route is agreed on.
  2. 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 .

Read the Outsourcing Guide to learn more about using AngelTrack with an outside biller.


Insurance Transmission Queue

When you create an 837P batch of claims, it appears in this queue while waiting for the clearinghouse to receive and accept it.

Once you've uploaded your batch to the clearinghouse, click the "✔ Mark as uploaded" button to record that you did it. The relevant "Claim filed" payment event records will be automatically created for you, and the affected dispatches will be advanced to  Awaiting payment , dropping out of the Insurance Filing Queue.

When the 997/999 reply document comes back, click the icon to feed the document into AngelTrack for processing. You will be taken to the Import an X12.997/999 page and prompted to select the document from your local computer. AngelTrack will parse the document, show you what's inside it, and attempt to match it up with one or more of your recorded batches in the system.

If the 997/999 document can be matched to a batch in AngelTrack, you can click the "✔ Import" button to import it. If the batch was accepted by the clearinghouse, then its underlying dispatches will be advanced to  Awaiting payment  (if not already); whereas if the batch was rejected, then its underlying dispatches will be pushed back to  Billing office  and reappear in the Insurance Filing Queue.

Do the same thing for any 277CA documents that are returned by the clearinghouse. Unlike the 997/999, a 277CA can accept and reject individual claims, rather than accepting or rejecting the entire batch.

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.

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 tell AngelTrack that it this is done, 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 disaptch, 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, 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, this queue should be assigned to 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 forgets to 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. You must decide on a case-by-case basis how to handle them. Read the Reversals guide to learn more.


Special Handling Queue

Everything that does not belong in the aforementioned queues, and is not picked up by Invoice Generators, appears in this queue. This includes strange billing arrangements, as well as dispatches with mistakes in billing settings:

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 will give th reason why.


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, so that no other billers will try to work on it. 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 as 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 causes that to happen; 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 buckets, each bucket representing a certain task that needs doing. The buckets can then be parcelled out to employers or to outside contractors (or both).

So, where do the dispatches go once the labors are finished and the buckets are empty?

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 Records, 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  literally 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, and this is 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 Records

The Master Billing Records is a flexible, filterable list showing all of your receivables. It has many filters that you can use to zoom in on groups of calls or even a single call. Use it to find a dispatch when unsure where in the billing process to look for it.

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

Try to avoid using the Master Billing Records for normal billing activities; use the other queues instead, 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, push your nursing homes to get their PANs filed, chase down 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 you can devolve onto 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 and knock out 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 demographic hunts.

Stale Receivables Queue

The Stale Receivables Queue shows all dispatches that have awaited payment -- with no recorded EOBs, denials, or invoice commits -- longer than 45 days (or whatever time period you specify using the date controls on the page). Dispatches in the queue probably require action, perhaps 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.



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