Automated Follow Up Actions

In follow up routing rules there are not any “when due” rules defined. (screenshot provided below)

Defining rules for some of the common actions taken by a team member can set these as an automated action, which can free up time for a real person to complete more complex claim follow up activities.

These are not currently in use, but could aid the team.

• There is an attachment below that shows the process in a detailed recording: https://drive.google.com/file/d/1GfMiEsw7YKsc8hw2IAlipBfzMBlj6Hhr/view?usp=drive_link
• The suggestion would be to begin with some of the straightforward follow up actions like a sending of medical records and identify when the team is taking this action consistently - Which payors is that done for? What ANSI reason code does that payor process with?
• Once these questions are clearly known a routing rule can be defined to take action automatically on behalf of the team. Below in the workflow to define the rules section, we will see an example for an insurance of Aetna and reason code 252 defined to run an automatic action of “medical records sending”.

These would be sent out via fax if possible, so may require a build up of fax numbers for the applicable insurance companies.

Not applicable