What is used to work payments that create credit balances, are undistributed, or have been recouped?
Credit Workqueues
What in Epic would you use to work overpayments and undistributed credits?
Credit Workqueues
When is a credit workqueue considered completed?
When the balance reaches 0
Resubmission, deferrals, and transfers are activities you can do in what type of workqueue?
Follow up Workqueues
What are follow up records made up of?
Charge transactions and the coverage that charge is assigned to.
How many account workqueues of a given type (self-pay / insurance) can a given transaction be assigned too?
Only 1, but that transaction can appear in multiple queues
What are Account Workqueues used for?
Used to do Self-pay collections & track productivity of users within the workqueue
What Workqueue allows users to fix errors on claims before the claims are sent out and allows you to test in real-time?
Claim Edit Workqueues
What are the 2 types of claim errors that are sent to the error pool?
Master File and User
What type of claim errors are related to items such as missing provider PIN and are usually corrected by administrators?
Master File Errors
What type of claim errors are usually related to those done by user in charge entry or registration and include coding errors and can usually be fixed in hyperspace?
User Errors
Where would you find the daily snapshot of how much was contained in a claim workqueue and how its size has changed over time?
CLAIM_EDIT_WQ_HX
Where would you find the date the claim error entered the Claim Error Pool and which day it was corrected. What are the column names for the dates?
Which table updates records for transactions on claims that are still in the claim error pool but leaves the records for transactions on claims that are no longer in the error pool?
CLM_EDIT_WQ_DETAIL
Where would you find claim errors that have been corrected as well as not been corrected?
CLM_EDIT_WQ_ERROR
Can you use the CLM_EDIT_ERROR.LINE = 1 to pull in 1 record for each claim for each day?
NO this could give you 2 records since you could have both User and Master File errors to get a single record use CLM_EDIT_WQ_ERROR.OVERALL_LINE = 1
What table would you use if you needed to write a report on how many workqueues a claim is in per day?
CLM_EDIT_WQ_STATUS
What table would you use in a report if you need to find every error a claim has when a claim is worked per user/workqueue/day combination and applies to both PB and HB?
CE_WQ_PRODUCTIVITY
Where would you find the details for the CE_WQ_PRODUCTIVITY table?
WQ_PRODUCTIVITY
As charges come into the Charge Router where are they first stored?
Universal Charge Line (UCL)
If the charges need to be processed as a unit where is the group number stored?
Universal Charge Sessions (UCS)
How does the group of charges in the UCS get triggered to be processed?
The last charge triggers that the entire charge session is ready to be processed
What workqueue’s purpose is to ensure that the charges can be processed by the remaining components in the Charge Router (the handler and the destination router) and are ready to enter a destination billing system?
Charge Router Workqueue
Where are messages used to communicate changes, charge sources, and destinations in the Charge Router?
Universal Charge Message (UCM)
If you needed to report on basic information for a workqueue containing universal charge sessions and which workqueue those charges sessions are being reviewed in?
If any charge qualifies for a charge review work queue only that charge goes to the workqueue?
NO the whole TAR goes to the workqueue
A TAR can only be in 1 CRWQ at a time?
NO, multiple at 1 time
What’s the difference between Front End Queues and Back End Queues?
Front End can be updated by the user in Epic
How long does a TAR record that meet a rule stay in a CRWQ?
Until they are either corrected, the error is overridden (in both cases the charge is then filed into ETR with other “good” charges) or the TAR record is deleted.
What table would you need if wanted to find all TAR records regardless if they have been caught in a CRWQ?
PRE_AR_CHG
Where would you find the current status of a TAR record?
PRE_AR_CHG.CHARGE_STATUS_C
If you wanted to report on activities performed on a TAR record which table would you use?
PRE_AR_CHG_HX
If you wanted to find out if a TAR record has been in a Charge Review Workqueue, where would you look?
CHG_REVIEW_*
If you wanted to report on specific values that have changed on the TAR record where would you look?
CHG_REVIEW_ACT_AUD
If you wanted to know what rules a TAR record violated where would you look?
CHG_REVIEW_WQRULES
If you wanted to look at transactions with a Non Zero balance and that have detail types of 60 and 61 only which table would you use?
CLARITY_TDL_AGE
How often is the CLARITY_TDL_AGE table refreshed?
Monthly
Is CLARITY_TDL_AGE affected by resetting actions?
NO so it won’t balance with Resolute Aging
Which aging report is based on variable aging dates of transactions and reflects changes over time due to manually or automatically updated aging dates arising from collection activities?
Aged Accounts Receivable Report
Which aging report is based on the posting dates of transactions?
Financial Aging Report
Which report Financial Aging or Aged Accounts Receivable will match with Clarity Enterprise Reporting?
Financial Aging
Which type of balances on a transaction can be aged by service date, posting date, or first statement date in static aging?
Self – Pay balances
Which type of balances can only be based on service date or posting date in static aging?
Insurance Balances
Can a transaction have both a self-pay and an insurance balance?
Yes
Is there a difference in aging days in Financial Aging?
No. Straight measurement over posting days
What workqueue is used to ensure that procedures have the proper information before they trigger charge information into a billing system?
Charge Router Reveiew Workqueues
The UCL, UCS, and UCM are all part of what?
The Charge Router
What type of process is used to check charges before they are filed into Resolute Professional Billing?
Charge Review Workqueues
What type of workqueues are used to do self-pay balances, follow-up on accounts or individual transactions, and can track productivity of users?
Account Workqueues
T or F
Charges that trigger an error message can be accepted without being corrected.
False
Charges that trigger a warning message can be accepted without being corrected
T or F
Charges that trigger a warning message must either be corrected in charge entry or tagged for further review by using the Pend Charges button.
False
Charges that trigger an error message must either be corrected in charge entry or tagged for further review by using the Pend Charges button.
T or F
The system creates a FOL record for each charge of a claim.
True
FOL = Coverage + Charge
What is the master file for follow up records?
FOL
What is aging a measurement of in Resolute PB?
The length of time you ar has remained outstanding.
What workqueue is used to check charges before allowing them to file into PB?
The Charge Review Workqueue
What is special about the File Date in PRE_AR_CHG table?
If the date is null then the TAR has not been filed into the ETR if it is NOT null then it has been and will match the POST_DATE in the Clarity_TDL
Explain what the Extract Date is in Claim Edit Workqueues.
It's the date that claim would leave the claim error pool if all errors have been corrected.
Can a voided payment happen any time after a payment?
No, a void can only happen on the same day as the payment
What is the Service Date and how is different than the post date in the TDL?
The Service Date is when the service took place and the post date is when the action on the transaction took place.
What is the difference between Post_Date and Orginal_Post_Date in TDL and when would you use them?
Post Date is any action that takes place on the charge after the Original Post Date
If you wanted to look for detail types under grouped by 15 unique columns, which table would you use?
CLARITY_SUM
What is a reversal in the TDL?
A reversal also indicates a mistake, but can only be performed on a payment. A reversal umatches the payment, and then posts a specific debit adjustment which is matched to the payment for the exact opposite amount of the payment
What is a void?
A void unmatches a transaction, and cancels out all outstanding amounts leaving a net outstanding amount of $0. A void indicates the charge or payment was a mistake. Charges can only be voided, while payments can be voided or reversed.
What causes new TDL Records?
Payments, Charges, and Adjustments
What Actions cause new TDL Records?
Claims, Bills, NRPs, Void, Matching Info
Do payment records (2) contain provider information?
