Populate Collection Roster
The Insurance Collections Module revolves around status codes. The status codes are static and cannot be changed.
- Insurance Denial
- Timely Filing
- Expected Payment Days
- Pending
- Timely Filing and Expected Payment Days
The Populate Collection Roster function is the key function for Insurance Collections. It determines which claims enter the collection process, the migration path for claims already in the collection process, and it removes claims from the collection process that are no longer delinquent. This function can be performed manually or you can have it automatically performed on a nightly basis by CGM webPRACTICE. The automatic roster population option is set in the Insurance Collections Integration located on the System, Database Maintenance Menu.
The Populate Collection Roster function:
- Evaluates each open (unpaid) item in the insurance balance on the patient accounts, not already in the collection process, to see if they meet the criteria to enter the collection process and at which status. This is done based on the criteria set in the Insurance Carrier Table for that carrier. If nothing is entered there, it will look at what was entered in the Insurance Collections Integration. It also evaluates accounts already in the collection process to see if they need to be transferred to another status.
- Insurance Denial Status: If a claim has been denied it moves into the Denial status. If that denied claim is subsequently refiled, it is not moved into the collections module. If there is a denial that is marked as a Patient denial, it is ignored.
- Timely Filing Status: This will compare the date the claim was originally filed to the date of service. If the difference is greater than what the Timely Filing is set to for that carrier, it will move into the Timely Filing status.
- Expected Payment Days Status: If a claim has not been paid within the Expected Payment Days set for that carrier, it will populate into the Expected Payment Days status.
- Pending Status: You can pend claims automatically when you work the collection accounts, or if an Insurance Collection letter has been printed, the populate will move the claim into the Pending status and attach a follow-up date as specified in the Insurance Carrier Table or the Insurance Collections Integration.
- Timely Filing and Expected Payment Days Status: Some claims, depending on the timeframe of the criteria that you set, may fall into both the Timely Filing and Expected Payment Days status.
- Removes accounts that no longer meet these criteria from the collection process.
- Evaluates which insurance carrier owes the balance on each item.
Upon accessing this function, the populate process will start immediately. Click OK when the message appears informing you the population will be performed in the background. This means the job will perfom independently and you do not have to stay in this function until it is complete.
You can continue with other tasks and CGM webPRACTICE displays a message in the upper-left corner of the screen when the population of the collection roster is complete. NOTE: The message will not display until the screen is 'refreshed' by you clicking on another function or menu.
If you choose to manually populate the collection roster:
- You MUST take care to ensure the populate function is run at the appropriate intervals so that claims move into the correct statuses at the right time depending on the timelines you've set.
- You should ALWAYS print your letters the same day your perform the populate.
If you choose the automatic roster populatation every night, you should work your accounts daily using the Work Accounts function, and you should print your letters daily. This will ensure the appropriate letters are generated for each claim and that each claim receives the proper attention while migrating through the collection process.
After you populate the collection roster you can then Print Collection Roster.
