Medical Insurance Payment Processing - Workflow - English - Foundation 22.1 - OnBase - Premier - external - Standard - Premier - Standard

Workflow

Platform
OnBase
Product
Workflow
Release
Foundation 22.1
License
Premier
Standard

The process begins with a fax, an image, or a text report. Claims documents enter the Workflow and initiate the process. An initial claim review queue in Workflow checks for duplicate claims and checks to see what related documents currently exist. Timers trigger notifications and check on documents that are missing. The claims are then load-balanced as they are assigned to an adjuster.

The adjuster reviews all the available information, making notes on the document. A fax or e-mail may be sent to the provider requesting more information. Ultimately, the claim is either accepted or rejected. Accepted claims then go to the accounts payable queue to be paid and the rejected claims go to the rejected claims queue where a letter is generated explaining to the provider the reason the claim has been rejected.