Work a Claim Review Item

A claim that fails the review rules arrives as a work item with its findings already attached to the fields at fault. Working it from the queue is the same job as checking a claim, with the queue moving you along.

Before You Start

You need the User role and a claim review queue with open items. Items are labelled with the claim and its error count.

Clear the Findings

1. Open the claim review queue.
2. Select an item in the Work Items rail. The workspace shows the claim with each finding painted on the field it concerns.
3. Correct the fields the findings name. Your first edit claims the item and moves it to In Progress.
4. Select Complete. The item closes and the processor advances.

Result: the claim re-checks. A clean result promotes it to Ready and the processor advances to the next item.

When Completion Is Refused

Completion validates before it closes anything. If a finding still blocks the claim, ClaimPod says which and stays where it is, so an item never closes over an unresolved problem.

Corrections That Belong Elsewhere

Some findings are really about the patient or the visit rather than the claim. Where a correction belongs to the master record, ClaimPod offers to write it back so the fix travels beyond this one claim.

Related: Check and Fix a Claim · Work a Queue Item · Claims