The Queue Processor

Opening a queue fills the screen with one item, under a band that names it and moves you through the queue. Most kinds of work share the same frame; Statement Review and Secondary Unwinds keep a simpler bar.

Who Can See It

User, when the client is licensed for work queues. A Manager or an Administrator sees the queue list on Work Queues, but opening a queue from an address or bookmark shows You Don’t Have Access, naming the User role. A row under Next up on the Dashboard opens its queue at that item.

The Band

Part	What it shows
Queue	Opens the queue list over the item. Key L does the same
Progress	A bar and 12 active · 3 waiting · 1 skipped · 40 done, where done counts completed items only
Previous and next arrows	Step through the active items, with your place as 4 of 16. J and K do the same
Faces	Who else is in this queue
Item #N	The open item, with an Open Nd age badge, and a flag when it is escalated
Who is on this item	Such as “Dana Reyes is working on this item”
Panel button and item menu	Show or hide the side panel, and the item’s own actions

The Queue List

The list opens by itself when you enter a queue and closes once you pick an item. Pin the queue docks it beside the item instead. At its top sit Search the queue (claim, patient or payer, across the whole queue), the sort menu and Select items.

Sort	Order
Default Order	The queue’s working order. The default except in Credit Balances
Oldest First	The items that arrived first
Largest Amount	The biggest dollar amount first
Nearest Deadline	The closest filing, appeal or refund deadline first. The default in Credit Balances

Each row gives the item number and what it is about, such as a claim or Row 12, with the reason underneath, such as Denied or 2 problems. The badge at the right is the nearest deadline (Filing in 9d, Appeal due today, Refund overdue 3d), or Open Nd. An escalated row says why, by whom and to which lead. Rows are grouped Active, Waiting, Skipped and Done, the last two folded; a waiting row ends returns and its date. New arrivals wait at the foot as 3 new items with Refresh.

Item state	What it means
Queued	Nobody has started it. Opening it does not claim it
In Progress	Someone has started it. It is theirs until they close it, skip it or leave it idle for 30 minutes
Completed	Closed, and its decisions applied
Skipped	Set aside with a reason, and still closable later
Waiting	Decided, with a date to come back on. It returns to the queue by itself on that date

Select items adds checkboxes to the unfinished rows. The bar that appears offers Assign, Move and Skip as a tracked run: items that can take the change are changed, the rest are skipped with the reason.

Claiming an Item

Your first edit, or choosing an outcome, claims an item; opening it does not. An item someone else holds says so in a banner, with its decision controls off and the holder’s initials on its row; Reassign to Me… takes it over. An item left untouched for 30 minutes goes back to the queue, and its holder’s banner offers Keep Working, with unsaved changes kept.

The Workspace

Every kind but Statement Review and Secondary Unwinds opens with key facts led by a Status tile (hover it for the reason), then Assigned To, Started and Completed By or Skipped By with the Skip Reason, then the record, edited in place.

Panel tab	What it holds
Problems	Errors, Warnings and Decided. A row that names a field or a decision goes to it when selected. A warning reads “Doesn’t block”
Changes	On Save for unsaved edits, then On Complete or On Resolve for the outcome, starting “Includes the 2 changes above, saved first” when there are some. A dated outcome ends Comes Back Later or on its date
Activity	The record’s notes and history, with a box to write a note. Key N opens it

Item kind	What the Status tile can read
Import Review	Needs Review, Ready to Complete, Skipped, Completed
Claim Review	Needs Review, Warnings Only, Ready to File, Resolved
Remittance Review	The remittance’s family, then Resolved
Follow-up Claims	Rejected, Denied, Partly Paid, Held, No Response, Waiting
Follow-up Visits	Not Checked, Can’t Bill, Generation Failed, Claim Voided, Ready to Bill, Waiting
Coding Review	Awaiting Coding, Ready to Release, Released, Waiting
Credit Balances	Open, Due Soon, Overdue, Resolved

The Action Bar

Action	What it does	When it is offered
Resolution	Picks the outcome, with its date or reason beside it	Where the kind has more than one outcome
Skip	Asks for a Reason (Needs a Colleague, Waiting on the Payer, Needs Records, Not Mine, Other) and a Note, required for Other, then Skip Item sets it aside	Any open item
Save Changes	Saves your edits, keeping the item open, and counts them as Save Changes · 3	Greyed with “No changes to save” until you edit
Complete	Saves, closes the item and opens the next	Import Review and Claim Review, from Queued on
Resolve	The same, applying the outcome chosen in Resolution	Remittance Review and the follow-up queues, from Queued on
Release to Billing	Re-checks the visit’s codes, marks its services coded and builds the claim	Coding Review. Greyed until edits are saved, the visit is checked again and no coding error remains
Apply to Account Charges	Applies the credit to the patient’s open account charges	Credit Balances, only while there are charges to apply it to
Record Refund	Records the credit being refunded	Credit Balances. Greyed with “This credit is already settled.” once it is
Release	Re-runs the statement’s check and, if it passes, releases it	Statement Review, from Queued on. Refused while a bill-to edit is unsaved
Mark Done	Closes the item once the secondary claim is dealt with	Secondary Unwinds, from Queued on
Next	Moves on without claiming anything	Statement Review and Secondary Unwinds; elsewhere, the band’s arrows
Return to Queue	Wakes a waiting item early	A waiting item’s only action

The closing button stays greyed until the outcome is complete, and hovering it says what is missing. Outcomes that move money or void a claim ask in the bar first, with the amount on the button, such as Write Off $120.00. A refused outcome shows its reason in the bar and leaves the item open.

The Item Menu

Reassign…, Move to Queue…, Escalate… (on an item not yet closed or waiting), View History, and Open Claim, Open Remittance, Open Visit, Open Statement or Open Patient for the record behind it. Claim Review and Remittance Review add View Raw EDI when the record came from EDI.

Escalate Item #N sends the item to the Escalations queue or to A lead (a biller who is also a Manager or Administrator), with a Reason: Needs Approval, Payer Dispute, Over My Limit, Policy Question or Other, which needs a Note.

The Workspaces

Item kind	What the workspace shows
Import Review	One staged row under its key facts, split into a section per record it carries (Patient, Visit, Services, Insurance, Claim, Payment), as cards on a wide screen and tabs on a narrow one, with a Decision first in each. The panel adds Source, the row as the file had it with the bad values highlighted, and Activity once the row is linked to an existing patient or visit
Claim Review	The claim’s sections over its service lines, with a mark on each field a finding concerns
Remittance Review	Key facts (Paid, the payer, Claim, Payer Status, Claim Balance), the amounts, the Remittance and Claim cards, whose menus hold View Raw EDI, and the service lines beside the adjustments
Follow-up Claims	Key facts (Payer Owes, the payer with Open Portal, Payer Claim #, Filing Deadline, Outstanding), the claim card with Open Claim and Open in New Tab in its menu, and Last Payer Response. The panel adds Remittance
Follow-up Visits	The visit’s Services, editable, with Add Service, then the visit card. Problems starts with Check Again and lists the checks that pass. The panel adds Coverage
Coding Review	Key facts (Captured charges, Payer, Patient, Feed, Waiting), the Services to code, offering codes in effect on the service date, and Diagnoses
Credit Balances	Key facts (Credit, Source, Determined, Refund Due) over the Ledger (excerpt). The item closes when the credit is applied or refunded
Statement Review	A held statement: its Holds and Bill To cards beside the document canvas
Secondary Unwinds	A filed claim whose earlier payer’s payment was taken back: its header and claim menu, a Primary claim card (Secondary claim for a tertiary) with that claim’s payer, status and balance, and read-only Activity. Void or replace the claim from the menu, then select Mark Done
Anything else	A generic view naming the work type

Import Review Decisions

Each record section opens with its Decision, and each service has one in its last column; Payment has none. Nothing is written until Complete, which applies every decision on the row in one step.

Decision	What it does
Link to existing patient, visit, insurance or claim	Ties the row to a record already in ClaimPod. A patient candidate shows its match percentage and what agrees and differs; hover it for the full comparison
Create new patient	Makes the record from the file. Other records offer it only when nothing was found to link
Ignore service {code}	Leaves that service out
Map {code} To	For a code ClaimPod does not know, such as a payer ID: maps it to an existing payer, provider or location, or creates one, for every file the mapping reads
Import {code} anyway	For a valid code newer than the code sets: imports it, with a required Note
Also link rows {n}, which have the same {MRN}	Links up to 50 other rows carrying the same patient

A chosen decision shows in the edited colour, and Changes lists it under On Complete. Save Changes saves field corrections, never decisions. Decisions survive moving between items, and are lost on reload or leaving the queue, which asks first. For an Unpriced Service, type the amount in the Charge cell. Resolution is Import Row or Reject Row, which needs a reason in Why this row won’t be imported and is final for that run.

Claim and Remittance Review

Both open the record itself, so it is worked where the data lives. Complete on a claim is refused while an error remains. Resolving a remittance with findings open asks first, such as Accept with 2 open findings?; Work a Remittance Review Item covers its outcomes. On the CR-TIME-002 finding, a Manager or Administrator who is also a User sees Record Delay Reason….

Follow-up Items

A scheduled sweep raises items for submitted claims the payer still owes on, for rejected claims, and for unbilled visits, past the schedule’s threshold in days. Claim rows read 45 days or 45 days outstanding, visit rows 45 days unbilled. Choose the outcome under Resolution, then select Resolve.

Item	Outcome	What Resolve does
Claim	Reverse Charges	Reverses the charge so the claim nets to zero; a patient payment stays as a credit. The payer isn’t told; use Void Claim on the claim page for that
Claim	Write Off	Writes the insurance balance off with a Reason, and closes the claim
Claim	Bill Patient	Moves the insurance balance to the patient’s next statement, and closes the claim
Claim	Appeal Denial	Records an appeal of the denial, and brings the item back on the Appeal By date
Claim	Resubmit Corrected Claim	Creates a replacement (frequency 7) and retracts the original; the replacement goes to Ready, or to Claim Review with problems. On a Rejected claim it voids the claim and makes a new one, which needs a Manager or Administrator
Claim	Rebill to Another Payer	Voids the claim, reverses its charges and raises a new claim to the coverage you pick. Needs a Manager or Administrator
Claim	Awaiting Payer	Brings the item back on the Follow Up On date
Claim	Records Sent	Records Sent On, Sent By and Attachment Control #, and brings the item back on the Response Due date
Visit	Not Billable - Closed	Cancels the visit with a reason. Duplicate Visit and Covered Under Another Encounter also ask for the other visit
Visit	Bill It	Creates the visit’s claim now, and closes the item
Visit	Check Back	Brings the item back on the Follow Up On date

Item kind	Outcome	Reasons
Claim	Write Off	Timely Filing, Administrative, Small Balance, Contractual
Visit	Not Billable - Closed	Duplicate Visit, Not a Billable Service, Covered Under Another Encounter, Entered in Error

Follow Up On defaults to the plan’s follow-up interval, or two weeks, and Appeal By to two weeks before the payer’s deadline, shown beside it. A dated outcome makes the item Waiting until then, or until Return to Queue. The next sweep updates an open item’s age and closes it once the payer’s share is settled or the visit billed. The sweeps run once scheduled on Tasks and Schedules.

Statement Review

A held statement is one decision: mail it or not. Holds names each reason, and Bill To is the one thing you can repair here, as on The Statement Page. A restriction hold links to the patient’s Billing Restrictions with Manage restrictions; a guarantor hold is fixed on the patient. Release re-runs the check, and a statement an error still holds is refused with Resolve N blocking findings before releasing this statement.

A Save Someone Else Beat

When someone else changed the record after you opened the item, your save is refused with Reload, which discards your unsaved changes; see A Save Was Refused. In Statement Review it shows in the save bar. Everywhere else the action bar reads “Your changes weren’t saved”, or “Not resolved. Your changes weren’t saved” on the closing button.

Press ? for every keyboard shortcut.

States

• Queue complete and All Clear - nothing left to open: how many items were resolved, when waiting ones return, and Back to Work Queues.
• This Claim No Longer Exists (or Remittance, Visit or Statement) - the record was deleted. Skip Item asks a reason and sets the item aside.
• Draft restored - Claim Review keeps unsaved edits in this browser for seven days, dropped on sign-out. Other kinds keep none, and switching items with unsaved changes asks to save or discard.
• Someone else finished it - a banner says who completed, skipped, reassigned or moved the item, with Go to Next Item.
• This statement was already released or already voided.
• A pinned note - a banner above the workspace; see Record Activity.
• Blocked - without the work queues module the screen is not in the sidebar, and a saved link says the module is not part of your plan.

Related: Work Queues · Work a Queue Item · Review an Import Row · Work a Claim Review Item · Work a Remittance Review Item · Bill Patients for What They Owe