Account Research

Account Research in Contract Manager allows you to view accounts by account number or through a worklist. In either case, you can drill down to detailed information, such as:

  • Payments and adjustments
  • Detail line item charges
  • Expected reimbursement detail
  • The contract profile
  • The UB-04 claim form representation
  • The CMS-1500 claim form representation
  • DRG lookup tables (and other procedure code lookup tables)

Account Worklist

The Account Worklist is a powerful tool for following up on accounts. On the Account Worklist, you can view the account number, DRG, billed charges, actual/expected total payments, actual/expected total discounts and other information. Each account appears as a line item in the worklist, from which you can drill down to account details.

You use the Account Worklist to find suspected underpayments, daily reporting, and for defined searches. The Account Worklist allows you to specify criteria to search for a group of claims. The search can be general or very specific, depending on the selected criteria. You can also generate daily, monthly or quarterly reports that can be exported to a Microsoft Excel® or text file.

Worklist Summary

The Worklist Summary is similar to the Account Worklist, but it summarizes all accounts for a product. Typically, you use the Worklist Summary to identify the payor with the largest underpayments and then research the source or cause of the underpayments.

The Worklist Summary compares expected and actual payments or discounts (or other parameters you can select) for a product as a whole. Each product appears as a line item in the summary where you can research the Account Worklist for more details, if necessary.

The top portion of the page summarizes the product details in the Submitted Criteria and Optional Submitted Criteria sections. It also includes a sort option. The lower portion of the page displays the worklist summary.

Flagged Accounts

Once an issue is identified, Contract Manager allows you to “flag” accounts in order to keep record of status and action against an account. The following are typical reasons for flagging one or multiple accounts:

  • Notations of follow-up on underpayments
  • Suspected errors
  • To note an internal billing procedure

Contract Manager maintains a history of all flag comments on accounts. Once a comment is saved, no one can edit, delete or overwrite it.

When reviewing the worklist, you can flag accounts for monitoring and add comments. From the Account Worklist, you can flag accounts individually or up to five at one time. Refer to Collections Tracking if you work with collection information.