View the Payor Worklist

The Payor Worklist allows you to create worklists at the payor level and to more easily identify secondary and tertiary expected payments. Like the Account Worklist, the Payor Worklist provides links that let you drill down to more detailed account information at both the account and payor level.

The Payor Worklist displays aggregate totals for all accounts and payors associated with the same account number. All dollar amounts reflect the total amounts for the payor level as a sum of all the associated accounts for that payor. For fields that do not display a combined calculation, such as DRG, Bill Type, and Reprice Type, the value for the primary account displays. The primary account is determined as the account with the highest expected reimbursement.

The Payor Worklist is only available if Coordination of Benefits (COB) is enabled for your facility. For more information about COB, refer to Coordination of Benefits.

Use this procedure to review accounts on the Payor Account Worklist page.

Procedure

Access the Payor Worklist page.
- Select Go To > Account Research > from Worklist. The Account Research from Worklist page opens.
- From the Task list, select Create Payor Worklist.
- Specify other selection criteria and click Display Accounts. The Account Worklist page opens. For more information about search criteria, refer to Specify Account Worklist Criteria.
Note: PEM claims are not included in worklist result
Select one of the following options from the Display list:
- Select All records for Payor to display one line item for each individual account.
  - This option enables the flagging feature so you can flag individual accounts.
- Select One record for Payor to display one line item for each payor. In this view, each line shows totals for all accounts under a common payor, tha3t is, all accounts with a common account number and payor.
  - This is the default view.
  - For columns that do not show totals, such as DRG, Bill Type, and Reprice Type, the value from the primary account displays.
  - Variance amounts show a total variance for all accounts with a common account number and payor.
Click Refresh View.
Review the Payor Worklist.
- Note that flagged accounts have a white rather than pale yellow background.
- An asterisk (*) appears next to the number in the No. column for an account to which an override was applied and the reprice was completed.
- For accounts with non-covered charges, the non-covered charges are subtracted from the billed charges and expected discount.
- To view the Patient Account Audit page for a particular account, click the account number in the Account Number column. For more information, refer to View the Patient Account Audit Page .
- The number of payors and accounts associated with the account number display in parentheses. For example, if there are two payors and three accounts associated with the same account number, the account number displays as “012345678 (2,3).”
- To display the Worklist Summary page for your current selections, click the name of the product in the Product field in the Selection Criteria section. For more information about the worklist summary, refer to View the Worklist Summary .
To change your current view options:
Note: This option is only available in the All records for Payor view.
1. Select one of the following options from the View list.
  - Select Single Line, which is the default view, to view one line of information per account.
  - Select Details to display a more detailed view of the worklist (which includes the patient service dates, the earliest claim submission date, earliest payment date, service type, plan name, FinThrive processing date, and other information).
2. Click Refresh View.
To change you sort options to sort by a different column or in a different order:
1. Select the name of the column you want to sort by from the Sort By list.
2. Select whether you want to sort in Ascending or Descending order.
3. Click Refresh View.
To flag an account so that it appears as a flagged account and is included in worklists that only include flagged accounts:
1. Select the check box to the left of the account number to mark it for flagging. You can mark up to 5 accounts at a time.
2. Click Flag Account to display the Assign/Update Collection Information page. For more information about this page, refer to Assign / Update Collection Information.
3. Click + (to the left of the account number) to expand the options. The Flag Account check box is already selected.
4. Click Save Changes to save the flag.
When you flag an account, the background for that account turns white once the page is refreshed. The background also turns white on the Assign/Update Collection Information page, and a green check mark appears in the column to the left of the + column on the Comment line to show that the account is flagged.
To remove the flag on an account:
1. Select the check box to the left of the item in the worklist.
2. Click Remove Flag. The Assign/Update Collection Information page opens.
3. Click + (to the left of the account number) to expand the options.
4. Clear the Flag Account check box.
5. Click Save Changes to remove the flag.
To export your worklist to an Excel or text file, click Export. The Account Worklist Export Options page opens. For more information, refer to Specify Worklist Export Options.
The following columns also contain hyperlinks that let you drill down into additional information for a selected account:
- Click a link in the Service Type column to display the Service Type Definition page. The Service Type Definition page shows how the service type is defined in the system.
- Click a link in the DRG/APC/CMG column to view a description of that code.
- Click a link in the Bill Type column to open the Billing Type Definition page for a description of the selected bill type.
- Click a link in the Message Code column for a description of that message code.
- Click a link in the Patient Liability column to override the patient liability for the selected account.

Field Descriptions

The following table describes each of the fields on the Payor Worklist page. The fields are sorted by section and listed in alphabetical order.

Field	Description
Submitted Criteria
______ Date	Date range for your query. The type of date that displays is determined by your selection in the Date Type field. For example, if you selected “Submit Date,” this field displays as “Submit Date” and shows the selected date range.
Account Category	Types of account(s) included in the worklist
Contract	Name of the contract profile
Flag Display	Whether or not flagged accounts are shown
Patient Type	Patient type assigned to the account: Inpatient/Outpatient
Plan IDs	Plan IDs included in the worklist
Product	Name of the insurance product
Secondary Plan IDs / Contract / Product	Plan IDs, Contract, or Product for secondary payors. This field only displays if COB is enabled for your facility. For more information about COB, refer to Coordination of Benefits.
Sorted By	Order in which the results are sorted
Tertiary Plan IDs / Contract / Product	Plan IDs, Contract, or Product for tertiary payors. This field only displays if COB is enabled for your facility. For more information about COB, refer to Coordination of Benefits.
Optional Submitted Criteria
Additional Amount	Specifies the criteria of (greater than, less than or equal to) account balance, actual discount, actual payment, expected discount, insurance payment, billed charges or patient payment AND/OR (greater than, less than or equal to another amount)
Calculation Method	The Coordination of Benefits (COB) calculation method included in the worklist. Calculation method is limited to secondary or tertiary payors. For more information about calculation methods, refer to COB Language Types.
Patient Liability	Specifies whether patient liability amounts were included in the search
User Code	User-defined code; four digit maximum
Variance Amount	Specifies a discount or payment variance in relationship to (greater than, less than or equal to) a dollar amount or a percentage
Variance By	Type of account variance employed in the search
Variance Percent	Specifies a percentage of variance in relationship to a dollar amount or a percentage
Results Area
Account Balance	Billed Charges, minus total payments, minus total adjustments
Account Number	Patient account number (for UB claims) or insured ID (for CMS-1500 claims). The number of payors and accounts associated with the account number display in parentheses.
Actual Discount	Total insurance adjustments for all accounts; Explanation of Benefits (EOB) write-off
Bill Type	Bill type
Billed Charges	The total charges incurred for the claim or set of claims that have been repriced
Cost	The actual cost amount associated with this account. Negative values display in red with parentheses. The Cost column only displays if your facility has a cost accounting system that sends Contract Manager cost on either a CDM or case level, and the cost and profitability feature has been activated for your facility. For more information, refer to Cost and Profitability Information.
Day	The number of days that display is determined by the day filter selected when creating the worklist. The available day filters include the following: Days to Payment – The difference between the submit date of the claim and the date of the initial payment Days Outstanding – The difference between the submit date of the claim and today’s date Length of Stay – The length of stay for the claim, in days If no day filter is selected, this column defaults to Days Outstanding.
Discount Variance	Expected Discount minus the Actual Discount
Display	Allows you to switch between the following views: One record for Master Account – displays one line item for each Master Account and shows totals for all accounts under that master account. For columns that do not show totals, such as DRG, Bill Type, and Reprice Type, the value from the primary account displays. All records for Master Account – displays one line item for each individual account. This view displays the same information as the Account Worklist.
DRG/APC/CMG (Highest Value)	The specified DRG/APC/CMG codes with the highest value on the account
Expected Discount	Billed Charges minus non-covered charges, minus Total Expected Reimbursement
Expected Insurance Payment	The calculated reimbursement based on the predefined contract terms and conditions and service type definitions in the system and the repriced claims data, minus patient liability
Expected PCR	Expected Payment-to-Charge ratio
Insurance Payment	The amount paid by the insurance company
LOS	Length of Stay, in days
Medicare Outlier Date	The date on which Medicare Inpatient claims reach the outlier threshold, based on detail charges
Message Code	Message code (a link to the message code description)
No.	Sequential reference number of the line item. An asterisk (*) appears for an account to which an override was applied and the reprice was completed
Patient Liability	The amount the patient is responsible for
Primary Expected Payment	The calculated reimbursement for the primary payor based on the predefined contract terms and conditions and service type definitions in the system and the repriced claims data, minus patient liability. This field only displays if COB is enabled for your facility. For more information about COB, refer to Coordination of Benefits.
Profitability	The profitability amount associated with this account. The profitability is calculated as the Expected Payment minus Cost. Negative values display in red with parentheses. The Profitability column only displays if your facility has a cost accounting system that sends Contract Manager cost on either a CDM or case level, and the cost and profitability feature has been activated for your facility. For more information, refer to Cost and Profitability Information.
Reprice Type	Indicates the reason the claim was repriced separately from other claims for this account. This column also helps to distinguish between multiple claims on an account. For more information about reprice types, refer to Multiple Reimbursement Calculations > Reprice Types.
Secondary Expected Payment	The calculated reimbursement for the secondary payor based on the predefined contract terms and conditions and service type definitions in the system and the repriced claims data, minus patient liability. This field only displays if COB is enabled for your facility. For more information about COB, refer to Coordination of Benefits.
Service Type	The highest ranked service type found in the Reimbursement section of the TAC. If the account matches a stop loss condition, an (s) precedes the service type name. If the account matches a stop cap condition, a (c) precedes the service type name.
Sort By	Allows you to specify the name of the column you want to sort your results by and the order (ascending/descending) of the sort
Tertiary Expected Payment	The calculated reimbursement for the tertiary payor based on the predefined contract terms and conditions and service type definitions in the system and the repriced claims data, minus patient liability. This field only displays if COB is enabled for your facility. For more information about COB, refer to Coordination of Benefits.
Total Expected Payment	The calculated reimbursement based on the predefined contract terms and conditions and service type definitions in the system and the repriced claims data
Total Payment	Insurance and patient payment posted to the account, as defined in the data
View	Allows you to switch between the Single Line summary view and the Details view