Specify Account Worklist Criteria

Use this page to specify criteria for the Account Worklist, Worklist Summary, or Master Account Worklist.

Click Try the new search feature link in the top right corner to access the new Worklist Criteria page.

Note: Not available for all facilities at this time. Also, not available for any facility in Audit mode.

Procedure

To access the Account Worklist Criteria page, select Go To > Account Research > from Worklist.
To use a previously saved filter, select the filter name from the Select Saved Filter list and click Display Accounts. If you do not want to use a saved filter, proceed to the next step.
Select the type of worklist you want to create from the Task list.
- Select Create Worklist to display the Account Worklist page. The Account Worklist allows you to create a worklist of all the accounts in your facility that meet a certain set of criteria. For example, you can create a worklist to list all accounts that are suspected underpayments. For more information, refer to View the Account Worklist .
- Select View Summary Results to display the Worklist Summary for All Products page. The Worklist Summary is similar to the Account Worklist, but it summarizes the accounts by product. For more information, refer to View the Worklist Summary .
- Select Create Payor Worklist to display the Payor Worklist page. This option is only available if Coordination of Benefits (COB) is enabled for your facility. The Payor Worklist allows you to view account details at the payor level.
  - For more information about the Master Account Worklist, refer to View the Payor Worklist.
  - For more information about COB, refer to Coordination of Benefits.
- Select Create Master Account Worklist to display the Master Account Worklist page.
  - The Master Account Worklist allows you to view account details at the master account level.
  - For more information about the Master Account Worklist, refer to View the Master Account Worklist.
Select Primary, Secondary, or Tertiary from the Payor Class field. This option is only available if Coordination of Benefits (COB) is enabled for your facility. For more information, refer to Coordination of Benefits.
Select a filter description from the Filter Description options. This selection affects the options for the next field.
- Select Product to search for accounts by product.
- Select Contract to search for accounts by contract profile.
- If you are working in Audit Mode, you can select Model to search by a specific model.
Do one of the following:
- If you selected Product or Contract as your filter, select a product or contract description from the list.
  - Select All Products for Facility or All Contracts for Facility to display all results.
  - Select a single name to display results for that name.
- Enter the payor code(s) you want to search for.
  - Separate multiple payor codes with a comma and no space. For example, “01234567,02345678.”
  - Leave this field blank to return claims for all payor codes.
  - You can also select an operator such as Equals, Does not equal, Starts with, and so on. For example, selecting Starts with and typing “01234” returns all accounts that begin with 01234.
- If COB is enabled, and you are creating a Master Account Worklist, you can define product, payor, or contract criteria for primary, secondary, and tertiary payors. Note that these criteria are combined. For example, if you select Payor A as the primary payor and Payor B as the secondary, only accounts that have Payor A as primary and Payor B as secondary are returned in your results.
To select multiple products or contract profiles, select Custom Selection from the Product Description drop down list. WIth this action, the Custom button appears.
- Click Custom to open the Multiple Product Selection or the Multiple Contract Selection window.
- Select the check box for each product or contract profile you want to include in your search.
  - To select all products or contract profiles, click Select All.
  - To clear the check box for all products or contract profiles, click Clear All.
- Click Select. The window closes.
Select an account category from the Account Category list to limit your search to specific types of accounts.
- This field defaults to All Accounts, but the following options are also available:
  - All Accounts
  - Suspected EOB Underpayments
  - Suspected Underpayments
  - Suspected Overpayments
  - Potential Denials
  - Paid Correctly
  - No Payment Received
  - Payment Received
  - Unusual Accounts
Select a patient type from the Patient Type list to limit your search to specific types of patients.
- This field defaults to All Patients, but the following options are also available:
  - Inpatients Only
  - Outpatients Only
- When you select All Patients or Outpatients Only, the following options are also available:
  - Select All to include all accounts in the selected category.
  - Select Exclude Recurring Outpatients to include all accounts in the selected category except recurring outpatients.
  - Select Only Recurring Outpatients to only include accounts that are marked as recurring outpatient accounts.
Select the type of date you would like to search by from the Date Type list.
- This field defaults to Service Through Date, but the following options are also available:
- Submit Date
- Admit Date
- Last Payment Date
- Latest EOB Processing Date
- Latest FinThrive Processing Date
- RA Date – This option is only available if your facility uses the Remittance Advice (RA) feature. This option is not available for a Payor Worklist.
- Payor Last Modified Date – This option is only available if COB is enabled; the payor class shows as modified anytime there is an override, reprice, or similar account change.
Type a start and end date for your search in the Start Date and End Date fields.
- The start and end date limits your search to accounts with a date between the dates you specify. The type of date considered by your search is determined by the Date Type field.
- To select a date from a calendar, click the calendar icon next to the field.
- To have the End Date field default to today’s date in future searches, select the Always use current date check box.
Select the check box for each optional criteria you want to include in your search and define the parameters for that criteria. For more information about a specific search criteria, refer to the Field Descriptions table below.
Note: Options available within the Optional Selection Criteria section are based on if COB is enabled for your facility, and the task you select.
To save your current selections to use in the future, you can use the following options in the Filters section. Otherwise proceed to the next step.
- Click Save Filter to save and name the current selection criteria settings for future use. Enter a name for your filter in the Save As field and click Save.
- Click Save Filter and Get List to save and name the current selection criteria settings for future use. The Worklist automatically opens after the filter name is saved, without clicking Display Accounts.
- Click Rename to rename a saved filter.
- Click Delete to delete a saved filter.
Click Display Accounts. Depending on what you selected in the Task field, either the Account Worklist, Worklist Summary, or Master Account Worklist page opens.
- If you have access to the Query Queue feature and are running a large or complex worklist, you can select the Add to Query Queue check box to run the worklist as a queued query and prevent system time outs.
  - If you select the Add to Query Queue check box, a progress window opens to show the status of your query once you click Display Accounts. When the query is complete, this window closes and the Account Worklist or Worklist Summary page opens. For more information about the query queue feature, refer to Query Queues.
  - The Add to Query Queue option is not available for the Master Account Worklist or Payor Worklist options.
- For more information about the Account Worklist, refer to View the Account Worklist .
- For more information about the Worklist Summary, refer to View the Worklist Summary .
- For more information about the Master Account Worklist, refer to View the Master Account Worklist.
- To clear your criteria and return to the default selection criteria, click Reset to System Defaults.

Field Descriptions

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

Field	Description
Filters
Select Saved Filter	Allows you to create or retrieve a search filter.
Selection Criteria
Account Category	Type of account(s) to search for
Always use current date	Selecting this check box always uses the current date as the end date if you save the search criteria as a filter and use that filter on a future date.
Date Type	Date type associated with the line item
End Date	Last date in the date range of the date type selected
Filter Description	Specifies the type of filter used: Product, Payor Code, or Contract
Patient Type	Patient type assigned to the account: Inpatient/Outpatient.
Payor Class	Payor class associated with the account, either Primary, Secondary, or Tertiary. This option is only available if COB is enabled for your facility. For more information about COB, refer to Coordination of Benefits.
Payor Code(s)	Payor code associated with the product
Product/Contract Description	Description of the product or contract; to select multiple products or contracts, select Custom Selection and click the Custom button
Secondary Product/Contract Description/Payor Code(s)	Description of the product or contract or payor code(s) for secondary payors. This option is only available if COB is enabled for your facility. For more information about COB, refer to Coordination of Benefits.
Start Date	First date in the date range of the date type selected
Task	Indicates whether you want to create an Account Worklist, Worklist Summary, Payor Worklist, or Master Account Worklist
Tertiary Product/Contract Description/Payor Code(s)	Description of the product or contract or payor code(s) for tertiary payors. This option is only available if COB is enabled for your facility. For more information about COB, refer to Coordination of Benefits.
Optional Selection Criteria
Activity in the last “X” days.	Specifies, within “X” number of days, any activity on the account. Activity is defined as an account that was repriced or an account that received a payment within the “X” days. By default, this option ignores your entries in the Start Date and End Date field. To limit activity to the date range specified in these fields, clear the Ignore Start/End Date check box.
Additional Amount	Specifies the criteria of greater than, less than, or equal to a specific amount for the following values: Account Balance Actual Discount Late Charge Alternate Calculation Insurance Payment Expected Discount Expected Payment Billed Charges Patient Payment Cost Profitability You can use the AND/OR field to specify an additional value or a combination of values to use in your search. The late charge alternate calculation allows you to search for accounts with associated late charges. For more information, refer to Alternate Late Charge Calculation. The Cost and Profitability options are only available 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.
Bill Type	Specifics the 3 digit code displayed on a UB that provides specific information about the intent of the claim. The first digit describes the type of facility, the second digit classifies the type of care being billed, and the third digit indicates the sequence of the bill for a specific episode of care. For example: 117 stands for an acute care facility - inpatient - replacement of a prior claim. To view bill type digit information, refer to Bill Types
Calculation Method	The Coordination of Benefits (COB) calculation method used for secondary or tertiary payors. The details of the calculation method are listed in the drop-down list. Your worklist returns accounts based on the calculation method associated with the account, not the calculation method associated with the contract profile. This option is only available when you select Create Payor Worklist from the Task list and then select Secondary or Tertiary as your payor class. For more information about calculation methods, refer to COB Language Types.
Day Filter	Specifies the type of day filter used and allows you to select an operator and enter a number of days. 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 For example, to search for accounts where the difference between the submit date of the claim and the date of the initial payment is more than 30 days, select Days to Payment, select the > (greater than) operator, and type “30” in the text field.
Denial Amount	Specifies the criteria of (greater than, less than, or equal to) the denial amount. This field only displays if your facility is set up for Contract Manager Denial Management. For more information, refer to Denial Management Methodologies.
Denial Resolution	Specifies specific denial resolutions to include in the search; options include All, Resolved, and Open. This field only displays if your facility is set up for Contract Manager Denial Management. For more information, refer to Denial Management Methodologies.
Denial Type	Specifies the type of denials to include in the search; options include All, Final, Information, Pending, and Review. This field only displays if your facility is set up for Contract Manager Denial Management. For more information, refer to Denial Management Methodologies.
Denials	Specifies whether to include accounts that were identified as denials by FinThrive Denials Management. You can select to include Denial Accounts Only or to limit your search to Non-Denial Accounts. Leaving this option unselected includes both denial and non-denial accounts in your search. This field only displays if your facility is set up for Integrated Denial Management. For more information, refer to Denial Management Methodologies.
Discharge Status	Specifies where the patient is physically located at the time of discharge or where the patient is located at the end of the billing cycle. When selecting the search criteria for your worklist, you can enter multiple discharge status codes separating each code with a comma.
DRG/APC/CMG (Highest Value)	Includes or excludes the specified DRG/APC/CMG codes with the highest value.
Exclude Stop Cap	Selecting this check box excludes accounts identified as meeting the stop cap threshold. Stop cap is a clause in a contract/proposal that adjusts the reimbursement of claims with low charges and high reimbursement. Stop cap accounts are indicated by a (c) in the Service type column of the results.
Exclude Stop Loss	Selecting this check box excludes accounts identified as meeting the stop loss threshold. Stop loss is a clause in the contract/profile that adjusts the reimbursement of claims with unusually high charges or lengths of stay. The contract/proposal sets a condition based on a threshold of charges or days. Stop loss accounts are indicated by a (s) in the Service type column of the results.
Extended Search	Specifies revenue codes, procedure codes, HCPCS/Rates, diagnosis codes, transaction codes, APC Codes, APG Codes, EAPG Codes, Medicare Provider Numbers, or Charge (CDM) Codes. You can enter multiple codes separated by commas (or dashes to specify ranges), such as 270, 271, 200-300, 425. Ranges do not apply to Procedure Codes, HCPCS/CPT, Diagnosis Codes, or Transaction Codes. The options that are available are determined by your facility and user settings. To select multiple types of codes: Select Custom Selection. The Custom button appears. Click Custom to open the Multiple Extended Search Selection page. Select the code type, operator, and value that you want to include in your search. Select AND to add additional code types. You can add up to four code types in a single worklist. When all code types are defined, click Select to return to the Account Worklist Criteria page. Note: If you select multiple code types, only accounts that contain all of the selected codes are included in your worklist.
Flag Display	Specifies flagged or unflagged accounts
Late Payment Penalty	Includes only accounts to which a late payment penalty applies as defined in the contract for this account
Medicare Outlier	Provides research for Medicare accounts that do or do not reprice with an outlier
Only Account Overrides	If applicable to your facility or log-on authorization, includes only accounts with overrides.
Only Pass-Throughs	Includes only accounts with pass-through service types in the contract document. These are service types for which the facility can collect amounts in addition to the per diem or case rate (such as implants, high-cost drugs and prosthesis). These service types are identified in the Pass-Through section of the Contract Profile
Only Reversals	Includes only previously repriced accounts that have new data
Only Write-downs	If applicable to your facility, includes only accounts for which FinThrive has already sent write-downs to the facility
Only Zero Balance	Zero balance accounts
Opportunity Type	Includes only accounts where the expected reimbursement is limited to the billed charges by the contract language in the following scenarios: All - Includes all accounts, regardless of opportunity type Contract - Reimbursement was capped based on the Stop Cap section in the contract Line Item - Reimbursement was capped based on the line item Not Capped - Reimbursement was not capped Contract or Line Item - Reimbursement was capped based on either the Stop Cap section in the contract or the line item Contract and Line Item - Reimbursement was capped based on the Stop Cap section in the contract and the line item
Patient Liability	Specifies the criteria to search for patient liability amounts To only show accounts where the patient liability is not specified, select Patient Liability is not specified from the Patient Liability list. To only show accounts where the patient liability is equal to the account balance, select Patient Liability equals Account Balance from the Patient Liability list.
Payment Ratios	Specifies an expected or actual payment-to-charge ratio
RA Claim Status	Selecting this check box includes or excludes the selected status. Selecting a status limits your search to accounts with the selected status only. This option is only available if your facility uses the Remittance Advice (RA) feature and is not available for the Payor Worklist. For a description of each RA claim status, refer to Remittance Advice Status Codes.
RA Payment Code	Selecting this check box limits your results to accounts with the specified RA payment code(s). You can enter multiple codes, separated by a comma with no spaces. If you are unsure of the RA payment code, click Lookup to view a list of available codes. This option is only available if your facility uses the Remittance Advice (RA) feature and is not available for the Payor Worklist. For a description of each RA payment code, refer to Remittance Advice Reason Codes and Remittance Advice Remark Codes.
Reprice Types	Allows you to include or exclude specific types of reprices in your search. The available types are determined by your facility, but typically include Standard, MCR Part-B Vaccine, CMS-1500 (Hospital-based), MCR Part-B, and Recurring OP. To select multiple reprice types, select Custom Selection and click the Custom button. For more information about reprice types, refer to Multiple Reimbursement Calculations > Reprice Types.
Secondary Payor Name	An insurance policy, plan, or program that pays an additional amount on the portion of a claim not paid by the primary payor
Service Type	Service type code
Stop Cap	Selecting this check box limits your results to accounts identified as meeting the stop cap threshold. Stop cap is a clause in a contract/proposal that adjusts the reimbursement of claims with low charges and high reimbursement. Stop cap accounts are indicated by a (c) in the Service type column of the results.
Stop Loss	Selecting this check box limits your results to accounts identified as meeting the stop loss threshold. Stop loss is a clause in the contract/profile that adjusts the reimbursement of claims with unusually high charges or lengths of stay. The contract/proposal sets a condition based on a threshold of charges or days. Stop loss accounts are indicated by a (s) in the Service type column of the results.
User Code	Specifies a user-defined FinThrive or Client (customer) user code; four digit maximum. If you select Between as an option, you can specify a range of user codes, such as all user codes between 400 and 600 (inclusive). The User Code field allows you to find accounts that currently have the selected user code associated with them.
User Code History	Allows you to find accounts that have historically had the selected FinThrive or Client (customer) user code associated with them (currently or previously).
User Comment History	Allows you to find accounts based on the text included in any user comment associated with the account.
Variance Amount	Specifies the discount or payment variance in relationship to (greater than, less than or equal to) a dollar amount or a percentage.