Tracking of missing data and follow-up at the guarantor and claim level is a basic feature of PiMS Collections.  The system produces automated worklists that provide appropriate information to allow the biller to make the proper follow-up decisions.

PiMS monitors the accounts and presents them to the biller’s worklist at the appropriate time, eliminating continual manual intervention. When the follow-up activity is complete, the worklisting criteria are again evaluated for the next follow-up event. The follow-up process, coupled with the automated billing process and automatic letter generation, creates a seamless billing and follow-up collection system.

Claims are displayed in follow-up date order. Claims are eligible to appear on the worklist when:

• A payment is posted but the final payment indicator is not turned on, claims that have been partially paid when a primary claim has been completed and the secondary claim is ready for review and that has not filed.
• When no payment activity has occurred or when the standard days for the last activity have expired which means claims have had no activity after a certain period of time.

Claims other than those ready for review will remain in the user’s worklist until payment is received or a new activity causes the claim to be rescheduled for action at a future date.

Activities are events that indicate a billing or collection function was performed. Activities record an action that has either occurred or needs to be taken. Activities can generate notes that are available for viewing in the View Account Notes function. Entering an activity will remove the claim from the worklist until the next follow-up date. PiMS will then reassign the entry to the appropriate worklist if the expected action has not taken place.

Worklists

When claims, missing information or guarantor balances are tracked and appear on a specific worklist it is based on an 'assignment' of the tracked information. The assignment is maintained by a profile to control the criteria and assignment. When the number of days for follow-up have expired, the system matches the assignment profile and places it on a worklist. The worklists can be assigned to a specific user ID or assigned a working ID and accessed by other staff. Worklist entries can be moved by the user from one worklist to another. Selecting a working activity will define when the worklist entry will be removed from the worklist and a next follow-up date for the next action. The worklists can be named for credit balance, small balance, high balance, review, missing diagnosis, missing documents - all of which can be user defined.

Automatic Letter Generation

PiMS provides the ability to print pre-formatted letters, tracers, or claim inquiry correspondence to insurance carriers, patients, and guarantors. In addition to letters generated by specific activities, the ability to create a letter series to augment or replace routine and scheduled statement or bill activity is provided. The letter series can also be utilized to accommodate small balance activities that require quality letter submission with specialized messages but without staff intervention.

A PiMS user can also generate letters based on an activity performed by that user working the account. Requested letter codes will be designated by the user for letter generation by PiMS on-line within the business office or during the batch process.