Navigating Queues: Provider Sessions, Services, and Case Closures
- Meagan Prost
Cloud Knowledge Base Home / Provider Relations / Providerfiles Provider Portal / Providerfiles Integration / Navigating Queues
Uncover the power of automation with the Providerfiles dashboard, revolutionizing claim data management. Say goodbye to manual data entry and hello to effortless electronic claim reviews.
Streamline your entire administrative process, from capturing and verifying service provider claims to maintaining impeccable financial records and ensuring top-quality service delivery.
In this guide we’ll review:
Action management for incoming provider sessions and case closures
Providerfiles facilitates provider submissions, placing them in a queue for your team's thorough review, approval, or denial.
Note: Providers are restricted to submissions aligned with the authorization, limiting the approved number of sessions.
Navigate to Integrations from the left-side menu navigation
Click on Providerfiles to open the dashboard
Ensure you are viewing the Portal Activity tab and scroll down the page, past the active authorizations
Click on the Incoming Files/Sessions tab to view this queue
Tip: Enhance organization by utilizing tab column headings to sort data. This is especially helpful for managing requests awaiting approval.
Notice the action buttons affiliated with this tab:
Review/Accept: When selecting a single provider item from the queue, utilize this button to review the submission and opt for acceptance or rejection. Opting for a quick acceptance will promptly approve the session without further review.
Accept All Pending Sessions: When clicked, this button will instantly approve all sessions in the current queue, eliminating the need for manual review.
Accept All Closing Files: Selecting this button will automatically approve all pending case file closures submitted, closing the case and transitioning it from 'Open' to 'Closed' in the provider's Files/Cases area within Providerfiles.
Accept All SAPs: Upon clicking, this button will promptly authorize all SAP sessions in the existing queue, eliminating the necessity for manual inspection.
Open File: After selecting a client from the queue, use this button to view a case file seamlessly directly within this dashboard.
Note: Providers can track the approval status of their sessions and services as they seamlessly transition from the 'Submitted' section to the 'Processed' area within the Billing section of their Providerfiles account.
Managing provider requests for additional sessions
When your team enables providers to request additional sessions through Providerfiles, items requiring review will be listed in this queue for approval or denial.
Navigate to Integrations from the left-side menu navigation
Click on Providerfiles to open the dashboard
Ensure you are viewing the Portal Activity tab and scroll down the page, past the active authorizations
Click on the Sessions Requests tab to view this queue
Please take note of the relevant action buttons associated with this tab:
Review/Accept: When selecting a single provider request from the queue, utilize this button to review the submission and opt for acceptance or rejection for the additional requested sessions. The quick accept option will promptly approve the requested sessions without further review.
Accept All SAPs: Upon clicking, this button will promptly authorize all SAP sessions in the existing queue, eliminating the necessity for manual inspection.
Open File: After selecting a client from the queue, use this button to view a case file seamlessly directly within this dashboard.
Processing provider organizational service submissions
When a provider closes an open organizational service, such as critical incident support, training, workshops, or orientations, it will appear in this queue for approval or denial.
Note: Providers are constrained by the organizational service authorization's parameters, which may restrict or extend reimbursable activities such as travel or meal disbursement.
Navigate to Integrations from the left-side menu navigation
Click on Providerfiles to open the dashboard
Ensure you are viewing the Portal Activity tab and scroll down the page, past the active authorizations
Click on the Services tab to view this queue
Please take note of the relevant action buttons associated with this tab:
Review/Accept: When selecting a single provider submission from the queue, use this button to review and accept or deny the organizational service. The quick accept option will instantly approve the submitted organizational service.
Accept All SAPs: Upon clicking, this button will promptly authorize all SAP sessions in the existing queue, eliminating the necessity for manual inspection.
Troubleshooting Information
Listed below are a few tips to assist with managing these queues:
Utilize Sorting Features: Take advantage of the sorting features within the queue. Use column headers or filters to organize sessions based on priority, submission date, or specific providers. This can streamline your review process.
Verify Required Information: Double-check that all necessary information is provided before approving or denying a session. Incomplete submissions may lead to delays or errors in processing.
Monitor Response Times: Keep an eye on response times within the queue. If there are delays or pending items, investigate and address them promptly to ensure timely processing.
Remember, if persistent issues arise, don't hesitate to contact your system administrator(s) for assistance.
