Workers’ Compensation Ticket Creation SOP

This SOP provides the general requirements for creating a Hubspot Ticket to have the AR Team work on outstanding workers comp and auto injury claims.

vOverview

Our Costa Rica office has an AR team dedicated to working all outstanding Workers’ Compensation claims, Auto Injury claims and Attorney liens. The Customer Success Team is responsible for providing a list to the work comp AR Team of outstanding workers’ compensation type claims that require follow up.

Any claims to be worked by Costa Rica AR team must be over 45 days in no response prior to being sent to this team. Below is a guide on how to create and populate these tickets correctly so our AR teams can provide effective follow up and/ or resolution and payment on them.

Step 1: Populating a WC Ticket

1. Open a Hubspot Ticket as follows
   1. Locate the company record (Parent company unless you need a child practice worked- if unsure use parent company record)
2. Populate the properties on your ticket per the below:
   1. Ticket Name: WC (or Auto, Lien if that type of AR ticket) + Payer Name (example: WC/ Corvel or Auto/ Gieco)
   2. Pipeline: Service Pipeline 2 (Blitz/FTE, Billing Support, WC/Auto)
   3. Ticket Type: WC/Auto
   4. Description: List Document ID number from PM report for follow up. Describe anything that you need if outside normal follow up including any portal logins or where these are to be found. ( Example: StateFarm claims show payer as StateFarm but MedRisk processed all claims. Please contact Medrisk for status using payer portal login found in practice settings.) 
   5. Source- Blank
   6. Ticket Owner- Name of ticket creator/ advisor/ Ops consultant
   7. Priority: Low
   8. Click Create

From the ticket please update the following:

j. AR Blitz & Billing Support

Check box for AR Follow up on AR Blitz actions and then add the below. 

i. Document ID submitted- mark Yes as long as ID was in description.

ii. Encounters Submitted - enter number

iii. Encounter amount submitted- enter dollar amount of claims submitted

Step 2: Reviewing Returned Work - AR Team Actions & Success Team Audit

The AR team will need to check off and document the ticket as follows

1. AR Rep who picks up ticket for working will update the "Assignment" field with their name when they begin work. 
2. When tickets are completed by the AR Team will return in stage Audit, it is the responsibility of the AR Team representative to reach out to their manager and the ticket creator/ Success Team to provide ETA of completion if it will take longer than expected. 
3. The Work Comp team will take all necessary actions such as printing any claims, submit medical records or appeals batches and will document all the actions in the excel spreadsheet for the Success Team to review. 
   1. Any PHI regarding the work being done on a ticket will be found in the Billing Software document storage spcace. 
4. Review returned Excel document in Billing Software document storage space for all claim status notes, actions taken, etc. Please communicate any mistakes to the Superisor of RCM in Costa Rica so it can be use as a training tool. 
5. If there is no new excel attached in the PM documents for this account work, please return the ticket with comments to provide an Excel document in the PM and reference Document ID number then chatter Superisor of RCM in Costa Rica and representative who worked on your ticket.
   1. on checklist- mark Completion Document Added
   2. Document ID completed- YES and notes with new document ID for completion notes
   3. Encounters completed number
   4. Encounters amount completed number
   5. Completion date added

    6. The ticket will automatically move back from the work comp team to the Success Team Member / ticket creator who initiated theh ticket request when stage is in AUDIT. The team member will then review and take any necessary actions. 

    7. Once all actions have been completed for the ticket, then mark the ticket as "Audit Completed". This will automatically close the ticket.