Overview
An optional workflow allows users to review that enables a manual review of claims that were abandoned or cancelled during the intake process. This workflow is disabled by default and must be explicitly enabled.
Settings
Pend and Review Abandoned Cases?
This setting must be enabled . Talk to your Client Experience representative for more informationto allow for the abandoned/cancelled claims workflow. Abandoned claims are claims that are not completed or cancelled within 8 hours. Cancelled claims are those that are withdrawn during the claim intake process.
Cancel Reasons
Require users to select a cancellation reason from a predefined list. Clients can determine how cancelled claims are handled whether they route for a manual review or resolve automatically.
Cancel Reason* | Free Form Text Required? | Cancel Reason Disclaimer | Should Route to Abandoned Claim Review | Should Auto Send Abandoned Correspondence |
|---|---|---|---|---|
Enter cancellation reasons or use our options below | Enable a required free form text box that must be completed by the user; the information here can be found in the Case Audit | Include a disclaimer, warning, or instructions for the user | Send the cancelled claim to a manual review | Automatically send out the Abandoned Claim letter |
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Examples
Cancel Reason* | Free Form Text Required? | Cancel Reason Disclaimer | Should Route to Abandoned Claim Review | Should Auto Send Abandoned Correspondence |
|---|---|---|---|---|
Customer recognized transaction - No longer in dispute | False | False | True | |
Disconnected call - Not enough information received | False | A review will be completed to ensure a callback or email was submitted | True | False |
Duplicate dispute on file | False | False | False | |
Started in error | False | False | False | |
System issue - Unable to submit | True | True | False | |
Customer withdrew | False | False | True |
Workflows
Auto-Resolve
When the claim is cancelled with a reason that does not route to a manual review, it is instantly resolved as withdrawn. If the Abandoned Claim letter is configured to send, it will generate and send in real time.
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Manual Review
Abandoned claims and claims that are cancelled with a reason that does route to manual review will generate the Review Unsubmitted Case task in the Non Reg assignment group. The assigned user will review the claim and determine next steps: resolve the claim as abandoned, submit the incomplete claim, or resume claim intake to complete the questionnaire.
References
| Stagil incoming links macro | ||
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