Debunking Accounting Exceptions

Overview

We call events that occur outside the expected workflow “exceptions”, and these typically indicate that some kind of error or defect had taken place.

The Accounting Exception assignment is present when an accounting exception is identified. Agents see this assignment in the Paid or Denied step and in the Daily Critical assignment group.

It’s critical that the accounting defect is resolved correctly because accounting adjustments have compliance implications associated. Accounting exceptions can happen for a number of reasons and it's often best to submit a support ticket so that Quavo can identify the issue, solve the defect, and ensure adjustments are correctly processed.

Process

1. Start by reviewing the Accounting tool. Often times an entry is missing, which is throwing off the balance.

   • Review the Collection balances. Suspense should be $0.00
     Example
     The claim was denied but the Suspense account shows a $100 balance. We need to figure out why the balance is not $0 and make the appropriate debit adjustment.

     Open

     

   • Use a similar, resolved claim to show you what entries should be present.
     Example
     This claim was denied and is the same claim type as the example above. We can review the history of adjustments on this claim to give us an idea of what adjustments should occur.

     Open

     

      

2. If you’ve identified the missing adjustment, correct the error that caused the exception by adding manual adjustment entries. Note that the accounting system will attempt to complete the adjustment if the box "Is only for tracking purposes (no accounting performed)?" is unchecked. 

   • Example
     We identified that an extraneous Return adjustment was processed and must be reversed.

   • Example
     The Suspense balance is $0.

      

3. Return to the Paid or Denied step and click the Accounting Exception Resolved button.

4. Click Process Actions to finalize the task.

Tips

• The Suspense balance should be $0, so start there if there’s a balance remaining

• The exception could be an incorrect adjustment, extra adjustment, or missing adjustment

• Any additional adjustments made to clear the exception should be equal or similar amount to the remaining balance. For example:

  • The Suspense balance is $50

  • An additional adjustment for $5,000 will likely create more issues

• If at any point you need assistance, please submit a ticket via QCC for expert-level guidance