Abandoned Claims Workflow

Overview

An optional workflow 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 to 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 Cancelled claims are those that are withdrawn during the claim intake process.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

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

Cancellation reason, free form text box, and disclaimer are enabled

Examples

Cancel Reason*	Free Form Text Required?	Cancel Reason Disclaimer	Should Route to Abandoned Claim Review	Should Auto Send Abandoned Correspondence

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When the claim is cancelled with a reason that does not route to a manual review, it is instantly resolved as withdrawn.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.

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.

QFD Knowledgebase