Workflow Queues

Last Updated v1

Inside the queue itself, you will see listed any outstanding transactions that need to be worked.  There are multiple tabs available at the top of the queue list for different transaction statuses.  See the definitions below.

• Narrow the list down by using any filter(s) at the top of each column.
• The tabs at the top of the queue list show different transaction types: NEW, WAIT MORE INFO, INFO RECEIVED, and TRANSACTION HISTORY.
  • NEW - Transactions that have not yet been reviewed or processed, or have been reopened by the customer.
  • WAIT MORE INFO - Transactions that have been sent back to the requester (Client or Provider) for more information.
  • INFO RECEIVED - Transactions that have come back from the requester, and are now ready for second review.
  • TRANSACTION HISTORY - View all transactions that have processed through this queue in the past.  Add notes or reopen any transaction as needed.
• Click the transaction from the list to be worked.

Transaction Detail

The transaction detail screens below allow the Admin users to correspond with the requester, add notes and attachments, transfer to another queue, answer questions, view Claim or Provider information, questions/forms and queue history, etc..

Customer Dialog Panel

• Use a template to fill in the note box, or type a note manually.  Templates can be designed in the SETUP - NOTE TEMPLATES main menu option (Setup admin access required).
• Click the Save button to permanently attached the note to this transaction.
  • These notes are immediately visible to the requester.
• Click the Print button to print a copy of the note dialogue to a printer or PDF.

Internal Notes Panel

Notes (Tab)

• These notes are only seen by internal Admin Center users.  Use these notes to communicate internal information regarding this transaction to the next Admin user that may review this transaction.
• Enter a note, and click the Save Note button.
• Pinned notes - Important notes can be pinned to the top of the Internal Notes list by selecting the Pin icon next to the note to be pinned.

Attachments (Tab)

• These attachments are only seen by internal Admin Center users.  They can be used to attach related information to the transaction for internal processing.
• Click the Choose File button to browse the local computer for a file to attach.  The restrictions for file types and size are shown on the screen.
• Once the attachment file is selected, click the Save Attachment button to complete the process.  The file will now be permanently attached to the transaction.
  • A record of the attachment name, upload date, and user that completed the attachment will be shown .
• Click any attachment to download and view it.

Check Out Panel

• When a transaction is opened in a queue, the system automatically performs a "soft check out".  This keeps the same transaction from being opened/worked by two people at the same time.  If the queue user times out, forgets to close the transaction, or improperly exits the transaction screen, the soft checkout process will automatically check the document back in (make it accessible/visible to another queue user) after a preset amount of time (usually 15-20 minutes).
• If the "Hard Check Out" button is selected, the system will override the soft check out process and keep this transaction permanently checked out to the user account until one of the following options take place.  This feature allows the user working the transaction to come back and work the transaction at a later time or multiple times before completing their process.
  • 1 - The user that performed the hard check out checks in back in using the Check In button (only displayed if the transaction is already in a hard check out status).
  • 2 - The user that performed the hard check out completes the transaction using the "Close This Transaction" option described later in this help page.
  • 3 - The user that performed the hard check out forwards the transaction to another queue using the "Forward to Internal Queue" option described later in this help page.
  • 4 - An admin level user unlocks the transaction with the utility located in the Admin menu (admin access required).

Status Panel

• Respond To Customer - Two options are available:
  • More Information Is Needed - This will send the transaction back to the original requester along with any notes added in the Note box.  The notes should be precise in requesting what information is needed to complete the transaction.
  • Close The Transaction - This will complete/close the transaction.  The requester will receive notification of the close, and be able to see the response via any notes added in the Note box.
• Response To Customer (Note required).
  • Use a note template for common responses, or manually enter a note in the Note box for response.  These notes are stored in the same area as the Customer Dialogue notes.
• Click the Save button to complete the status update.
  • The transaction will close from the screen and return the user to the queue.

Forward To Internal Queue

If the transaction when to the wrong queue, had more than one question, or cannot be answered by you, you can forward it to another Admin Center queue to be worked.

• Queue - Select the queue to transfer to from the drop down list.
• User (Optional) - Select an Admin Center user to assign the transaction to when it reaches the new queue.
  • The Queue selection field must be completed to enable this field.
• Internal Note - This will add an internal Admin Canter only note for the user that receives the transaction in the next queue.
• Click the Save button to complete the forwarding process.
  • The transaction will close from the screen and return the user to the queue.

Bottom Tab Information

Transactions

• The transactions tab show detail about this transaction including number, the user that submitted it, (also an admin center user if there was impersonation), and the type of transaction.
  • All transactions are questions or forms and the details will be shown on the Form Versions tab.

Coverage Info

• This tab shows a snapshot of member demographic and coverage information.  This will help answer coverage questions without having to leave the Web eXchange system to review similar data in an adjudication system.
• Click on any coverage or dependent row to see detail.
• Click the View Plan link to view a copy of the plan document.

Claim Info

• This tab is only available on Claim Question Types.  This will help answer claim questions without having to leave the Web eXchange system to review similar data in an adjudication system.
• Click the EOB or Plan document buttons for views of those documents.

Queue History

• The Queue History tab show all queues this transaction has moved through.\
• Admin user and date/time stamps are added as the transaction flow in and out of each queue.