Journeys
The journeys an insurance approval officer walks, step by step. Each step opens the screen it happens on.
For an insurance approval officer
Ask a payer to approve a treatment
Send a prior authorization that does not bounce.Open Prior authorization.
Open screen 2Prior authorization setupPrior authorization setup.
Open screen 3Patient identityPatient demographics.
Open screen 4Insurance and coverageInsurance and coverage.
Open screen 5Clinical contextClinical context. Optical requests hide what does not apply.
Open screen 6Care teamCare team (section 6). At least one member is required.
Open screen 7DiagnosesDiagnoses with a searchable ICD-10 list.
Open screen 8ServicesServices. Net amount and shares are calculated and checked.
Open screen 9Review and submitReview. A missing care team shows as Required.
Open screen 10Authorization resultRead the result: approved amount, patient share and outcome.
Open screenExtend an authorization that is about to expire
Keep a valid approval alive.Handle an authorization the payer started
Pick up payer-issued approvals that you never requested.Poll NPHIES. Old results clear before the new one shows.
Open screen 2Advanced authorizationOpen Advanced authorization.
Open screen 3Advanced authorization detailRead the coverage and the linked patient.
Open screen 4APA communicationSend a communication or a cancellation against it.
Open screenFix a denied or errored authorization
Correct it and ask again.Cancel a request
Stop a request that should not go on.Send a vision request
Vision requests get their own section.Resume a prior authorization draft
Pick up where you stopped.Answer a payer question
Reply with the right attachment.Change an amount after an exception
Override a net amount with a reason.Work your queues
Expiring authorizations and payer questions, oldest first.Take over a colleague's case
Keep work moving when someone is away.Receive an authorization without polling
The portal asks NPHIES on a schedule.When NPHIES is down
Save the request and send it later.For everyone
Sign in
Get in safely. After sign in the wireframes ask who you are; the real portal opens the home of your own role.First sign in
Replace the temporary password, then enroll.First time with two-step sign in
Enroll before you continue.Lost your phone
Get in without the Authenticator app.Forgot the password
Recover without calling anyone.Your password expired
Replace it when the policy says so.Ask for an account or for access
No account yet, or the wrong role.Look after your own account
Password, sessions, history and notifications.Time out and sign out
What happens when you step away.When you cannot open something
A clear reason and a way forward.A record of another facility (CL-30091) shows as a hidden row with no patient details. The Administrator and the Auditor read every facility, so they see it listed with its facility in the Multi-facility state.
Open screen 2This record belongs to another facilityClick the hidden row. Read why, then go back.
Open screen 3HomeOpen an area your role does not have.
Open screen 4No access to this areaAsk for access. The request is sent and logged.
Open screen 5Page not foundA wrong address ends here.
Open screenWhen the portal or NPHIES is down
Know what is saved and what is not.Find help
Get an answer without leaving the portal.Hospital flows, end to end
Flows that cross roles. Each step names the role that does it. A step you can open in your own menu is a link. A step that only another role can open is shown as text with that role named.
Patient arrives to cash collected
The revenue cycle, from the front desk to the bank.Check eligibility before the visit.
Open screen 2ReceptionistEligibility resultRead the answer, print it for the file, hand the case to the approval desk.
Open screen 3Approval officer (you)Prior authorization setupAsk for prior authorization.
Open screen 4Approval officer (you)Authorization resultRead the approval. It now shows in Ready to bill.
Open screen 5Claims officerWork queuesTake it from the Ready to bill queue.
Open screenReview and submit the claim.
Opens in the Claims officer menuSend it in a batch.
Opens in the Claims officer menuMatch the payment.
Opens in the Accounts receivable (A/R) menuRecord the payment notice.
Opens in the Accounts payable (A/P) menuRead the notice.
Opens in the Accounts payable (A/P) menuWhen NPHIES is down
Nothing is lost and nothing is sent twice.A banner says NPHIES is not answering.
Open screen 2ReceptionistReview and submitSave and send later.
Open screen 3Approval officer (you)Review and submitSave and send later.
Open screenSave and send later.
Opens in the Claims officer menuSee what is saved.
Open screenSee what was sent after the recovery (second release option).
Opens in the Administrator menuWhen the hospital system is down
Desks keep working where the fallback allows, and nothing is lost.A banner says the hospital system is not answering.
Open screen 2ReceptionistPatient identityLookup is unavailable. Enter the patient by hand if the fallback allows.
Open screen 3Approval officer (you)Care teamPractitioners come from the last known copy, marked as not refreshed.
Open screenThe service catalogue is read only until the source is back.
Opens in the Claims officer menuRead the status and the fallback per entity.
Opens in the Super admin menuAfter recovery, fix the rows that failed.
Opens in the Super admin menu