Finalize Claims

How to finalize the lifecycle of claims

Aubree Dorr avatar
Written by Aubree Dorr
Updated over a week ago

The Finalize Claim Workflow is a feature designed to help you manage your claims more efficiently. This feature allows you to mark a claim as finalized, indicating that no further action is needed on the claim. This can be particularly useful in keeping your work queues organized and preventing unnecessary reworking of claims.

Purpose of the Finalize Claim Workflow Feature

The main purpose of this feature is to provide a way for you to indicate that a claim has been completed and does not need any further action. This can help to keep your work queues organized and prevent claims from coming back up for review when they have already been addressed.

How to Use the Finalize Claim Workflow Feature

To use the Finalize Claim Workflow feature, follow these steps:

  1. Navigate to the claim action menu.

  2. Select the "Finalize claim" option. This will open a modal where you can confirm that you want to finalize the claim and add a reference note, if needed.

  3. Click "Save" to complete the workflow and see the finalized banner at the top of the claim.

  4. To finalize multiple claims at once, simply select the applicable claims in the table, then select "Finalize claims" from the "Edit claims" menu.

  5. To undo the finalization of a claim, select the "Rework claim" option from the action menu. This will remove the finalized indicator from the claim, but the claim will retain the lifecycle status it was in at the time of finalization.

Finalized and un-finalized claims can be included and excluded from filtered claims list as desired. Typically, you'll want to review claims that haven't been finalized by default. To do this, simply add the "Finalized is False" filter parameter to the query builder, and any claims that have been finalized will automatically be removed from view.

Additional Information

When a claim is finalized, it will be removed from RCM work queues. However, if additional payer data is received after a claim has been finalized, the finalized flag will be removed, and the claim will update according to the additional information.

For example, if the status of a claim changes from Submitted to Paid or from Paid to Reversed/Denied after it has been finalized, the finalized flag will be removed and the claim will update accordingly.

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