Abstract: Account prioritization for a patient access workflow is provided. The patient access workflow may be an exception-based integrated workflow. An indication of discrepant data, missing data, or input/user-interaction that may be needed for performance of a patient access workflow process for a patient account may be provided via alerts displayed in an integrated user interface. A prioritization engine may determine a priority score for a patient account based on various determining factors and weightings applied to each determining factor. The patient account may be placed in a queue of accounts needing to be cleared in order by priority score, such that when a user selects to receive a next account to clear, the account with the highest priority score may be provided to the user. Accordingly, a user may be able to address and resolve alerts to ensure patient access workflow processes are performed prior to a healthcare encounter.

Abstract: Patient risk assessment if provided. Admissions scenarios that may negatively affect a health care provider's quality metric may be identified, and a patient risk score may be calculated and used to determine a likelihood of readmission of a patient. One or a combination of weighted factors may be utilized in determining quality metric contribution and for calculating the patient risk score. According to the calculated risk score, a case management recommendation may be provided.

Abstract: Front-end patient financial triage is provided, wherein various financial clearance checks may be processed prior to proceeding with a non-emergent patient encounter. A patient's credit history, historic payment information, and symptoms of his/her financial health, such as employment and income, family size, etc., as well as address and social security number verification may be utilized to help a health care provider determine if a patient may pay for health care services. A web-based configuration tool may be provided for allowing the health care provider to dynamically change rules that define cascading processes of a financial clearance transaction. A health care provider may be able to use this actionable financial information to make better up-front decisions about which financial category may be most appropriate for a patient. Embodiments may help to protect a health care provider's financial liability, reduce bad debt and preventable write-offs.

Abstract: User self-service registration and queue status prioritization is provided. A user may check into an appointment via a web-interface prior to the appointment. He may enter and/or verify information such as demographic information, insurance information, payment information, financial information, etc. If there are any discrepancies in the information provided, the user may be alerted to the discrepancies, wherein he may be able to correct the discrepancies prior to arriving for the appointment. When an indication is received that the user has arrived for the appointment, the user may be elevated to the top of a queue and thereby minimizing wait time.

Abstract: Estimate of benefits (EOB) data and healthcare billing data are provided in a single user interface. By providing a display of billing information and EOB information on a same screen, a patient may be enabled to better understand his payment responsibility compared to an amount owed to a healthcare provider. When a patient logs into a healthcare billing account, healthcare billing data may be provided, as well as input fields for entering EOB data. When EOB data is received, the billing data received from the healthcare provider billing system and the EOB data may be displayed in the single user interface. If a total of entered EOB amounts does not equal a total amount owed to the healthcare provider, a notification may be provided.