Dream Factory by TruBridge Ideas Portal
If the insurance denies for a workable reason, we need the ability to leave it with that insurance FROM THE RECEIPTING SCREENS. Sending it to the patient when they shouldn't get a bill, or the secondary before it is ready is not helpful. It will not fall on the right ATB list, if at all> This creates unnecessary extra work, extra costs, delays and/or patient upset.
I logged into the Dream Factory for the first time today to mention this. I added a vote for this existing idea instead, but wanted to also elaborate a bit more.
Problem Statement
Accounts are aged by current Financial Class: Non-covered charges trigger a shift to the next class.
Premature shift to "Patient" class: Accounts move to the "Patient" class before insurance denials or non-covered issues are fully resolved.
Vendor-confirmed limitation: The current system behavior expects billers to work denials as they post, with the only workaround being to flag claims as “unchecked” for future review. (This is not a feasable option for our current staffing levels)
Manual intervention required: Our team must centrally post charges and manually apply collect codes to prevent premature patient billing, increasing the administrative burden and risk of error.
Enhancement Request
Request: Implement configurable logic to control when accounts transition between Financial Classes, specifically to prevent premature movement to the "Patient" class due to non-covered charges or unresolved insurance issues.
Desired Features
Hold on Financial Class transition: Allow accounts to remain in the insurance class until all insurance-related activity (including denials and appeals) is resolved, regardless of non-covered charge posting.
Configurable transition criteria: Enable administrators to define rules for when an account should move to the "Patient" class (e.g., after all insurance follow-up is complete).
Automated flagging: Integrate system logic to automatically flag and hold accounts with outstanding insurance issues, reducing manual intervention.
Reporting and visibility: Provide clear reporting on accounts held for insurance resolution, with actionable work queues for staff.
Business Impact
Reduces manual workarounds and errors
Prevents premature patient billing and dissatisfaction
Improves the accuracy of financial class reporting
Supports efficient and compliant revenue cycle operations
Priority
High – This enhancement will streamline workflows, improve billing accuracy, and reduce administrative overhead.