Approvals
Overview
The approval flow is a configurable extension that creates manual assignments for manager review in the event of denials, write-offs, and provisional credit issuance. The thresholds that trigger the approval flow are customizable and based on the claim dollar amount.
When enabled, a decision that requires approval is suspended until the approval assignment is worked by a manager.
Purpose
The approval flow ensures that acceptable decisions are being made.
How to Complete an Approval Assignment
The approval assignment is housed in the Manager Assignment Group. Access the task in the Decision Approval node.
Review the claim and evaluate the validity of the decision. Click the "Decision Approval" button.
Review the "Description" and the "Additional Details." Select a decision from the "Decision" drop-down.
If the decision is denied, select a reason from the "Deny Approval Denied Reason" drop-down.
Enter a detailed explanation for the deny decision reasoning in the "Comments" text box. Then click the "Apply" and "Process Actions" buttons.
How to Manage Approval Assignments
Details of the approval assignment outcome can be found in the Decision Approvals node under the Completed Actions section.
The dispute-level audit reflects approval decisions.
In the event of a decision denial, the Alerts alarm bell will present a notification.
When a denied decision is made, the dispute will route back to its prior assignment and will be available for a user to work. The assignment will not route back to the original user. After the dispute is reworked and routed back to the Decision Approval node, the manager working the assignment can see the history of decisions on the dispute.
Approval Assignments are Not Available
The approval flow is optional so it may not be present based on how the portal was built.
Manager approvals are configurable so the claim may not meet the criteria for an approval decision to be made.