Athenahealth’s Claim Worklist feature in athenaNet is one of the most powerful, yet often under-utilized, tools for boosting billing efficiency and correcting denials. At its core, the feature organizes claims into actionable queues, helping teams focus on the right work at the right time. But when paired with thoughtful setup, custom filters, and smart workflows, Claim Worklists can transform how a practice manages revenue cycle operations.
How Claim Worklists Improve Efficiency
Claim Worklists streamline claim follow-up by automatically grouping claims based on hold reasons, kick codes, payer, or custom logic your practice defines. Instead of manually searching for claims, picking claims at random, or relying on inbox chaos, staff receive a curated list of claims that can align with a staff member’s area of expertise.
Worklist instructions and claim note highlighting add another layer of clarity. When a claim appears in a worklist, staff can immediately see what action is required to remove it, especially helpful when multiple hold reasons exist. This reduces guesswork and shortens resolution time.
Denial prevention is all about catching trends. Claim Worklists help by:
- Surfacing claims with specific errors before submission
- Grouping claims by kick code or rule so patterns become visible
- Ensuring no claim sits untouched due to unclear ownership
Tips & Tricks for Getting the Most Out of Claim Worklists
Below are practical ways to optimize your setup and daily use:
1. Document Workflows First
Map responsibilities before creating worklists to avoid overlap or gaps. Document each claim management process and the person or team responsible. This ensures your custom worklists mirror real-world responsibilities and eliminate unnecessary handoffs.
2. Start Small with Filters
When building the worklist in Billing Admin, avoid applying too many attributes and/or issues. Over application of the attributes and/or issues creates criteria that are too strict to be applicable to a subset of claims – claims are likely to not populate in the worklist when the criteria is too specific. Use “Any of the selected” instead of “All of the selected” under “Claim Issues” to ensure your logic remains simple enough for claims to still populate.
3. Consider Use Custom Filters
The Custom Filters tool, also available in Billing Admin, allows you to slice and dice your tablespace build based on your practice’s preferences. The highly customized filters can then be applied in the Claim Worklist configuration, allowing your bespoke workflows and divisions of your organization to carry through the build, and into the actual application of workflows across all areas of your business.
4. Escalate Claims Strategically
Set strict protocols as to when the “escalation” feature should be utilized to ensure that escalation is not used as a parking lot.
5. Repopulate
Use the “Repopulate all worklists on save” checkbox whenever you make changes to an existing worklist or create a new worklist. This ensures that team members that are actively working on claims receive accurate assignments in their worklists in real-time. This also allows you to immediately QA the changes you made within the worklists.
6. Avoid Claims Aging > 2 years
This should be a best practice for clean AR in general, but it should also be taken into consideration for the Claim Worklist. Claims with no activity for more than 730 days (2 years) will be excluded from all Claim Worklists daily and weekly refreshes, until the next action is taken.
7. Consider Priority
A claim may have more than one error but cannot exist on more than one worklist at a time. The Priority listed on the Claim Worklist sets the logic for which worklist the claim will flow to first.
8. Run Performance Reports
The Performance tab within the Claim Worklist allows managers to run reports based on user and worklist. Managers should check this data weekly to ensure that staff is not over-utilizing the escalate, pend and release features. Managers can also compare inflow and outflow productivity to identify stragglers who may require more training.
The Bottom Line
Athenahealth’s Claim Worklist feature in athenaNet isn’t just a sorting tool, it’s a workflow engine that, when configured well, can dramatically improve productivity and reduce preventable denials. By aligning worklists and applying the above tips, practices can create a cleaner, faster, and more predictable revenue cycle. Have questions or need help optimizing your Claim Worklists? The Ignite team is here to help. Reach out anytime.
