Note: This view is only visible for User Roles with Work Queue Assignment Settings = Can View and Can Edit.
The Work Queue Assignment feature allows users to automatically assign incoming claims to the appropriate team member based on configurable rules.
Instead of manually assigning every claim, you can create assignment workflows that evaluate claim parameters, such as Provider, Payer, Review Reason, or Denial Reason, and automatically route each claim to the correct assignee.
Each work queue has its own independent workflow.
To access your Work Queue Assignments, click on Profile > Settings > Work Queue Assignment
Here, you will see a list of all the work queues available for your organization. For each work queue, you can see the number of assigned users in the work queue assignment, names of the current assignees, the assignment parameters used and the last updated information.
Click Details to view or edit a work queue assignment.
Understanding a Work Queue Assignment
When a new claim enters a Work Queue, we will match the claim based on the work queue assignment configuration and then assign it to the respective user.
If a claim doesn't match any of your specific rules, it follows the Else rule, which acts as a catch-all for everything that hasn't already been assigned.
In the example below, we can see that when a claim enters the queue, if the
Provider on the claim is Allan Lee, Payer for the active Order of Benefit is UHC and Review Reason is Coding, the claim will be assigned to Ashley White. (As shown in red)
Provider on the claim is Allan Lee, Payer for the active Order of Benefit is UHC and Review Reason is Authorization, the claim will be assigned to Bridget Lee. (As shown in green)
Provider on the claim is Allan Lee, Payer for the active Order of Benefit is UHC and for all other Review Reasons, the claim will be assigned to Charles Johnson. (As shown in blue)
Editing a workflow
Note: This view is only available for User Roles with Work Queue Settings = Can Edit.
To edit the workflow, click “Edit Workflow and Assignment” to the top right hand corner.
Creating a rule
By default, each parameter in the workflow contains an Else rule. This is the default catch-all rule, meaning any claim that doesn't match a specific rule you've created will follow the Else path.
If no rules have been added to the first parameter, all claims entering the work queue will follow the Else path.
If rules have already been created in an earlier step, the Else rule will only apply to claims that reached that point in the workflow but did not match any of the rules in the current step.
To create a new rule:
Click Add a Scenario.
Select one or more values from the dropdown list for that parameter.
Repeat this process to create additional rules as needed.
As you add new rules, the system automatically creates the remaining steps in the workflow based on your parameters. Simply continue configuring each step until you reach the final assignee.
Example: If your parameters are Review Reason → Provider → Payer, adding a new Review Reason rule will automatically create the corresponding Provider, Payer, and Assignee sections for that new workflow path.
Changing the parameter order
You can change the order in which the system evaluates claims. The system always evaluates parameters from left to right, so the order determines which criteria are checked first when assigning a claim.
To change the parameter order:
Click Change Parameters.
Drag and drop parameters within the Active section to reorder them.
If you no longer want to use a parameter, drag it to the Inactive section. This removes the parameter from your workflow, so claims will no longer be evaluated based on that parameter and you won't need to configure assignment rules for it. To use it again, simply drag it back to the Active section.
Please Note: Changing the order of active parameters or moving parameters between Active and Inactive will reset the current workflow. You'll need to recreate your assignment rules before saving your changes.
Deleting a rule
To delete a rule, simply click the trash icon on that row. Removing a rule also removes any assignment underneath it, so review your workflow carefully before deleting.
In the image below, if I select the trash icon highlighted in red, it will remove all fields and cards highlighted in green.
Select to Highlight
Large workflows can contain many assignment rules.
Instead of scrolling through the entire workflow, click Select to Highlight.
Choose:
the type of information (for example, Provider or Payer)
the value you're looking for
The system will automatically highlight every matching rule, making it much easier to find.
Saving your Changes
Before saving, make sure that every rule has a value selected and every assignment has a user assigned to it. If something is missing, the system will tell you what needs to be completed before saving.
When all fields are completed, simply click “Save” to save your work queue assignment. Once saved, all new claims entering that work queue will use the updated assignment rules.
Note: Once saved, the default assignee will be applied to future claims only and will not affect the assignee of any existing claims. To change the assignment of existing claims, you would need to manually assign the claims to that user. You can read How to assign claims for more details.