END-TO-END WORKFLOW CASE
The case, from start to finish.
Revenue teams follow the visit’s insurance and financial work through the payer response.
The situation
An insured specialty visit includes diagnostics and medication. The revenue team follows coverage, approvals, claims and payment allocation across those services.
What MANSOQ connects
Several departments can contribute to one claim without losing the origin of each service.
The complete journey
Verify coverage
Access & coordinationRecord eligibility and the relevant coverage context for the visit.
Eligibility · Coverage · EncounterFollow service approvals
Revenue teamConnect required preauthorization requests and payer decisions to the requested services.
Service · Authorization · ResponseCapture delivered services
Department teamRecord consultation, diagnostic and pharmacy activity with its encounter reference.
Department activity · Charge referenceReview and submit the claim
Revenue teamReview the claim work items and use the agreed, activated exchange channel.
Claim · Submission · Exchange traceResolve payer responses
Revenue teamAssign rejection reasons for correction, review and documented resubmission where needed.
Response · Reason · ResubmissionReconcile the remittance
Finance teamMatch payer remittance to claim records and assign remaining financial differences.
Remittance · Claim · Difference
The factors that make it work
Starting information
Eligibility · Coverage · Encounter
Responsibility at every step
Each stage identifies the team, the action and the record carried forward.
An agreed operating scope
Confirm the selected capabilities, required companions and external connections during configuration.
Exceptions. A clear next responsibility.
A partially paid claim
A partially paid claim keeps the paid allocation and unresolved lines separate, with a documented reason and follow-up owner.
Responsible team · Finance teamAn incomplete referral or department request
Return the missing information to the referring or requesting team while retaining the original patient and encounter references.
Responsible team · Department teamA charge or payer response needs correction
Review the reason against the delivered service and agreed contract scope. Record the correction and next financial owner.
Responsible team · Revenue teamScope and delivery boundaries
External systems, device connections, catalogue licenses and national exchanges are activated only within their agreed delivery scope. The professionals retain clinical decisions.