Building a Rules-Based AR Queue Management System for Healthcare RCM

Multi-Tenant Data Foundation: Scoping Every Hospital Client's AR Rules Independently

The first architectural decision was scope: the client's EBO serves many hospital clients, each with its own payors, follow-up policies, and AR strategy, so nQ had to be multi-tenant at every layer, not just at login.

Ideas2IT built an entity hierarchy running from Client down through Facility, Account, and Claim, with Payor Master, Payor Grouping, and Aging Bucket Policy scoped per client rather than global. Aged Trial Balance, denial, and productivity data ingested from the EBO's existing systems fed this model, so every downstream queue rule and follow-up configuration applied to one client's accounts without affecting another's.

This Phase Produced

• Multi-tenant Client-to-Claim entity hierarchy
• ATB ingestion pipeline
• Denial and productivity data integration
• Payor Master and Payor Grouping model
• Per-client aging bucket and follow-up configuration

Rules-Based Queue Engine: Prioritizing Accounts by Financial Class, Dollar Value, and Age

With the data model in place, Ideas2IT built the queue engine that turns configured rules into daily work assignments. Queue Definitions break into Queue Slices and Work Items, prioritized in Phase I by financial class, dollar value, and aging bucket, with users assigned to queues by client, financial class, alpha split, and dollar grouping.

Rather than build a second note-taking interface, Ideas2IT kept users inside the EBO's existing productivity tool: creating a note launches an SSO deep-link with claim, encounter, payor, and follow-up fields preloaded, and requeuing an account generates a system note and resets its follow-up clock automatically.

This Phase Produced

•  Queue Definition, Queue Slice, and Work Item model
• Financial Class x Dollar Value x Aging prioritization logic
• User-to-queue assignment by client and financial class
• SSO deep-link note creation
• Automated requeue and follow-up reset

Monitoring and Administrative Control: Giving Managers Real-Time Load Visibility

The final layer gave managers and admins control without engineering dependency. Admins configure clients, mark payor groupings active or inactive, and build custom alarm queues by dollar or account threshold, all without a code change. Email alarms flag contracted payors left unassigned and thresholds exceeded.

A Resource Assignment Review Monitor shows account counts and dollar value by user for load balancing, and a Claim Exceptions Monitor surfaces categories including claim in flight, denial likely, overpaid, and timely filing likely. Every assignment, note, and requeue writes to an audit log, so any action taken on an account is traceable after the fact.

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This Phase Produced

• Client and payor administration console
• Configurable email alarm rules
• Resource Assignment Review Monitor
• Claim Exceptions Monitor
• Full action-level audit logging