Add / Update Worker's Comp Policy Details

athenaCollector + athenaClinicals

This page allows you to:

Enter policy information when you add a Workers Comp policy for a patient
Update an existing policy for a patient
Convert a temporary, generic workers comp policy to an actual policy

Step-by-step instructions

To add a Workers Comp policy

Display the patient's Quickview page.
Scroll down to the Insurances heading and click Add case policy.
The Add Policy page appears with the Case policies option selected by default.

To search using the Case Policy Lookup tool

Type — Select Worker's Comp from the menu.
You can search for a policy using the Case Policy Lookup tool or your practice's Most Used Case Policies list.
Insurance/Employer name, address, or phone — Enter the insurance or employer name, address, and/or phone number of the case policy; or, enter any part of these attributes, separating each attribute with a space.
Click Find.
A list of workers compensation case policies appears.
Note: If you cannot find the case policy, select the I've entered all available information and can't find a match option at the bottom of the page, and then click Request New Insurance Package. The Insurance Package Requests page appears.
When you locate the correct case policy, click Select.
The Add Worker's Comp Policy Details page appears.

Policy Information fields

Patient's relationship to policy holder — Select the patient's relationship to the policy holder. For workers compensation policies, the relationship is usually "Employee." If the patient is the owner of a sole proprietorship that holds the policy, select "Self."
Policy/group number — Enter the patient's group number from the insurance card.
Issue date — Enter or select the issue date of the policy, if applicable.
Expiration — Enter or select the expiration date of the policy, if applicable.
Copay amounts — Enter the copay amount in these fields, if applicable. This same value is found in the "expected office visit copay" when collecting patient payments.
Coinsurance percentage — Enter the coinsurance percentage, if applicable. This same value is found in the "usual coinsurance" when collecting patient payments.
Referring provider — Click Choose/view to locate the provider who referred the patient.
Primary care provider — Click Choose/view to locate the patient's primary care physician, if that provider is not at this practice.
Pricing product type — Select a product type from the menu.
Notes — Enter any notes about this policy for this patient, if applicable.

Policy Holder fields

If you selected "Self" from the Patient's relationship to policy holder menu, follow the steps under the Policy Holder fields — Self section.

Entity type — Select the policy holder's entity type. For a business, select Non-person entity.
Employer — Click the Choose link to access the Employer Lookup tool.

Type the first letters of the employer name and click Find. Select the appropriate employer to populate the Employer fields on the Policy Details page.
If the employer information is not available via the Employer Lookup tool, enter the employer information in the fields provided, then click Add to populate the Employer fields on the Policy Details page.

Policy holder name — Enter the name of the company or organization that holds the policy.
Employer address, Employer ZIP, Employer city, and Employer state — Use the ZIP Lookup tool to auto-populate these fields, if the information is available from the employer database.
If the employer information is not available via the Lookup tool, enter the address information in the fields.
Patient SSN — Enter (or verify) the patient's Social Security number. This field is auto-populated from the patient information.
Note: Practice staff registering patients for the first time or editing registration information can enter SSNs, and can re-enter SSNs. To see the full Social Security number after it is entered, you must have the Display Full SSN user permission.
Patient DOB — Enter (or verify) the patient's date of birth. This field is auto-populated from the patient information.
Patient sex — Select (or verify) the patient's gender. This field is auto-populated from the patient information.

Policy Holder fields — Self

Follow the steps in this section only if you selected Self from the Patient's relationship to policy holder menu.

Entity type — Select Person.
Employer — Click the Choose link to access the Employer Lookup tool.

Type the first letters of the employer name and click Find. Select the appropriate employer to populate the Employer fields on the Policy Details page.
If the employer information is not available via the Employer Lookup tool, enter the employer information in the fields provided, then click Add to populate the Employer fields on the Policy Details page.

Last name — Enter the policy holder's last name.
First name — Enter the policy holder's first name.
Middle name, suffix — Enter the policy holder's middle name and name suffix if any).
Address — Enter the first line of the policy holder's address.
ZIP — Enter the policy holder's 5-digit ZIP code. The ZIP code auto-populates the City and State fields from the athenahealth ZIP code database.
City — Verify the policy holder's city.
State — Verify the policy holder's state.
Country — Enter the policy holder's country.
SSN — Enter (or verify) the patient's security number. This field is auto-populated from the patient information.
Note: Practice staff registering patients for the first time or editing registration information can enter SSNs, and can re-enter SSNs. To see the full Social Security number after it is entered, you must have the Display Full SSN user permission.
DOB — Enter (or verify) the patient's date of birth. This field is auto-populated from the patient information.
Sex — Select (or verify) the patient's gender. This field is auto-populated from the patient information.

Worker's Comp Specific Fields

Workers' Comp claim number — Enter the workers comp claim number (assigned by the payer).
Patient's condition related to — Select Yes for one of the options (usually Employment).
Case injury date — Select or enter the date of injury for this case. Enter the injured body part in the Injured body part field.
Description of injury — Enter a description of the injury in this field.
State — Select the state in which the first report of injury is filed (required).
Accepted diagnoses — Enter up to five accepted diagnoses from the workers comp carrier. (Press period (.) to use the diagnosis code lookup tool.) You can enter ICD-9 codes, ICD-10 codes, or both in this field. You can search for ICD-10 codes by entering ICD-9 codes, ICD-10 codes, or SNOMED terms in the ICD-10 lookup tool.
After you enter five codes, another line appears with five more fields for additional accepted diagnoses. (Entering accepted diagnosis codes may prevent denials based on invalid diagnosis codes.) Both Ohio and the U.S. Department of Labor (USDoL) assign specific diagnosis codes to each injury and typically deny claims with diagnosis codes that are not on their accepted diagnoses list.
Click Add Policy or Add & Perform Eligibility Check.
You may see this message: "There are open claims for this patient which may need to be changed. Do you want to see them now?" Click Yes to display the View Claim History page or No to return to the Quickview.
The policy and eligibility status message appear on the patient Quickview page under the "Insurances" section.

To convert a temporary workers compensation policy to an actual insurance policy

After you create a placeholder MVA or workers compensation policy, you can convert the temporary policy to an actual policy when you obtain information about the insurance company or party responsible for payment.

Display the patient's Quickview page.
Scroll down to the Insurances heading and locate the GENERIC WORKERS COMP or GENERIC AUTO INSURANCE policy.
Click Update this policy.
The Update Auto Insurance Policy Details or Update Worker's Comp Policy Details page appears.
On the upper left side of the page, click Update insurance plan.
The Add Policy page appears with the Case policies option selected by default.
Search for the insurance package and select it.
Note: You can instead select one of your practice's Most Used Case Policies from the list.
1. Type — Select Auto Insurance or Worker's Comp from the menu.
2. Insurance name, address, or phone — Enter the name, address, and/or phone number of the case policy; or, enter any part of these attributes, separating each attribute with a space.
3. Click Find.
4. Locate the correct policy in the search results and click Select.

The Replace Auto Insurance Policy Details or Replace Worker's Comp Policy Details page appears with the information that you entered for the placeholder policy filled in.

Enter or edit the policy information, as necessary.
Scroll down to the Replaced Policy Details section.
Deactivation reason — Enter the reason for deactivating the temporary policy in this field.
Click Replace Policy.
The patient's Quickview page is displayed.

Field Reference

Policy Information
Patient's relationship to policy holder	The patient's relationship to the policy holder. For workers comp policies, this value should usually be set to "Employee." If this value is set to SELF, athenaOne will automatically attempt to default policy holder information. If this value is set to something other than SELF, athenaOne clears all policy holder information except for the policy holder's last name and address. This field affects CMS-1500 Block 6.
Policy/group number	The patient's group number. Prints in CMS-1500 Block 11.
Issue date	The issue date of the policy.
Expiration	The expiration date of the policy. If the issue date/expiration date are set, and a charge is created under this policy with a date of service outside the issue/expiration dates, the claim will be put into HOLD.
Copay amounts	The office copay amount. This same value is found in the "expected office visit copay" field when collecting patient payments, for example, at check-in.
Coinsurance percentage	The coinsurance percentage. This same value is found in the "usual coinsurance" field when collecting patient payments, for example, at check-in.
Referring provider	The provider who referred the patient. This value will be defaulted into the referring provider field of claims with this insurance.
Primary care physician	The patient's primary care physician, if that provider is not at this practice
Pricing product type	Select the product type from the menu.
Notes	Any notes about this policy for this patient
Policy Holder
Entity type	Indicates whether the policy holder is a person or another type of entity, for example, a state or company. For Workers' Comp, the entity type is usually non-person entity — that is, the company that employs the patient.
Employer	The employer's name (Click Choose to access the Employer Lookup tool).
Policy holder name	The policy holder's last name.
Employer address	The first line of the employer's address.
Employer address (ctd)	The second line of the employer's address (use only if needed).
Employer ZIP	The employer's 5-digit ZIP code. Entering the ZIP code fills in the City and State fields from the athenahealth ZIP code database.
Employer city	The employer's city.
Employer state	The employer's state.
Country	The employer's country. This field appears only if the "Foreign Patient Addresses" feature is turned on for your practice.
Patient SSN	The patient's Social Security number This is auto-populated from the patient information Note: Practice staff registering patients for the first time or editing registration information can enter SSNs, and can re-enter SSNs. To see the full Social Security number after it is entered, you must have the Display Full SSN user permission.
Patient DOB	The patient's date of birth. Auto-populated from the patient information.
Patient sex	The patient's gender. Auto-populated from the patient information.
Workers' Comp Specific Fields
Workers' Comp claim number	The Workers' Comp Claim Number assigned by the payer.
Patient's condition related to Employment Auto accident Other accident	For Workers Comp, the Employment option should be set to Yes. These informational fields do not directly appear on the claim. They drive the default answers to the same accident-related questions on scheduling and check-in. When scheduling or checking in a patient, you have the option to specify the policy for the encounter. Similarly, you are asked to specify whether the condition is employment, MVA, or other accident related. When choosing the policy at scheduling or check-in, the default values of these accident-related fields are based on the fields set here.
Case injury date	Date of injury for this case. When a case policy is chosen on a claim, the current illness date field on the claim will default to the value specified here. This field also appears in the insurance lists on the Schedule Appointment and Check-in pages to more easily identify the appropriate policy for an encounter.
Injured body part	This field appears in the insurance lists on the Schedule Appointment and Check-in pages to more easily identify the appropriate policy for an encounter. This field will not explicitly appear on claims.
Description of injury	This free-text description of the injury may not appear on the claim, depending on the format and the payer.
Adjuster last name (for reference only)	The adjuster's last name. (For use by athenahealth staff)
Adjuster first name (for reference only)	The adjuster's first name. (For use by athenahealth staff)
Adjuster phone/contact info (for reference only)	The adjuster's contact information. (For use by athenahealth staff)
Adjuster fax (for reference only)	The adjuster's fax number.
Repricer name (for reference only)	The repricer name. (For use by athenahealth staff)
Repricer phone/ contact info (for reference only)	The repricer's contact information. (For use by athenahealth staff)
State	Select the state in which the first report of injury is filed. (Required field)
Accepted diagnoses	Enter up to five accepted diagnoses from the workers comp carrier. (Press period (.) to use the diagnosis code lookup tool.) You can enter ICD-9 codes, ICD-10 codes, or both in this field. You can search for ICD-10 codes by entering ICD-9 codes, ICD-10 codes, or SNOMED terms in the ICD-10 lookup tool. After you enter five codes, another line appears with five more fields for additional accepted diagnoses. Entering accepted diagnosis codes may prevent denials based on invalid diagnosis codes. Both Ohio and the U.S. Department of Labor (USDoL) assign specific diagnosis codes to each injury and typically deny claims with diagnosis codes that are not on their accepted diagnoses list. Diagnosis code denials account for approximately 20% of all denials for Ohio and USDoL workers comp carriers. Ohio mails accepted diagnosis code information to patients and also provides this information directly to providers by phone or online. USDoL lists accepted diagnosis codes on the patient's insurance card.