Quick Reference — To correct ADJUST claims

athenaCollector

Worklist: MGRHOLD

 

Issues: An adjustment is necessary on this claim.

 

Next Steps: Make a full balance adjustment, partial adjustment or transfer the balance to patient responsibility.

  • Perform full or partial adjustments
  • Transfer the balance to patient responsibility

Note: If after acting on this error, the claim remains in a hold status (HOLD or MGRHOLD), the claim requires additional review or work.

 

 

 

  1. Display the Claim Action page: Select a claim from the Workflow Dashboard, Claim Worklist, or click the Claim Action Page link on the Claim Edit page.
  2. Review the claim information.
  3. Actions — If the claim requires a balance adjustment, select Adjust Balance.
  4. Applies to — Select the payer to which the adjustment applies.
  5. Charges — Select the charges that need to be adjusted.
  6. Reason — Select the reason for the adjustment.
    Note: Each adjustment reason maps to a kick reason, so that reports are unaffected.
  7. Custom transaction code (Optional) — Enter a custom transaction code or enter a period to access the lookup tool.
  8. Claim note — Enter a claim note explaining why the charges are to be adjusted off the claim.
  9. Click Submit. This action closes the claim.

 

  1. Display the Claim Action page: Select a claim from the Workflow Dashboard, Claim Worklist, or click the Claim Action Page link on the Claim Edit page.
  2. Review the claim information.
  3. Actions — Select Transfer Balance.
  4. Select the charges that you want to adjust.
  5. Transfer to — Select Patient or Next Payer.
    Note: Both options map to kick reasons, so reporting is unaffected.
  6. Claim note — Enter a claim note to indicate why the balance is being transferred.
  7. Click Submit. Claims with a balance transferred to Patient are kicked with PTRESP; claims with a balance transferred to Next Payer are kicked with NEXTPAYOR.

 

 

 

  1. Display the Claim Edit page.

Full balance adjustment

  1. Applies To — Select the correct insurance type.
  2. Charges — Select all the charges that are to be adjusted.
  3. Kick Reason — Enter GLOBAL, CONTRACT, ADMIN, or BADDEBT.
  4. Click Save.

Partial balance adjustment

  1. Click the Select Post Payments/Adjustments link.
  2. Click Create New Batch.
  3. Enter today's date.
  4. Set the deposit amount to $0.00 and select the appropriate bank account or UNKNOWN.
  5. Select Assign Payment Batch.
  6. Click Continue.
  7. Enter the appropriate partial adjustments.
  8. Click Save.

 

  1. On the Claim Edit page, scroll down to the Claim Notes section at the bottom of the page.
  2. Review the claim notes.
  3. Action Taken/Note Source — Select Generic Note/From Other Source.
  4. Kick Reason — Select PTRESP.
  5. Claim Note — Enter a note to indicate why the balance is being transferred to the patient.
  6. Click Save. A statement will be sent to the patient.

 

 

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