Quick Reference — To correct BADPKG claims

• Review and verify insurance package selection
• Make necessary corrections and resubmit the claims

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

First, run an updated DOS eligibility check through athenaOne. Based on that response, contact the patient to verify eligibility with the insurance carrier. If the patient has new information about the current insurance policy, display the Quickview and update the insurance information. If another insurance needs to be billed, obtain the insurance information. If this new insurance package does not exist in the patient record, display the Quickview and add the insurance package. If the insurance information is correct, ask the patient to contact the payer for details about eligibility.

1. Display the Claim Edit page: Click the edit claim link on the Claim Review or Post Payment page (the link is on the line item's advanced.
2. Make sure that there is an open balance in the payer column. For example, to bill a different primary, there must be an open balance in the primary column of the claim.
3. Void any previously posted adjustments and transfers in the payer columns that you wish to change. Do not void any payments or takebacks.
   If you billed the incorrect payer in error and that payer paid on the claim, contact the payer to issue a refund. If the balance cannot be opened properly because of the way payments are posted, contact the CSC by selecting Support > Create Case or Call in the Main Menu.

Note: At least one change must be made to the claim before it can be resubmitted. It is not compliant to resubmit a claim without changes only to see whether the claim will be paid if you resubmit it to the payer.

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 needs to be resubmitted to the payer, select Add Kick Reason.
4. Make any necessary changes to the claim details.
5. Kick reason — Enter DRPBILLING.
6. Claim note — Enter a clear, detailed note for athenaOne users, describing what actions have just been taken.
7. Click Submit.

Note: At least one change must be made to the claim before it can be resubmitted. It is not compliant to resubmit a claim without changes only to see whether the claim will be paid if you resubmit it to the payer.

1. On the Claim Edit page, scroll down to the Claim Notes section at the bottom of the page.
2. Review the claim notes.
   1. If athenahealth has researched the denial with the payer, a detailed description is included.
   2. If there is an EOB or letter from the payer, click the link to review it.
3. If further clarification is needed, contact the payer directly.
4. Applies to — Select the correct insurance type.
5. Status — Select DROP.
6. Kick reason — Enter DRPBILLING.
7. Claim note — Enter a clear, detailed note for athenaOne users, describing what actions have just been taken.
8. Click Save.