Quick Reference — To correct FIXATTACHMENT claims

athenaCollector

Worklist: HOLD

 

Issue: Current attachment or digital interface is illegible, too large, missing signature, or is unrelated to the claim, etc.

 

Next Steps: For attachments, perform the necessary edits or additions using the Manage Attachments link. You may also choose to resubmit the claim after an attachment is added or edited. For Interface issues, please follow current practice guidelines.

  • Edit or add an attachment
  • Make necessary corrections and resubmit the claim

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

 

 

 

 

If a placeholder for documentation exists in the claim, the placeholder prevents the claim from being dropped after being kicked with PLSAPPEAL, and the claim remains in HOLD status. If you believe that the requested documentation has already been sent to the payer or is not required, you can remove the attachment placeholder.

  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 and the existing documentation.
  3. In the Existing Attachments section at the bottom of the page, click Edit next to the attachment placeholder.
    The Attachment Detail page appears.
  4. Attachment required — Select No and then select the reason why the document is not needed from the menu.
  5. Click Save.

 

 

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.

 

 

 

  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 of the documentation requested by the payer is included.
    2. If there is an EOB or letter from the payer, click the link to review.
  1. If further clarification is needed, contact the payer directly.
  2. Click Edit on the Attachment placeholder.
  3. Type — Select the type of documentation being added to the claim.
  4. Source — Select athenaClinicals document to attach a document from the patient's chart, or select Upload file to attach a file from your local computer.
  5. Documents — Select the appropriate attachment from the list provided.
  6. Attachment Note — Enter a note describing the attached document.
  7. Click Save.
  8. Scroll down to Add Note section.

In the Add Note section

  1. Applies to — Select the correct insurance type.
  2. Status — Select DROP.
  3. Kick reason — Enter PLSAPPEAL.
  4. Claim Note — Enter a note to indicate what has been attached and why an appeal of the payer's decision is requested.

If a placeholder for documentation exists in the claim, the placeholder prevents the claim from being dropped after being kicked with PLSAPPEAL, and the claim remains in HOLD status. If you believe that the requested documentation has already been sent to the payer or is not required, you can remove the attachment placeholder.

  1. On the Claim Edit page, click Edit on the Attachment placeholder.
  2. Attachment required — Select No, and then select a reason why the attachment is not needed.
  3. Click Save. The placeholder row is updated. The attachment note changes from [Attachment Required] to [Attachment Not Required].

 

 

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.

 

 

Related Topics Link IconRelated Topics