Quick Reference — To correct HOLD claims

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. 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.

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.

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.