Quick Reference — To correct PRACCHGRVW claims

• Revert charges
• Refund
• 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.

Before posting an insurance refund to a claim in athenaOne, contact the applicable claim payers to determine the appropriate payee, the amount of the refund, and whether the payer will instead perform a takeback.

Important: athenaOne cannot issue actual refund checks for you. You must generate the refund check from the relevant practice bank account checkbook or using another refund method that you manage within your practice. If you use athenaMailbox, in most cases, patient refunds issued with a Payment method type of Check can be issued from your local/TOS bank rather than U.S. Bank. A Cut Refund Check Remittance Record will be created for refunds using U.S. Bank.

1. Display the Issue Insurance Refund page.
   If displaying the Issue Insurance Refund page via the Claim Edit page, by default only the paid charges on the claim appear. If displaying the page via the Patient Actions Bar, by default only overpaid charges on that patient's claims appear.
2. If the charge for which a refund needs to be issued does not appear, use the filters at the top of the page to find the charge.
3. Refund Amount — Enter the refund amount to issue for the charge. The refund amount cannot be greater than the amount of the payer's payment.
4. Payee — Select a payee for the refund. Begin typing in the Payee field to search existing payee addresses. Select an existing payee or select Add new payee.
   If selecting Add new payee, a pop-up box appears. Enter the payee name and address. The new payee is added to that payment row and to the practice's list of payees for future use when refunding that payer.
   Note: in rare cases, payers may request that refund any excess payments directly to the patient or guarantor. In this case, select Patient as the payee, which populates the guarantor's information with the payee name and address. This refund will still be posted to the claim as an insurance refund transaction; the payee information pertains only to where the refund should be sent.

5. Repeat the steps above for each charge to be refunded on the claim. If posting a refund to an additional payment for the same payer as one for which has already entered a refund amount and payee, the payee for that refund is automatically populated.
6. Notes — Enter any notes. athenaOne automatically posts these notes to the payment batch associated with the refund.
7. Do one of the following:
   1. To post additional refunds, click Post Refund. This option posts the current refunds and refreshes the page so that additional refunds for the patient can be posted or find the next patient/claim for which refunds need to be posted.
   2. When completed entering refunds, click Post and Batch Refund. This option posts the current refunds and displays the Batch Refunds tab of the Manage Refunds page, where the refunds can be included in a deposit batch.

8. Both options post the refund transactions for the amounts that you specified. Both options also create and then close a payment batch for each refunded payer.
   Note: For reconciliation purposes, batch the payment batches into deposit batches.

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.