Quick Reference — To correct SENDREFUND claims

• Refund to avoid recoupment.
• Close the claim manually.

 

If an IRC has been identified as a payer that charges interest, athenahealth kicks that claim with SENDREFUNDINTEREST, which places the claim in MGRHOLD. After 60 days, athenahealth follows up with the payer on the remaining claims where a takeback has not occurred and CHECKREFUND has not been posted to the claim.

 

If the payer indicates that it will recoup and requires a refund with no interest assessed, athenahealth kicks the claim with SENDREFUND, which places the claim in MGRHOLD. A claim note accompanies the kick, along with notes from the follow-up user regarding the communication with the payer.

 

 

Please follow the instructions in the claim note carefully. Actual refunds may vary by payer and claim issue.

 

If a claim is in the MGRHOLD worklist with the kick code of SENDREFUND or SENDREFUNDINTEREST, it means that athenahealth staff has worked this claim on your behalf. You do not need to contact the payer.

 

Payers recoup overpayments in different ways; a refund and a takeback are different. If a claim has been moved to MGRHOLD with SENDREFUND, the payer will not do a takeback – the payer wants a refund. If a claim has been moved to MGRHOLD with SENDREFUNDINTEREST, the payer will recoup the funds later, but the payer will also charge/recoup interest feeds.

 

Claims with the SENDREFUND and SENDREFUNDINTEREST kick codes will have a previous claim note with the REFUND kick code. Within this note is a link to the Refund Request Letter record. Click the unpostable ID link to display the unpostable that contains a notice from the payer indicating the process to follow for issuing the refund. Click the EOB link and follow the payer instructions.

 

Note: It is always mandatory to submit a copy of the refund request letter when submitting a refund to the payer.