Quick Reference — To correct ZPPRAC claims

athenaCollector

Worklist: HOLD

 

Issue: athenahealth has reviewed this claim for possible resubmission for additional payment on charge(s) with zero-dollar payment.

 

athenahealth will review zero paid claims when CPT codes are greater than $200. When no corrections have been made to CPT codes, modifiers and/or diagnosis codes the claim will be moved with ZPPRAC for your review and make corrections before appealing.

 

Next Steps: Correct charges according to policy and resubmit the claim. If payment was made by the payer as expected, manually close the claim using the kick code RVCLOSE.

  • Make necessary corrections and resubmit the claim
  • If payment was made by the payer as expected, manually close the claim by using the kick code RVCLOSE.

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

 

 

 

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.

 

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