Check Allowable Schedule

athenaCollector

athenaOne for Hospitals & Health Systems   

This page allows you to check the allowed amount for procedures in your allowable schedules.

 

On the Main Menu, click Claims. Under RESOURCES, click Check Allowable Schedule

 

 

  1. Display the Check Allowable Schedule page: On the Main Menu, click Claims. Under RESOURCES, click Check Allowable Schedule.
  2. Procedure Code — Enter the procedure code or enter a period to access the Procedure Code Lookup tool. You can also use wildcards and ranges (for example, 992* or 99000-99100) to locate the code that you need.
    Note: You can also look up an allowable by description: click the Description option and enter a description. You can use a partial description. For example, enter "office" to see a list of all procedure codes with the word "office" in the description.
  3. Search by — Select the name of the allowable schedule.
    Note: You can also search by insurance package: click the Insurance Package ID option and enter the name of an insurance package, or enter a period to access the Insurance Package Lookup tool.
  4. Service department — Select the service department where the procedure will be performed.
  5. Supervising provider — Select the supervising provider for the procedure to further refine your results by provider.
  6. Click Search.
    The search results are listed below, with a link to the allowable schedule and a list of procedure codes and their base allowed amounts.

 

 

Because any procedure code may have any number of amounts based on the terms and conditions of your contract, athenaOne estimates based on:

The more information you record in the Allowable Schedule Terms and Conditions page, the more accurate the estimate.

 

Note: Claim-specific information is required to price some procedures for certain payers accurately. Therefore, in some cases, the Check Allowable Schedule page may not be able to return allowable amounts for:

  • CPT codes not included in both the allowable schedule and the corresponding fee schedule
  • Procedures priced by Global allowable schedules (for example, those for which reimbursement differs by patient age)
  • Drug and lab procedure codes priced by allowable schedules based on Medicare
  • Ambulance procedure codes priced by allowable schedules based on Medicare

 

Procedure

Enter the procedure code or enter a period to access the Procedure Code Lookup tool. You can also use wildcards and ranges, for example, enter 992* or 99000-99100 to locate the code you need.

Note: You can also look up an allowable by description: click the Description option and enter in a description. You can use a partial description. For example, enter "office" to see a list of all procedure codes with the word "office" in the description.
Search by

Select the name of the allowable schedule.

Note: You can also search by insurance package: click the Insurance Package option and enter the name of an insurance package, or enter a period to access the Insurance Package Lookup tool.
Service Department

Select the service department where the procedure will be performed.
Supervising Provider Select the supervising provider for the procedure to further refine your results by provider.
Column headings
Procedure Code Procedure code for the allowable amount.
Description Description of the procedure code (from the Procedure Fees page).
Amount Base amount for the allowable (based on the terms and conditions associated with your allowable schedule). This amount does not include any possible adjustments.

 

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