Claim Edit

Select the reason the abortion services were performed.

Compliant use of this field is applicable according to the state laws of each client, and may be provider-driven.

Please consult your legal advisor or state healthcare agency for compliance guidelines.

Select the primary surgeon from the menu. This menu is populated from the Referring provider table.

A claim level field typically populated by the value calculated in the anesthesia time sheet. When entering charges outside the anesthesia workflow, however, the practice user can enter the concurrency level, calculated manually, in this numeric field.

This value is typically populated from the anesthesia time sheet. But, the practice user can complete this field on the charge entry page. Further, rules can be conditioned on the anesthesia type selected.

For example, if the practice user identifies the services as a monitored anesthesia case (MAC), a rule could be created to require the user to modify the anesthesia services with a MAC modifier.

The start time of an anesthesia case is entered in 24-hour format.

Minutes are exclusive. A start time of 08:00 and end time of 08:30 returns total minutes of 30.

The end time of an anesthesia case is entered in 24-hour format.  

Minutes are exclusive. A start time of 08:00 and end time of 08:30 returns total minutes of 30.

Users entering anesthesia services using the Charge Entry page generally complete the Procedure code field with an ASA code.

Practice users have the option of recording the surgical CPT code describing the patients surgery.

Note: Although athenaOne does not systematically map CPT codes to ASA codes on the Charge Entry page, rules have been created to compare the two values when entered to ensure that they are appropriate.

The date the primary insurance denied the claim. (Note: TPL = Third Party Liability).

Result code for breast or cervical procedures. Select from the menu of acceptable values provided by the Program.

Recommendation Code for breast or cervical procedures. Select from the menu of acceptable values provided by the Program.

Result code for breast or cervical procedure(s). Select from the menu of acceptable values provided by the Program.

Recommendation Code for breast or cervical procedures. Select from the menu of acceptable values provided by the Program.

Required if recommendation code is 2.

Size of Tumor.

Required for procedures 19160, 19162, 19180, 19240.

Required if tumor size is present.

Select Yes if surgery, chemotherapy, or radiation has been started; otherwise, select No.

Select if treatment has not started.

Select an acceptable value provided by the Program from the menu.

Enter the provider ordering services or supplies, if different from the rendering provider (Referring Provider Lookup tool available).

This is required for HCPCS procedure codes that describe consultative services.

Medicare claims require a referring provider and/or an ordering provider.

Select Yes if the claim is for a second opinion for surgery; otherwise select No.

Enter the test/specimen number in the field provided.

Note: To enter additional notes in the Line note field, click edit (upper right corner of the charge line) and then click Add next to Line note.

Select Yes or No to indicate whether the claim is for services related to COVID‑19 care. If you select No, you cannot select answers in the remaining fields.

The athenahealth rules engine uses the answers to these questions to determine which COVID-19 related rules should fire on the claim, particularly when the patient is COVID-19 presumptive positive. You may notice a change in hold volume for claims related to COVID-19 care as rules adapt to changing payer requirements and as athenahealth gains more information about COVID-19 federal grant requirements.

Note: You can use the Report Builder to report on the answers to this question in the COVID-19 service type add-on. The COVID-19 Suspected display column and filter are available in the Claim category of these report types in the Report Builder: Appointment, Claim, FCC Activity, Transaction Activity, and Transaction Aging.

Select Yes or No.

The COVID-19 service type add-on appears on claims created with or without an appointment.

Note: You can use the Report Builder to report on the answers to this question in the COVID-19 service type add-on. The COVID-19 Testing display column and filter are available in the Claim category of these report types in the Report Builder: Appointment, Claim, FCC Activity, Transaction Activity, and Transaction Aging.

Select Yes or No.

You can use the answer to this question in conjunction with the COVID‑19 related patient balance hold to help you meet the CARES Act Provider Relief Fund grant requirements. For information about the COVID-19 related patient balance rule, see COVID-19 Management: Patient Balance Hold Rules Request on the Success Community.

Note: You can use the Report Builder to report on the answers to this question in the COVID-19 service type add-on. The COVID-19 Out of Network display column and filter are available in the Claim category of these report types in the Report Builder: Appointment, Claim, FCC Activity, Transaction Activity, and Transaction Aging.

Select Yes for claims with modifier -90 (Reference (Outside) Laboratory). This indicates your practice has purchased testing kits from an outside party (CMS-1500 line 20 or equivalent).

Select the provider supplying purchased services. For example, a physician may purchase a diagnostic exam from an outside entity. (Referring Provider Lookup tool available.)

Required if Purchased Services? is set to Yes.

Select the provider who ordered the services

this is required if Purchased Services? is set to Yes.

You can type a period to access the (Referring Provider Lookup tool.

Enter the total cost (dollar amount) or the purchased services included on the claim.

This is required if Purchased Services? is set to Yes.

Enter the patient's weight in pounds.

This is required for EPO claims for patients on dialysis.

DME Section — This section of the add-on is used to report the length of need and certification type for DMERC CMNs excluding O2.

Complete the DME section fields only for procedures where a certificate of medical necessity (CMN) from the provider is required. For oxygen therapy claims, however, do not complete these fields.

Code indicating the type of certification.

The date the last certification was obtained from the Provider. The DME Certification Revision date must be provided if you have indicated a DME Certification Type of Renewal or Revised.

Used to report the length of need for this CMN. Quantity is reported in months.

Note: For the DME information to be submitted with a DME claim, you must complete both the DME certification type as well as the DME CMN quantity.

The date DME therapy began.

Oxygen Therapy — Used to report O2 CMN information. Required for all home oxygen therapy claims.

Code used to specify the type of certification.

The date the last certification was obtained from the Provider. The Oxygen Therapy Certification Revision date must be provided if you have indicated an Oxygen Therapy Certification Type of Renewal or Revised.

Used to report length of need for this CMN. Quantity is reported in months.

Note: For the Oxygen therapy information to be submitted with a DME claim, you must complete both the Oxygen therapy certification type as well as the Oxygen CMN quantity.

Used to report arterial blood gas result.

The date of the arterial blood gas test.

Used to report condition under which test occurred.

Used to report oxygen saturation blood result.

The date of the oxygen saturation test.

Valid values are 1 — 999 liters per minute and X for less than 1 liter per minute.

Used to answer questions 8, 9, and 10 of the Oxygen CMN. User can select multiple findings from the list.

The date oxygen therapy began.

CRC DMERC Condition Indicators — Used to report conditions related to all DMERC CMNs. If either the DME section or the Oxygen therapy section is completed, this section of the add-on is required.

Qualifier specifying the use of this section of the add-on.

The "Condition Apply Y/N" flag is the ANSI Certification Condition Code applies indicator. A "Y" response indicates the condition codes in Condition Indicators Codes apply; an "N" response indicates the condition codes in do not apply.

Condition Code describing either patient or equipment status.

If you have indicated with a condition code that the 38-Certification signed by the physician is on file at the supplier's office, you must provide the date that the certification was signed by the physician.

Patients weight is required when submitting claims to Medicare Durable Medical Equipment Regional Carriers with certificates of medical necessity.

Supporting Documentation — This section of the add-on is used to report responses to CMN questions.

Used to report the CMN form number. Must be a valid OMB approved CMN form number excluding alpha characters.

Used to report CMN question number. For multi-part questions that are not numbered individually, assign letters left to right, top to bottom, keeping question numbers constant. Must include both numbers and letters together in this field.

Used to report responses to any CMN question that requires a Y/N response.

Used to answer CMN questions that require a date response format.

Used to answer CMN questions that require a percent response.

Used to answer CMN questions that use a text or uncodified response format.

Note: These information fields do not appear until a number is provided in the question number/letter field.

Enter the patient's weight in pounds.

Enter the number of times the patient has given birth.

Select the appropriate option for pregnancy desirability.

Select all routine medical services provided.

Select all lab services provided.

Select all STD tests and diagnoses administered.

Select Yes if HIV pre-test counseling was provided.

Select the result of an administered HIV test (negative or positive). If no test was given, select not tested.

Select all providers of medical services.

By default, the value of this field is hidden unless the + is clicked. The values populating the Foreign System Identifier fields are controlled by the interface; however, users can manually modify these values.

Additional values can be stored at the charge level in addition to the claim level (see Foreign System Identifier field below).

This appears on the charge level so you can store a Foreign System Identifier for an individual charge.

Enter the prescription date.

Required if it was required in the Reserved(19) (remarks).

Select Yes if the patient is homebound, otherwise select No.

Hospice or Home Health Agency name — click choose/view to select from a list.

Note: A claim rule assigns HOLD status to all claims billed with procedure codes 99374, 99375, 99377, 99378, G0179, G0180, G0181, and G0182 that do not contain the complete name and address of the Hospice/HHA facility and Medicare ID number.

Enter the 6-digit facility ID of the patient's hospice or home health agency.

Note: A new scrub rule assigns HOLD status to all claims billed with procedure codes 99374-99375, 99377-99378, G0179, G0180, G0181, and G0182 that do not contain the complete name and address of the Hospice/HHA facility and Medicare ID number.

Select Yes if the provider is an employee of the hospice.

This flag is necessary for all Medicare claims involving physician services to hospice patients.

Select the provider ordering services or supplies; if different from the rendering provider, click choose/view to select from the Referring Provider Lookup tool.

Enter the serum lot number if required by state law for health data reporting.

Note: You can report only one serum lot (or batch) number per claim. You must create an additional claim if you need to report a second serum batch number.

This field is automatically populated with the information from the OB episode.

Required in some states.

Required for Indiana Medicaid.

Required if LMP is entered.

This field is automatically populated with the date from the OB episode.

This field is automatically populated with the date from the OB episode.

Select Yes to indicate that the rendering provider on the claim is also the delivering provider. Select No to indicate that the rendering provider on the claim is not the delivering provider.

Note: When the provider of antepartum care is the same as the delivering provider, denials are common because of global coverage for pregnancies. For antepartum care, it is important to indicate when this is provided by the delivering provider.

Select the reason why a provider did not obtain a service authorization for a service that state law (for example, New York State Medicaid) requires an authorization.

Select the reason why a claim was filed past the filing date or the reason why a claim transmitted in response to a request for information was delayed.

Select the program under which services provided to the patient were performed.

NDC information is copied from your practice's fee schedule, unless you enter it manually.

When you enter a valid number in the NDC Number field, athenaOne displays the corresponding athenaCodesource trade name to the right of the field. This allows you to confirm that the NDC number entered is correct for the procedure code.

Note: NDC is an 11-digit number with the format "xxxxx-xxxx-xx." If one segment is not formatted correctly, add a leading "0" to that segment (for example, 12345-123-12 becomes 12345-0123-12). For more information, see NDC number formatting.

Note: To edit the NDC number or dosage for a procedure code, click the edit procedure fees link on the Fee Schedules page.

Enter the patient weight in pounds.

If a patient’s Out-of-Network Billing consented amount was entered in the appointment AND a signed consent form was attached, you’ll see that amount in this field.

Note: If no signed consent form was uploaded, the cost estimate will NOT carry over to the consented amount in Charge Entry, as it is assumed that the patient did not consent to paying Out-of-Network rates.

If a patient’s consented amount is missing at Charge Entry or Claim Edit: you can check the patient’s appointment to see if a signed consent form was attached, and then enter the consented amount.

For details, see the O-help topic: To view and edit patient's Out-of-Network Billing consented amount at Charge Entry or Claim Edit

Provider ordering services or supplies if different from the rendering provider.

You can type a period to access the Referring Provider Lookup tool.

Select Yes to indicate that additional documentation is required.

Enter a control number for the required attachment.

Select the type of paperwork attachment from the menu.

Select the means for transmitting the attachment paperwork.

Enter the date last seen by the physician supervising care for the underlying condition.

Enter the date care was assumed by another provider during post-operative care if the claim has Modifier 54 (for Surgical care only) or Modifier 55 (for post-operative care only).

Required on Medicare claims involving shared post-operative care. See Relinquished Care Date (below).

Enter the date that the provider filing the claim ceased post-operative care — (i.e., the last day of care by this provider) if the claim uses Modifier 54 (for Surgical care only) or Modifier 56 (for Pre-op management only).

Required on Medicare claims involving shared post-operative care. See Assumed Care Date (above).

Select the provider ordering services or supplies if different from the rendering provider (Referring Provider Lookup tool available).

Enter the date when patient was last seen by the ordering provider (above) who is supervising care for the underlying condition.

Select click the choose/view link in the Reference Lab service type add-on. Search by lab name or by CLIA number.

If not found, click the add new referring provider link.

Select the provider ordering services or supplies if different from the rendering provider (Referring Provider Lookup tool available).

Required for procedure codes (HCPCS) that describe:

• Diagnostic radiology
• Diagnostic laboratory
• Durable Medical Equipment (DME)
• Orthotics
• Prosthetics

Medicare claims are placed in HOLD status if you have not entered either a referring provider and/or an ordering provider for the types of service described above.

Date spinal manipulation services were initiated.

Date last X-ray was taken (for example, to demonstrate a subluxation of the spine).

Describes the nature of the patient's condition necessitating spinal manipulation.

CODE NAME

A  Acute Condition

C  Chronic Condition

D  Non-acute

E  Non-Life Threatening

F  Routine

G  Symptomatic

M  Acute Manifestation of a Chronic Condition

Free-form description to clarify patient's spinal manipulation condition.

Date the patient's condition became acute.

Select Yes or No.

The Telehealth service type add-on appears only when the claim is created without an appointment. If an appointment is associated with the claim, the appointment should have the Telehealth Distant Site Visit appointment type class applied (see To add Telehealth Distant Site Visit to your available appointment types).

Note: The athenahealth rules engine uses the Telehealth Distant Site Visit appointment type class or the Telehealth service type add-on information to identify the claim as telehealth and apply the appropriate billing rules per payer guidelines.

Select the Received option if the patient received a clinical breast exam during the visit.

Select the override type from the menu. To exclude the visit from UDS reporting, select Non-UDS Visit from the menu.

Note: The UDS STAO works only on claims. If you create a clinical encounter with no associated claim, athenaOne automatically flags the encounter as a UDS visit type for reporting, and you cannot change the visit type in athenaOne. Your UDS report details (filtered and raw files) will include all encounters, in addition to claims.

Visit type (Clinic or Virtual) selected by athenaOne based on the department's place of service code (POS 02 - Telehealth), certain modifiers on procedure codes on the claim or encounter (.GT, .G0, or .95), or certain procedure codes. Virtual visits are reported on UDS Table 5 - Staffing and Utilization.

Note: You can find the list of virtual-only procedure codes on the 2019 CPT inclusion and exclusion list on the Success Community.

To override the value in the Clinic or Virtual field of the UDS STAO, select Clinic or Virtual from the menu.

Indicates whether an EPSDT referral was given to the patient.

Indicate reason why an EPSDT referral was given.

Required if an EPSDT referral was given.

Indicate second reason why an EPSDT referral was given.

Primary, Secondary, and Patient indicate the responsible payer (primary insurance, secondary insurance, or the patient).

• DROP indicates this portion of the claim is ready for submission to the responsible payer
• CLOSED indicates this portion of the claim is completely accounted for (either not responsible, fully paid, or adjusted off)
• HOLD indicates this portion of the claim is waiting for corrective action before the claim can be submitted
• BILLED indicates this portion of the claim has been sent to the payer and is awaiting remittance

Note: If your practice is a no-posting or no-follow-up practice only, select DROP if you are requesting a proof of timely filing.

For additional information about claim status, see Claim Status.

The date of service for the claim.

The Date of service field must be populated before you can enter procedure and diagnosis information on the Charge Entry page.

Note: If you arrive at the Charge Entry page through the appointment workflow, this field is pre-populated based on the appointment date.

The patient's current department of care, usually the department where the patient's chart resides. The default value is the patient's primary department as shown on the Quickview. This field is sometimes used to determine the contents of the 33A (PIN) (currently used only for Medi-Cal).

This facility appears in Block 32 of the CMS-1500. It also determines the place of service code (CMS-1500 24B).

Determines which policy this claim should be billed under. By default, the patient's current primary policy is displayed.

Note: Deactivated payment plans do not appear in this menu unless the charge is currently assigned to that plan. You cannot assign the primary charge to a cancelled plan using this page.

For anesthesia claims generated from time sheets:

• When you change the primary payer for an existing anesthesia primary claim, athenaOne can re-create a claim's charges according to the new destination payer's anesthesia settings.
• athenaOne re-creates the charges using the original time sheet data. Claim data is otherwise preserved, including claim notes, original claim ID, prior authorization number, etc.
• When charges are re-created from the time sheet as a result of changing payers, all time sheet data is refreshed. This refresh includes, but is not limited to, data such as diagnosis codes, service department, referring provider, surgeon, etc.
• Data entered on the charge entry page, such as Reserved 19 comments and Prior Authorization data, is not affected by changing payers.

Indicates whether the provider accepts assignment of benefits from the primary payer for this claim and determines whether the Accept Assignment box will be checked off (CMS-1500 Block 27) for the primary claim.

• Y — Assigned
• N — Not Assigned
• B — Assigned on Clinical Lab Only
• P — Patient Refuses to Assign

Select either:

• No — The claim does not drop to paper automatically and is submitted according to the default submission method for the payer.
• Yes-Athena — Routes claims to athenahealth for paper claim submission. This option causes the claim to appear in the list of claims on the Generate Claims page that you can select to include in a paper claims batch.
  

Refer to Generate Claims for more information about generating "force drop to paper" claims.

Note: If your practice is a no-posting or no-follow-up practice only, select Yes-Athena if you are requesting a proof of timely filing.

If Force drop to paper for primary is set to Yes-Athena, select a reason for the force-drop.

Note: If your practice is a no-posting or no-follow-up practice only, select CSTPRFSUBM if you are requesting a proof of timely filing.

If set to Yes, indicates that any $0 charges should be included on the claim when it is printed or submitted electronically. This setting applies to charges of $0 and to outstanding balances for a charge that result in $0. If all charges on the claim are $0, the claim is set to DROP status (or HOLD status, if appropriate) until the claim is submitted, at which time the claim is closed. This option defaults to No.

Note: If this field does not appear on the Charge Entry page and you want to use it, contact the CSC by selecting Support > Create Case or Call in the Main Menu.

Determines which secondary policy this claim should be billed under. By default, the patient's secondary policy is displayed. If the patient has no secondary policy, defaults to No Insurance/Self Pay.

Indicates whether the provider accepts assignment of benefits from the secondary payer for this claim and determines whether the Accept Assignment box will be checked off (CMS-1500 Block 27) for the secondary claim.

• Y — Assigned
• N — Not Assigned
• B — Assigned on Clinical Lab Only
• P — Patient Refuses to Assign

If set to Yes, this claim will be submitted on paper to the secondary payer, even if the payer could accept it electronically.

Refer to the Generate Claims page for more information about generating "force drop to paper" claims.

If Force drop to paper for secondary is set to Yes, select a reason for the force-drop.

The authorization or referral number used for the services. Typically, this number is assigned by the payer or utilization management organization to authorize a service prior to its being rendered.

Enter any notes about the authorization. These notes appear on the Insurance Authorization page.

Select Pre-cert or Referral.

Enter the insurance authorization number.

Enter or select the effective dates for this authorization or referral.

Select Visits or Units from the menu, and then enter the number of approved units or visits in both fields. athenaOne automatically decrements the number of authorized visits or units.

If you select units, a procedure code is required. The count of remaining units decreases by the number of units associated with the procedure codes listed in the authorization, regardless of any other charge on the claim. For example, you first create an authorization using units = 10 and a procedure code of 99215. You then create a claim using this authorization where procedure code 99215 bills for 3 units. The authorization decreases by 3, and the remaining units on that authorization are now 7.

Select the provider to whom the patient is being referred. This field automatically displays the name of the provider with whom you are scheduling the appointment.

Select the specialty of the provider to whom the patient is being referred.

Enter or select the diagnosis code associated with the authorization. You can type a period to access the Diagnosis Lookup tool in the ICD-10 fields. After you enter a diagnosis code, a description of the code is displayed to the right of it.

Note: If the diagnosis code that you entered is not coded to the highest level of specificity, a warning appears next to the code.

Enter or select the procedure codes associated with the referral. You can type a period to access the Procedure Lookup tool. After you enter a procedure code, a description of the code is displayed to the right of it.

Note: The exact procedure code is required if you select Units from the Authorized visits/units menu. The procedure is validated against your fee schedule.

Enter any additional information that you want to record about this incoming authorization.

Indicates whether the provider has on file a signed statement by the patient authorizing the release of medical data to other organizations. This field corresponds to CMS-1500 Block 12.

Indicates whether the insured or authorized person authorizes the primary payer to assign benefits to the provider (that is, authorizes the payer to remit payment to the provider directly). This field corresponds to CMS-1500 Block 13.

Indicates how patient signatures (for release of information and assignment of benefits) were obtained and how they are being stored by the provider. This field defaults to Signed form for both HCFA-1500 block 12 & 13 on file.

To change the default value for this field, please contact the CSC by selecting Support > Create Case or Call in the Main Menu.

This field is to be used for specific information required by a payer (for example, source code or TPL codes).

Use this field only for information that pertains to the entire CMS-1500 claim. Report charge-level information elsewhere.

Box 22 on the CMS-1500 is labeled RESUBMISSION and has two data components:

• Code — Typically indicates type of resubmission, such as reconsideration, adjustment, or void; specific use varies by Medicaid.
• Original Ref No — Typically indicates the payer's internal control number (ICN) or claim reference number (CRN) for the resubmitted claim; specific use varies by Medicaid.

The provider whose credentials you intend to submit on the claim. This can be the provider who supervised the services or an individual who was supervised by another provider. In either case, use this field to identify the provider that you want to submit on the claim. The provider you select using the Supervising provider field typically appears as the rendering provider on the claim. For example, on a CMS-1500 claim form, the provider you select using the Supervising provider field typically appears in Box 24J, and the provider's name appears in Box 31.

Note: If the selected Rendering provider has a supervising provider, a note appears next to the Supervising provider field.

If you arrive at the Charge Entry page through the appointment or missing slips workflow, the default selection in the Supervising provider - Required field is as follows:

• Rendering provider — If the rendering provider is classified as a supervising provider.
• Patient's usual provider — If the rendering provider is not classified as a supervising provider.
  Note: If the patient's usual provider is not indicated in athenaOne, a link to the Quickview appear, so that you can add the usual supervising provider for the practice.

Important: Any provider whose credentials you intend to submit on claims must be configured as a supervisory provider type on the Providers page so that you can select that provider using the Supervising provider field. For example, you cannot select a physician's assistant with a provider type of PA, but you can select a physician's assistant with a provider type of PASUP.

The provider selected as the Rendering provider appears by default as the Supervising provider if the Rendering provider is one of the following provider types:

• OPTOMETRIST (OD)
• PHYSICIAN'S ASSISTANT, SUPERVISING
• LICENSED PROFESSIONAL COUNSELOR (LPC)
• DOCTOR OF PODIATRIC MEDICINE
• CLINICAL PSYCHOLOGIST (PHD)
• PHYSICAL THERAPIST (OTR)
• NURSE PRACTITIONER, SUPERVISING (NP,S)
• MD
• MS/RD
• Licensed Social Worker (LCSW)
• LICENSED PRACTICAL NURSE
• DOCTOR OF OSTEOPATHY (DO)
• CLINICAL PSYCHOLOGIST (EDD)

See the Providers page for more information about rendering and supervising providers.

Note: If the supervising provider is non-participating with a payer listed on the claim, their non-participation status is indicated.

The provider who referred this patient for services. This field defaults to the referring provider from the primary insurance policy. If you select an authorization/referral, the referring provider of the authorization overrides the selection for this field. You can click Find a provider to display the referring provider lookup tool.

The date of onset of the current illness.

LMP = Date of last menstrual period.

ED = Estimated date of delivery. If the EDD is given, the LMP is automatically calculated using the OB feature.

Enter or select the date that the patient had the same or a similar illness.

Prints in CMS-1500 Block 15.

Enter the date range for the period when the patient was hospitalized as a result of the condition related to this claim.

Prints in CMS-1500 Block 18.

Enter the date range for the period when the patient was unable to work as a result of the condition related to this claim.

Prints in CMS-1500 Block 16.

Select the condition that is related to the injury or illness: Employment, Another party responsible, or Accident.

Note: If your practice has the "Date of Accident" feature enabled, a Date of Accident field may appear. You can record the accident date in this field.

This field appears only when the patient has an outstanding balance. Although this field appears on the Claim Edit page, a statement hold is a property of the patient (not the claim). Therefore, if you select a reason to hold statements, athenaOne holds the entire statement, not just the charges associated with this claim.

Check the relevant checkboxes to display fields for each service type add-on used for this claim.

Note: Please see the Service type add-ons field reference (above this field reference) for details about each service type add-on.

Number of units.

The line note that prints in the CMS-1500 shaded area over the charge line. This note should contain information that would pertain to a single charge on the claim (for example, notes for an unlisted procedure code).

The place of service (automatically determined from the facility).

Indicates that this line item is for Early and Periodic Screening, Diagnostic, and Treatment (EPSDT).

Family Planning code; used for some Medicaid programs.

The total allowed amount (payments plus transfers) from the primary payer after the payment has been posted.

As long as a claim is not in a HOLD status, athenaOne attempts to calculate the Allowed amount for each charge as it is entered and saved. athenaOne uses the reimbursement method and the payment adjustments in the allowable schedule terms and conditions (ASTC) to price the charge.

athenaOne updates estimated allowed amounts each night. If you make mid-day changes to an allowable schedule and/or the associated ASTCs, you can still prompt athenaOne to recalculate the estimated allowed amounts for all affected charges using the Payment Mismatch Tracking page. Otherwise, allowed amounts will be estimated each time the individual claim is saved.

The estimated allowed amount for the charge, as calculated by athenaOne, based on the allowable schedule and applicable terms and conditions. If athenaOne is unable to estimate the allowed amount of a service or procedure, –Unknown– appears in this column.

The type of adjustment, the transfer reason, or the current kick reason.

• ACH — EFT Payment. (Automated Clearinghouse (ACH) is a transaction format that is standard across the banking industry.)
• AMEX — American Express Payment Amount.
• BADDEBT — Amount Written Off as Bad Debt.
• CAPITATED — Adjustment to close claim that is paid separately under Capitation Agreement.
• CASH — Cash Payment Amount.
• CHECK — Check Payment Amount.
  Note: If the Type column displays PAYMENT and the amount is a positive value, the charge in this row represents a takeback, that is, a posted reversal of a previous payment. A takeback can be included in check calculations, or it can be offset by a readjudication remittance record in the same batch.
• COINSURANCE — Coinsurance Transfer Amount.
• COLLECT — Amount Adjusted off into Collections.
• CONTRACTUAL — Contractual Adjustment.
• COPAY — Copay Transfer Amount.
• DEDUCTIBLE — Deductible Transfer Amount.
• DISCOVER — Discover Payment Amount.
• FEE — Collections Fee Amount.
• FREE CARE — Free Care Adjustment.
• GLOBAL — Global Adjustment.
• INTEREST — Interest Payment Amount and negative Interest adjustment to balance the claim.
• MC/VISA — MasterCard/Visa Payment Amount.
• NON — Payment offset with negative adjustment (takeback or withhold amount). Common uses for NON payment posting include when a claim is paid with a management fee or from a recoupment of funds from another claim.
• OTHER — Adjustment or Transfer that is not included in any other type shown.
• RECOVERY — Collection Agency Recovery Amount.
• UNAPPLIED — Unapplied Credit Amount.
• VENDOR-ADJUSTMENTS — This adjustment type is used when a Third Party Patient Pay vendor posts a payment adjustment. Note: When Practice Setting: Patient pay vendor adjustments is enabled, vendors can apply adjustments via an API call on the given practice.
• WITHHOLD — Amount Withheld.

Enter any other relevant diagnosis codes (for internal documentation only).

The date the action occurred.

The username of the person who took the action. AUTO indicates an automated system function.

Usernames that belong to your practice appear in regular font, but athenahealth usernames are italicized. Perot users have the prefix "vhs" in front of their usernames.

The action taken on the claim. Highlighting indicates a system-generated action.

• SCRUB — Claim rule fired for this claim
• APPEAL — Appeal
• EOB — From EOB
• INQUIRY — Electronic Claim Status Inquiry
• MAILRETURN — Mail Return
• NOTE — Generic Note/From Other Source
• PHONE — Phone Call
• PRINT — Print Claim/View Printable Claim
• CLEARINGHOUSE — Claims Clearing-House File Check
• ERA — Electronic Remittance Advice
• TRACERESP — Claim Trace Response
• ACK PAYOR — Acknowledgement response from the payer, either direct or through a clearinghouse
• ACK PAYOR BATCH — Acknowledgement response from the payer, either direct or through a clearinghouse
• ACK INTERMEDIARY — Acknowledgement response from the clearinghouse
• ACK INT BATCH — Batch-level acknowledgement from the clearinghouse (usually a standard batch-level report)
• CLWIZARD — Claim Wizard
• CSI — Claim Status Inquiry (CSI) transaction; these Claim Notes are the default CSI history.
• CSIINFORM — Claim Status Inquiry (CSI) transaction; these Claim Notes plus the items marked CSI in the Action column are the full CSI history.

The status of the claim following this action.