User Guide — Bidirectional Kick Codes

 

These kick codes are often used incorrectly. Misusing them can increase your claim case volume and aging A/R.

 

ADNEOB

This denial mapping kick code moves a claim to CBOHOLD status. Do not use the ADNEOB kick code to send claims back to athenahealth for review.

Instead, use the ADNREVIEW kick code to request that athenahealth review and research unspecified denials or complex issues.

 

AIP

This kick code should be used only to indicate that an appeal is still in process with a payer. The claim is pended based on payer performance.

This code routes the claim to BILLED status.

 

CIP

This kick code should be used only to indicate that a claim is still in the adjudication process with a payer. The claim is pended based on payer performance.

This code routes the claim to BILLED status.

 

CORRECT

Do not use this kick code to submit the claim to the payer. It does not route the claim to DROP status.

Instead, use the DROP kick code to submit a claim to a payer.

 

INFORM

This kick code should be used to leave a claim note, provide additional information, etc.

The claim status does not change.

 

RECONSIDERATION

Use this kick code to initiate an appeal.

This code routes the claim to BILLED status.

 

REPROCESS

This kick code indicates that as a result of athenahealth payer research and outreach, the payer representative has chosen to file the claim with the payer again.

This code routes the claim to BILLED status.

 

 

The following kick codes are the most appropriate codes for moving claims to a BILLED status after taking an action on the claim or performing work outside athenaOne.

 

CLIENTAPPEAL (code used by your practice only)

To indicate that an appeal has been initiated by practice staff, use this code only when completing an appeal outside athenaOne.

 

OTHERSYSBILLED (code used by your practice only)

To indicate that a claim was billed through an external system — not athenaOne. The claim returns to MGRHOLD in 45 days if no response is received from payer.

 

PTCALLED (code used by your practice only)

To indicate that a call was made by the practice to the patient and that a message was left. The claim returns to HOLD after 10 days.

 

 

The CBOHOLD status is used when athenahealth acts on your behalf to resolve payer denials.

 

ADNREVIEW

To request that athenahealth review and research unspecified denials or complex issues.

 

DMCODINGRVW

To request that athenahealth review coding-related denial information.

 

TERTIARY

To request that athenahealth submit the claim to a tertiary payer.

 

 

COLLECT

To send an eligible patient to collections manually, when payment is overdue.

 

 

RVCLOSE

To indicate the claim was reviewed and closed manually by practice staff.

 

 

CCO (code used by your practice only)

To indicate that a practice user reviewed the coding on the claim, that the user disagrees with CodeCorrect (now nThrive) and would like to submit the claim without changes. (Stands for CodeCorrect Rule Override.)

 

DROP

To indicate that the claim should be sent to the payer.

 

DRPPATIENT

To resubmit a claim to the payer after patient information or insurance has been corrected or updated. An appropriate alternative is PTRESP.

 

DRPPROVNUM

To resubmit a claim for which the Provider Number information was corrected.

 

NEXTPAYOR

To bill the next responsible party, for balance transfers.

 

PTBALANCE

To bill the charge to the patient, after practice staff completes manual review.

 

 

For these kick codes only, if there are payer requirements for appeal and corrected claim submission, the claims will temporarily be routed to CBOHOLD for automation to review all aspects of the claim. This will occur even if your staff has already entered the specific details.

 

DRPBILLING

To resubmit a claim for which billing information has been changed, making the claim different from the initial submission. If the payer has submission requirements, the claim is routed to CBOHOLD status temporarily to confirm requirements have been satisfied.

 

PLSAPPEAL

To indicate that an appeal should be sent to the payer for a claim. If the payer has appeal requirements, the claim is routed to CBOHOLD status temporarily to confirm that requirements have been satisfied.

 

 

HOLD

To request an additional review of the claim.

 

 

MGRHOLD

To request that a practice manager review the claim.

 

PROVHOLD

To request that a provider in your practice review the claim.

 

 

COINSURANCE

To transfer the full outstanding balance to the patient as a coinsurance amount, typically indicated by the payer.

 

COPAY

To transfer the full outstanding balance to the patient as a copay amount, typically indicated by the payer.

 

PTRESP

To transfer the full outstanding balance to patient responsibility.

 

 

ABANDONED

To close out a credit balance when a payer will not take back or accept a refund. The balance is adjusted off and the claim remains closed.

 

BADDEBT (code used by your practice only)

To adjust a charge off for a reason of bad debt. The balance is adjusted off and the claim remains closed.

 

FREECARE (code used by your practice only)

To indicate that the amount is associated with Freecare Adjustment. The balance is adjusted.

 

SMALLBAL (code used by your practice only)

To indicate a small balance write-off.

 

INFORMPT (code used by your practice only)

To post information data only to the claim notes. This code requires no next action by athenahealth or practice staff.