User Guide — Creating Claims Outside the 5-Stage Patient Encounter

1. Display the patient's Quickview.
2. On the Patient Actions Bar, click Billing, and then click Create New Claim.

The Charge Entry page appears. This page has two views: simple and advanced.

For most claims, you can use the Basic view. But you must use the Advanced view if:

• You need to enter more than four rows of procedure codes.
• You need to create a claim that requires additional information (for example, claims for services related to employment, an auto accident, an accident where a third party is responsible, hospitalization, or a test/specimen number).
• You need to use corporate billing.

For non-athenaClinicals practices, you should always refer to the paper billing slip as you enter charges for a patient encounter or other services. However, athenaOne provides several tools that you can use to ensure that the diagnosis and procedure codes you enter are valid and appropriate.

On the Main Menu, click Claims. Under RESOURCES, clickone of the following links to display the research options:

• You can use the Code and Knowledge Base and Code Check tools to verify codes and troubleshoot error messages.
• You can use the Diagnosis Lookup tool to locate a diagnosis code by description or code.
• You can also use the Check Fee Schedule lookup tool page to look up the billed amount for a given procedure. You can search by procedure code or by procedure description.

After charge entry is accomplished, the claim is instantly checked for errors by the powerful athenaOne Rules Engine. After the claim is "scrubbed" by the rules engine, it is assigned a claim status.

The billing workflow then proceeds to the Claim Review page, where you can check the claim status. DROP indicates that the claim is ready for submission to the payer. If the claim is not in DROP status, you may need to access the Claim Edit page to make the necessary corrections.

Billing follow-up includes reading claim notes and taking the appropriate corrective action. Claim notes appear on the Claim Action, Claim Review, Claim Edit, and View Claim History pages. Claim notes track follow-up actions performed for each claim and often indicate the appropriate corrective action. Active claim errors appear in red. See also: Billing Follow-up — Who is Responsible?