User Guide — Claim Status Inquiry

 

CSI is the ANSI-standard 276/277 transaction that searches the payer's claims database to pinpoint exactly where a claim is in the payer's adjudication system. For payers using CSI, automated CSI transactions eliminate the need for calls to check on claims that are still in process or that have recently been paid.

 

athenahealth offers CSI as part of our athenaCollector service solution to automate a significant volume of claim follow-up processing.

 

CSI automatically checks the status of your claims with payers that offer this service. For a given claim, athenaOne sends an initial CSI transaction as soon as a week after the claim is submitted, and then sends intermittent transactions to follow up on the claim's status. athenaCollector practices are already configured for CSI, and there are no setup requirements or additional costs to you.

 

Automated CSI transactions:

• Follow up on claims much faster — as soon as 7 days, by default
• Increase the accuracy of the data we get back from payers
• Show exactly where a claim is in the payer's adjudication system
• Show exactly how long a payer is taking to process any particular claim
• Increase the transparency of EOBs, ERA, and checks that are lost or misrouted, so we can find and fix problems sooner

For payers live with CSI, automated CSI transactions eliminate the need for calls to check on claims that are still in process or that have recently been paid. CSI is the ANSI-standard 276/277 transaction that searches the payer's claims database to pinpoint exactly where a claim is in the payer's adjudication system.

 

CSI transactions return this data to athenaOne:

• Claim level status (ANSI Category Code)
• Detail on status (ANSI Status Code)
• Payment date (final disposition date)
• Check number
• Payment method
• Payment amount
• Procedure code (optional by payer)
• Charge payment amount (optional by payer)

Charges that are finalized in the payer's system are kicked with the CHKCUT kick code to notify both you and athenahealth that a particular claim has finished processing. If we don't receive remittance, we know that the problem is related to receiving remittance (such as a pay-to error), and not related to processing the claim.

 

We also kick claims with the CSICIP kick code, if the claim is still in process at the payer and the billed claim alarm is going to fire.

 

 

You don't need to do anything to use CSI. athenaOne automatically initiates CSI transactions after claim submission and then sends subsequent transactions at set intervals. The timing of CSI transactions is determined by the Claim Status Inquiry Class.

 

CSI responses appear in the Claim Notes on these pages:

• Claim Action
• Claim Edit
• View Claims for Charge Entry Batch
• View Claim History

The default CSI notes are marked CSI in the Action column, and they communicate:

• Whether the claim is still in process when the billed claim alarm would have fired. This time frame varies by payer.
• Payment details for claims that have been paid.

Additional notes (marked CSI INFORM in the Action column) include an acknowledgment that the payer received the claim along with the information that the claim is in process in the payer's adjudication system. athenaOne automatically sends a new CSI transaction every three days to follow up on the status of the claim.

 

More efficient CSI process

Beginning in Release 18.7, claim status inquiries from payers kick claims to the appropriate status so that you or athenahealth can begin resolving claim holds sooner. For example, when a payer sends CSI to indicate that the claim requires additional documentation, the ADNMEDREC kick code (instead of the INFORM kick code) is applied to the claim immediately, along with clear instructions to resolve the hold.

Note: Over time, your organization will notice more eligible claims kicked by claim status inquiries.

 

 

No, but CSI is available in athenaOne for a growing list of payers. All claims submitted to these payers via batch submission are subject to CSI transactions. We plan to add more payers in the future.

Note: Manually appealed claims are not eligible for CSI.

 

 

athenahealth enrolls your organization and individual providers for the CSI transaction type with the growing list of payers that offer this service. athenaOne sends automated CSI transactions only if the provider and the provider's medical group are properly enrolled with the payer and/or clearinghouse receiving the transaction.