User Guide — Corporate Billing

 

athenahealth provides corporate billing functionality, used to send invoices or CMS-1500 claim forms to employers and companies. If your practice would like to enable this feature, please contact the Client Support Center (CSC) by selecting Support > Create Case or Call in the Main Menu.

 

Charges for a corporate account's contracted services appear on the invoice with a returnable coupon that contains key identifiers to ensure that athenahealth processes the remittance correctly. A corporate invoice includes the corporate account's claims that enter DROP status in a defined accounting period. Claims in HOLD status are not invoiced until the reason for the hold is resolved.

 

athenaOne automatically applies any contractual adjustments to charges based on the associated allowable schedule. If you want to also apply manual adjustments to the charges you bill to your corporate payers, you must contact the CSC (by selecting Support > Create Case or Call in the Main Menu) to request this feature.

Note: To include contractual or manual adjustments in the invoices you send to your corporate payers, the Show allowable adjustments field on the Insurance Package Requests page must be set to Yes.

 

Each corporate account invoice contains this information:

• Invoice ID number — Unique identifier for a given batch of claims in the defined accounting period. Editing or re-dropping claims does not change the invoice ID.
• Invoice date — The date on which the first invoice was sent.
• Payment due — The amount outstanding on the invoice.
• Payments processed in the last 30 days — The sum of all payments made to the corporate account in the last 30 days.
• Pay online — The Online Statement-based Experience (formerly QuickPay Portal) is available at https://payment.athenahealth.com. Each invoice includes a unique code to facilitate online payment. Payment can be made via credit card.
• Patient information — Name, patient ID, date of birth, claim ID, service location, and provider name.
• Service information — Includes:
  • Date of service, procedure, description, and charge.
  • Charges in accordance with the fee schedule that was selected for the corporate account. If a contracted service with a price override was used, the override price appears on the claim and subsequent invoice.
  • Notes added to the charge line of a claim.
• Returnable coupon — A perforated, detachable coupon is included on the first page of the invoice, which the corporate payer must return to athenahealth. This coupon includes the return address for payment, the invoice ID, and a barcode that athenahealth scans for identification purposes. This coupon helps us process the payment correctly, so returning it is important.
• Contested charges — On the back of the returnable coupon is a section where the corporate payer can contest charges. This allows the corporate payer to communicate to athenahealth which charges are being denied and why.

See a sample corporate invoice.

 

Note: See Paper Claims to learn more about diagnosis pointers and paper claims.

 

 

athenahealth sends invoices and claims directly to corporations, law firms, and other non-health insurance payers; we call this "corporate billing," "legal billing," or "contract billing," depending on the type of payer. If athenahealth classifies a payer as a corporate, legal, or contract payer, we post their payments but do not follow up on unpaid claims or invoices, research denials, or verify overpayments. Unpaid or denied corporate, legal, or contract claims and invoices are your responsibility.

 

athenaOne provides several advanced options for managing Corporate Contract and Legal Contract local insurance packages. You can set these options when you request a new insurance package using fields on the Insurance Package Requests page and when you edit an existing package using fields on the Locally Administered Insurance Packages page. These fields are:

• Delivery format — Set the claim delivery format to Invoice or CMS1500.
• Frequency — Set the invoice frequency (available for Invoice delivery format only).
• Delivery method — Set the delivery method to Paper or Email.
• Send overdue invoices — Send overdue invoices (available for Invoice delivery format only).
• Purchase order number — You can add a purchase order number for the insurance package in this field. This field accepts alphanumeric and special characters, up to a maximum of 20 characters. The purchase order number appears in the header information on the first page of the invoice and in the footer of every page of the invoice.

To take advantage of the corporate billing features, please create a support case by selecting Support > Create Case or Call in the Main Menu and request that advanced corporate billing be enabled for your practice.

 

Secure email delivery is available for both the Invoice and CMS‑1500 formats. To send these batches via secure email, the Corporate Contract or Legal Contract insurance package must have the Delivery method set to Email, and the Email address must be valid.

 

Important: Claim batches contain PHI. athenahealth recommends that you use this feature if you email bills to your corporate or legal billing clients. Batches that you print or convert to a .pdf file and email via your regular email server are not encrypted and secure.

 

When you set up secure email delivery for a Corporate Contract or Legal Contract insurance package:

1. athenaOne generates a .pdf file that includes your charges and the relevant attachments.
2. athenaOne encrypts the email and sends it via our secure email server to your corporate or legal billing client.
3. The corporate or legal billing client receives an email with the secure message attached.
   Note: The first time that the corporate or legal billing client receives a secure message from your practice, the recipient must create an account.
   
4. The recipient clicks the attached secure message to view it and download the .pdf file with your charges and attachments.

 

On the Insurance Package Requests page and the Locally Administered Insurance Packages page, you can enter the number of days after which you consider payment for an invoice to be overdue in the # of days before overdue field. We mail the overdue invoice on the next business day after it becomes overdue (for example, when the number of days before overdue is 90, we batch the invoice on the 91st day and mail the invoice on the next business day).

 

We limit the number of overdue invoices that athenaOne sends to two. We send an original invoice and up to two overdue invoices as a courtesy follow-up for local insurance packages (if you enabled the overdue invoices feature). After the second overdue invoice, your practice is responsible for any follow-up and manual regeneration of invoices.

Important: Changing the overdue setting from Yes to No and back to Yes disrupts persistent invoices. Invoices are considered persistent based on the most recent activation of the setting.

 

After the specified number of days since the last invoice elapses, athenahealth resends the invoice if there is an outstanding balance. The invoice retains the original invoice number, and OVERDUE appears at the top of the first page. The original invoice date appears, along with the current billing date.

 

The # of days before overdue field appears only if you select Yes in the Send overdue invoices field. Enter the number of days before invoices are overdue (required). The default value is 90 days; you can select 60, 90, or 120 days.

 

 

Corrected invoices are sent as soon as the correction is made. If you make a change to a claim that is part of a persistent invoice, we mail the corrected invoice on the next business day after you make the change. This includes a manual redrop, editing the charges on a claim, or changing the insurance package (so that the claim is no longer part of the invoice).

 

A corrected invoice retains the original invoice number, and CORRECTED appears at the top of the first page. The original invoice date also appears, along with the current billing date. As long as there are open claims associated with an invoice, we resubmit a corrected invoice to the payer. Closed claims do not appear on an invoice.

 

Important: Because a change to a single claim can result in the resending of an entire invoice immediately, you should make every effort to make changes to multiple claims on the same invoice on the same day. Otherwise, changes to multiple claims over several days result in athenaOne mailing multiple corrected invoices.