User Guide — Coverage Scan

You must be a CBO or Billing user with permissions to void charges and edit claims in closed months.

The coverage scan feature reduces uninsured patient balances by locating missing insurance information.

• When a claim is first created for a self-pay patient who does not have insurance on file, athenaOne automatically checks Medicaid.
• If the scan detects Medicaid eligibility, athenaOne adds the insurance to the visit, triggers the automated claim update process, and moves the claim to CBOHOLD with the code INSURANCERVW for athenahealth to work on.

Note: If a patient presents Medicaid as the primary insurance, athenaOne searches for any other insurance packages before claims are billed. If another insurance is detected, athenaOne makes the appropriate updates to the patient's primary and secondary insurances and to any visits and claims.

If you prefer to review claims flagged by coverage scan before the claims are sent to a payer, contact the CSC to request this option. With this feature enabled, coverage scan works as follows.

1. If the scan detects insurance eligibility, athenaOne updates the visit and moves the claim to PATIENT HOLD status with the code INSURANCERVW so that you can review the claim before it is billed to the payer.
2. Click eligibility details in the claim note to verify the patient's insurance eligibility on the Eligibility Detail page.

Coverage scan uses all the payer knowledge built into eligibility checks, adapting to the changing requirements and capabilities of payers. For payers that do not interact well with coverage scan, the patient is considered ineligible, and a claim note indicating the payer status is added to the claim.

Note: As of January 1, 2020, Medicare ID cards use the Medicare Beneficiary Identifier (MBI) instead of SSN-based IDs. For this reason, athenahealth can no longer check Medicare eligibility and, therefore, coverage scan no longer adds Medicare policies to self-pay claims.

athenahealth, Inc., advises that you speak with your Compliance department about:

• Electronic transmission of personal health information to third parties for the purpose of establishing payment information.
• Any applicable state laws and guidelines regarding balance billing patients who are in any applicable Medicaid Pending status.

To prevent coverage scan from checking insurance eligibility for a claim:

1. Display the Charge Entry page: On the Patient Actions Bar, click Billing, and then click Create New Claim.
2. Deselect the Auto scan eligibility and submit claim option. When this option is selected, athenaOne automatically checks for insurance eligibility for self-pay and Medicaid-pending patients.
   Note: If the HIPAA Self-Pay restriction is enabled on the Privacy Information page for the patient, you cannot select the Auto scan eligibility and submit claim option (a message informs you that you cannot select the option because the patient HIPAA Self-Pay restriction is in force).
   

To prevent coverage scan from checking insurance eligibility for self-pay claims created for a specific patient:

1. Display the Privacy Information page: On the Quickview, click Manage Privacy (under the Privacy heading).
2. In the HIPAA Self-Pay Restrictions section, select the Patient Requested Health Plan Restriction for Self-Pay Services option.
   When this option is selected, athenaOne does not run eligibility checks (including coverage scan eligibility checks) on self-pay claims for this patient.

Note: When the Patient Requested Health Plan Restriction for Self-Pay Services option is selected, the patient is also excluded from Pay for Performance programs. For more information, see the Privacy Information page.