User Guide — Enrollment Services

Our enrollment process and services help ensure that the claims submitted by athenahealth on behalf of your practice are not delayed or rejected by payers because of information errors. Our enrollment services are ongoing because, over time, your practice may add payers, add providers, or require changes to your pay-to address. Our goal is to ensure that all information is current so that submitted claims are adjudicated by the payer without unnecessary delay.

The main components of the practice enrollment process are:

• NPI number verification
• Pay-to address verification and changes
• EDI enrollment
• Preliminary insurance package verification

You can enter your NPI numbers on the NPIs and Other Numbers page. athenahealth verifies your NPI numbers.

The Pay-to address is the address where payers send checks and remittance information. This address is usually a lockbox or P.O. box at a bank. The Pay-to address is also referred to as the remittance address or the billing address.

When we perform provider number verification with a payer, we also confirm that the Pay-to address on file with the payer is the same as the pay-to address stored in athenaOne. We must confirm the Pay-to address (not the physical or office location address) because these are often different addresses. If the Pay-to address is incorrect, Pay-to address change forms must be submitted to each payer.

In athenaOne, you can administer the Pay-to address field using the Pay-To Address Admin page. The office location address appears on the Office Locations page.

EDI stands for electronic data interchange. EDI is the standard means for transmitting electronic data from one business entity to another. EDI enrollment is the athenahealth setup process for a medical group to submit claims electronically. EDI enrollment is required for the majority of payers.

When the provider and medical group number verification process is complete, athenahealth prepares EDI enrollment documents, sends them to you for signatures, and then submits them to each payer. Each payer has its own forms and requirements for submitting these forms, and most require that the forms have original practice/provider signatures.

athenahealth then confirms that the EDI information has been received by each payer and added to its system.

As part of the athenaOne implementation process, your practice identifies the payers that represent 80% of your claim submission revenue. Your practice administrators enter these "top payers" into athenaOne using the Preliminary Insurance Packages page.

athenahealth then attempts to identify the payers in the global database of payers that we maintain for all our clients. If the payer (or insurance package) is found in our global payer database, the payer is assigned the insurance package ID number. If the payer (or insurance package) is not already listed in our global database, athenahealth adds the payer and generates a new insurance package ID number for the payer (or insurance package). athenahealth phones each of these payers to verify the Federal ID Number (tax ID number) and Pay-to address on file.

Clearinghouse enrollment

For every medical group that submits electronically through a claim submission clearinghouse, (for example, McKesson, WebMD, etc.), athenahealth must enroll the practice with the clearinghouse.

MedAssets

When we register a practice with MedAssets®, our partners for coding intelligence, we obtain and record the MedAssets clinic ID and user ID for your practice.

W-9 form

athenahealth saves a digital image of your practice W-9 form. This image is stored outside athenaOne.

Practice Letterhead

athenahealth saves a digital image of your practice letterhead. This image is stored outside athenaOne.

The Practice Enrollment Status Summary page allows you to view and monitor the progress of enrollment tasks for your practice.