User Guide — Interest Payment Posting

athenaCollector

A claim interest payment is an additional payment paid by an insurance company for delayed claim adjudication.

 

An interest payment is a financial transaction that increases or reduces the batch total. Interest payments are returned in the provider-level adjustment segment, typically with provider level code (PLB) L6 or 51. These adjustment codes may or may not refer to particular claims. In addition, payers are required to mark the claims that are being paid interest to help providers validate the amount owed for each claim. Such claims are tagged with a supplemental information segment with code "I" for interest. The athenaOne-replicated EOB displays code I as "interest" at the claim level.

 

athenaOne applies interest payments and adjustments to claims based on the claim supplemental code I. Payers are responsible for reconciling the total interest amount reported for individual claims with the total interest reported in the provider-level adjustment segment. These amounts should always reconcile for the batch to be in balance. If the amounts do not reconcile, the following scenarios occur:

  • If the payer issued a larger interest payment than the total interest reported on each claim, athenaOne places the excess payment in a remittance record of type "Interest" in a closed status. You can see these records using the Financial Controls Center (click the Financial Summary Review tab and locate the Closed Other Revenue/Expense item) or by searching for the unpostable on the Find Unpostables page (search for Unpostable type of Interest).
  • If the payer issued a smaller interest payment than the total interest reported on each claim, athenaOne creates a negative remittance record of type "Check Amount Different than Remittance Amount." athenahealth reviews the remittance and voids excess interest payments from claims to close the record.
  • If no claim level information is provided in a payer's file, we create a remittance record of type "Interest" in a closed status. You can see these records using the Financial Controls Center (click the Financial Summary Review tab and locate the Closed Other Revenue/Expense item) or by searching for the unpostable on the Find Unpostables page (search for Unpostable type of Interest).

athenahealth posts interest based on the type of remittance received.

  • Paper remittance displays interest on its own payment line.
  • ERA displays one payment amount that includes the claim payment and interest payment.

A positive interest adjustment offsets the interest payment, whereas an interest takeback negates a previous interest payment. No interest adjustment is applied with an interest takeback.

 

athenaOne-replicated EOBs that are created from electronic payer files display all the provider-level adjustment segments returned with code L6 or 51.

Note: You can apply interest adjustments to claims manually using the Post payments/adjustments link on the Claim Edit page. Interest adjustments applied manually do not create separate payment transactions.

 

 


 

 

John Smith, a provider at Seven Hills Medical Group, receives a $78.00 payment on a claim with an additional interest amount of $0.42 because the claim was processed beyond the payer's reasonable time.

 

The claim is marked with interest in the amount of $0.42 and, in addition, there is a provider-level adjustment with code L6 for $0.42 confirming the interest payment.

 

athenaOne posts the claim payment of $78.00 as one transaction and creates a second payment transaction for $0.42 to represent the interest payment. athenaOne also posts an interest adjustment for $0.42 to balance the additional payment because the payment detail was remitted on paper.

 

 

 

John Smith, a provider at Seven Hills Medical Group, receives a $78.00 payment on a claim with an additional interest amount of $0.42 because the claim was processed beyond the payer's reasonable time.

 

The claim is marked with interest in the amount of $0.42 and, in addition, there is a provider-level adjustment with code L6 for $0.42 confirming the interest payment.

 

athenaOne posts the claim payment of $78.42 as one transaction. athenaOne also posts an interest adjustment for $0.42 to balance the additional payment because the payment detail was remitted on ERA.

 

 

 

John receives a $78.00 payment on a claim with an additional interest amount of $0.42 because the claim was processed beyond the payer's reasonable time.

 

The claim is marked with interest in the amount of $0.42, but the provider-level adjustment code L6 was reported as $0.21, causing the batch to be out of balance.

 

athenaOne posts the interest payment of $0.42 to the claim and places the out-of-balance amount of -$0.21 in a "Check Amount Different than Remittance Amount" record. athenahealth resolves the record by voiding the excess interest payment from the claim.

 

 

 

John receives a $78.00 payment on a claim with an additional interest amount of $0.42 because the claim was processed beyond the payer's reasonable time.

 

The claim is marked with interest in the amount of $0.42, but the provider-level adjustment with code L6 was reported as $0.84.

 

athenaOne posts an interest payment of $0.42 to the claim and places the out-of-balance amount of $0.42 in a remittance record of type "Interest" because the extra interest payment is unaccounted for at the claim level.

 

 

 

 

John receives interest at the batch level with provider-level adjustment code L6 for $0.84. No claims have been marked with interest.

 

athenaOne creates a remittance record of type "Interest."

 

 

 

John receives interest at the claim level, but there is no provider-level adjustment with code L6 returned for the interest payment.

 

athenaOne posts the interest to the claim and creates a remittance record of type "Check Amount Different than Remittance Amount" for the out-of-balance amount. athenahealth resolves the record by voiding the excess interest payment from the claim.

 

 

 

John receives interest at the provider level with provider-level adjustment code L6 and no claim-identifying data.

 

athenaOne creates a remittance record of type "Interest."

 

 

 

John receives paper remittance that reports interest paid for individual claims.

 

athenaOne posts the interest payment to each claim in a separate payment transaction.