User Guide — Overpayments Service

athenaCollector

athenahealth intercepts and reviews claims in HOLD, MGRHOLD, or OVERPAID status within 10 business days for claims with any of the following kick codes:

• OVERPYMT
• OVERPY1MRY
• OVERPY2NDY
• OVERPYEOBPOST

Claims intercepted by athenahealth can be identified with one of the following Overpaid Intercept athenahealth kick codes:

• OVERPYMTATHENACALLPAYER — Used when the overpaid claim requires a call to the payer (or a "Voice Scenario") to gather more information as to how the claim was processed (the root cause of the overpayment), and how it will need to be resolved.
• OVERPYMTATHENARVW — Used to intercept claims that may not require a call to the payer because the information provided on the Claim Edit or Quickview page should suffice to understand the reason for the overpayment and either resolve it or provide clear direction.

You can run the Kickcode report on these two kick codes from the Report Library.

 

Highly trained athenahealth staff take the appropriate actions to resolve the overpayment or provide clear next steps for how your organization or the payer should resolve the overpayment.

 

If athenahealth cannot determine why the claim was overpaid or what the next steps or resolution should be, athenahealth will contact the payer for clarity and confirmation. Based on our findings we will:

• Prompt the payer to reprocess the claim or recoup the overpayment.
• Manually resolve the claim on your behalf.
• Send the claim back to you with clear instructions on how to work the claim.

You are responsible for working claims with insurance credit balances (overpayments) that appear in OVERPAID status. This work includes contacting the payer, reviewing EOBs, and initiating takebacks or refunds. athenahealth applies the following kick codes when an overpaid claim requires action from you.

Kick Code	Status	Action
ACCEPTOVERPYMT	MGRHOLD	You can keep the remaining payment due to payer or allowable verification.
CLAIMCHANGEAFTERBILL	OVERPAID	You changed information on the claim after the claim was billed. You need to review and confirm the information you changed on the claim, and refund the overpayment because it was made based on the original claim. If necessary, re-bill the claim with the updates.
OVERPAYCOB	OVERPAID	You need to review the coordination of benefits (COB).
OVERPYMTPRACRVW	MGRHOLD	You need to take an additional action, as described in the claim notes.
PORTALTAKEBACK	OVERPAID	You need to go to the payer Web portal and void the charge.
SENDREFUND	MGRHOLD	You need to refund the overpayment.
SENDREFUNDINTEREST	MGRHOLD	You need to refund the overpayment with interest.
UNVERIFIABLEBALPRAC	MGRHOLD	You posted the payment without remittance attached. You need to review the claim to see if you should void the payment or issue a refund.

 

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