User Guide — Understanding Claim Forms

 

Only a small percentage of claims are printed and mailed to the payer using paper claim forms. If athenahealth submits paper claims for your practice, your claims are automatically submitted on the appropriate paper claim form. For those practices that submit their own paper forms, athenahealth posts the names and dates of payers and transition dates as they become known on the athenaNetwork.

 

athenahealth is responsible for sending all claims to payers except for claims that have been marked as "Force Drop to Paper — practice." See also: Generate Claims.

 

If a payer communicates a change that is not listed or has different information from what is published, please contact the CSC by selecting Support > Create Case or Call in the Main Menu.

 

More information about the CMS-1500 claim form, including the complete instruction manual, is available at www.nucc.org.

 

 

athenahealth formats and submits most claims electronically using the ANSI standard electronic claim formats that are mandated by HIPAA.

• Professional Health Care Claim (ASC X12N 837 (004010X098A1)) — Used to submit professional healthcare claims and/or encounters
• Institutional (ASC X12N 837 (004010X096A1)) — Used to submit institutional healthcare claims and/or encounters
• Health Care Payment and Remittance Advices (ASC X12N 835)
• Health Care Eligibility Benefit Inquiry and Response (ASC X12N 270/271)
• Health Claims Status Inquiries and Responses (ASC X12N 276/277)
• Referral Certification and Authorization (ASC X12N 278)
• Benefit Enrollment and Maintenance (ASC X12N 834)
• Health Plan Premium Payments (ASC X12N 820)