User Guide — What Happens When You Edit a Claim

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When you correct a claim error and then click Save Claim or Save Claim & Add Follow-up Note, athenaOne automatically re-scrubs the claim and updates the claim status to reflect the correction. If the claim scrub is clean, athenaOne automatically sets the status to DROP. But suppose a claim had two errors:

  1. The claim has an expired policy, a claim error that normally places a claim in HOLD.
  2. The claims department is missing a place of service type, a scrub error that normally places a claim in MGRHOLD.

If you correct the second error, then save the claim, athenaOne immediately assigns the claim to HOLD status, because the first error is still valid.

 

You must enter a kick reason each time you change the status of a claim to a HOLD status (for example, HOLD, MGRHOLD, or CBOHOLD).

 

 

 

When you edit a claim with transactions posted in a CLOSED period, the system transparently voids and re-creates the entire claim if any of the following fields are updated:

  • Primary/Secondary Insurance
  • Provider/Supervising Provider
  • Procedure
  • Service Dept/Patient Dept

Because the claim has been voided and re-created, the post date is changed to the current date. For technical reasons, the time stamp on the Claim Edit page is set to 00:00:00 when a charge is voided.

 

 

 

When you change the primary payer for an anesthesia claim, you have the choice to reload or not reload the claim data from the original anesthesia time sheet. Your choice is recorded in the audit record for the claim, and athenaOne displays your username and a note that describes the choice you made in the Claim Notes section.

 

When you attempt to change the primary payer for a claim, you receive this warning message:

 

"Changing the primary payer may affect the data that has been pre-populated from the time sheet. Click "Yes" below to reload the page according to the new payer's settings. Note that any other changes you have made will be lost. Click "No" to continue using the current data.

 

Do you want to reload the Claim Edit page for the new payer?"

 

If you click Yes, athenaOne reloads the claim data from the original anesthesia time sheet. After you've finished editing the claim and you click Save Claim, this note appears under the Claim Notes section:

 

"The claim's primary payer was changed on [date]. The charges that appear on this claim have been re-created according to the new payer's settings using the information found in the time sheet."

 

If you click No, athenaOne does not reload the claim data from the original anesthesia time sheet. After you've finished editing the claim and you click Save Claim, this note appears under the Claim Notes section:

 

"The claim's primary payer was changed on [date]. The charges that appear on this claim were not modified."

 

 

 

CSI returns claim-level and charge-level parsing of code and payment information that appears in the Claim Status Inquiry section at the bottom of the Claim Edit page, for claims that have CSI transactions with charge-level data in the inquiry response.

 

 

 

athenahealth provides corporate billing functionality, used to send invoices or CMS-1500 claim forms to employers and companies. If your practice would like to enable this feature, please contact the Client Support Center (CSC) by selecting Support > Create Case or Call in the Main Menu.

 

Charges for a corporate account's contracted services appear on the invoice with a returnable coupon that contains key identifiers to ensure that athenahealth processes the remittance correctly. A corporate invoice includes the corporate account's claims that enter DROP status in a defined accounting period. Claims in HOLD status are not invoiced until the reason for the hold is resolved.

 

athenaOne automatically applies any contractual adjustments to charges based on the associated allowable schedule. If you want to also apply manual adjustments to the charges you bill to your corporate payers, you must contact the CSC (by selecting Support > Create Case or Call in the Main Menu) to request this feature.

Note: To include contractual or manual adjustments in the invoices you send to your corporate payers, the Show allowable adjustments field on the Insurance Package Requests page must be set to Yes.

 

Each corporate account invoice contains this information:

  • Invoice ID number — Unique identifier for a given batch of claims in the defined accounting period. Editing or re-dropping claims does not change the invoice ID.
  • Invoice date — The date on which the first invoice was sent.
  • Payment due — The amount outstanding on the invoice.
  • Payments processed in the last 30 days — The sum of all payments made to the corporate account in the last 30 days.
  • Pay online — The Online Statement-based Experience (formerly QuickPay Portal) is available at https://payment.athenahealth.com. Each invoice includes a unique code to facilitate online payment. Payment can be made via credit card.
  • Patient information — Name, patient ID, date of birth, claim ID, service location, and provider name.
  • Service information — Includes:
    • Date of service, procedure, description, and charge.
    • Charges in accordance with the fee schedule that was selected for the corporate account. If a contracted service with a price override was used, the override price appears on the claim and subsequent invoice.
    • Notes added to the charge line of a claim.
  • Returnable coupon — A perforated, detachable coupon is included on the first page of the invoice, which the corporate payer must return to athenahealth. This coupon includes the return address for payment, the invoice ID, and a barcode that athenahealth scans for identification purposes. This coupon helps us process the payment correctly, so returning it is important.
  • Contested charges — On the back of the returnable coupon is a section where the corporate payer can contest charges. This allows the corporate payer to communicate to athenahealth which charges are being denied and why.

See a sample corporate invoice.