Generate Claims

1. Display the Generate Claims page: On the Main Menu, click Claims. Under CLAIM MANAGEMENT, click Generate Claims.
2. Filter Provider Group — If your practice uses provider groups, select the provider group from the menu.
3. Click the type of charges you'd like to generate. (The clickable types are located at the top of the page under the column heading Type of Charge.) The list of charges appears below. Notice that the subheading has changed to reflect the type of charge you selected.
4. If the claims are available for the selected type of charge, you can use the filter fields to locate the claims that you want to force drop to paper.
5. Select the claims that you want to force drop to paper.
6. Select the claim format (in most cases, CMS1500).
7. Enter the maximum number of claims that should be generated in this batch in the Maximum # of claims in batch field.
8. Click Generate Claim File to scrub the claims before submission. This scrub ensures that any new claim rules (those added since the claims were entered) are applied before the claims are generated.

Please be patient during the scrub; you can monitor the progress in the Task Bar by counting the vertical lines as they appear (one line = one claim). The scrub results appear in the Task Bar:

• Red claims indicate that there was an error with the scrub. By default, these claims are unchecked. Any claims with errors are assigned an appropriate hold status.
• Gray claims indicate that the claim has passed the scrub, but does not belong in this claim batch. By default, these claims are unchecked. Gray claims appear if the claim is scrubbed and a claim rule changes some attribute of the claim. While force-drop is almost always set manually, it (like anything else on the Claim Edit page) can be changed by a rule.
• Tan claims indicate that the claim has passed the scrub. By default, these claims are checked.

9. Review the scrub results displayed in the Task Bar. You can click the edit link for any claim to display the Claim Edit page and edit the claim. Click Scrub Again to re-scrub this set of claims after your edits.
10. Check or uncheck the checkboxes to create the final list of claims to generate. You can check unchecked boxes to override the error blocking; you can click Check All Claims to check all the checkboxes.

You now have these options:

1. Click Scrub Again to re-scrub this set of claims.
2. Click Generate Claim File to generate the claims. (You can monitor the progress in the Workspace.)

Please be patient during the generation process; when it's done, the View/Edit Billing Batch page appears.

 

 

Note: The PDF Claim Printing feature must be enabled for your practice.

1. Display the Generate Claims page: On the Main Menu, click Claims. Under CLAIM MANAGEMENT, click Generate Claims.
2. Generate a billing batch.
3. Scroll down to the table at the bottom of the page.
4. Claim Submission Category — Select a category.
5. Claim Format — Select CMS1500.
   An additional field appears.
6. Claim Format Version — Select 02/12.
7. Click Generate Claim File.
   After scrubbing, the Scrub Results appear in the Task Bar.
8. Click Generate Claim File.
   The View/Edit Billing Batch page appears.
9. Click Print to Local Printer.
10. You can select alignment settings from the menu and then click Realign Claim.
11. Click the Print icon in the inset window.
    A print version of the file appears in a new window.
12. Select the printer that you loaded with the appropriate preprinted forms and then click Print.

 

To generate a claim on paper, set the Force drop to paper for primary field on the Claim Edit page to "Yes." This option causes the claim to appear in the list of claims (on this page) that you can include in a paper claims batch.

 

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

Exception: To comply with Minnesota Statute § 62J.536, athenahealth will not submit paper claims originating from Minnesota places of services.

 

Claims that may need to be sent on paper include:

• Case policies (case policies automatically drop to paper)
• Secondary claims
• "Problem" claims that need additional documentation (for example, surgeries that require a consent form, secondary or tertiary ultrasound exams, claims in which the practice's charge exceeds the standard)

 

No Follow-Up and No Posting practices are responsible for submitting their own corrected claims. To submit a corrected claim to Medicare, the No Follow-Up and No Posting practice can follow one of these two methods:

 

Method 1

If the Medicare carrier has a phone number referred to as a "re-opening line" and you have a minor administrative change to the claim, you can call the re-opening line at the payer and make the corrections right over the phone. Examples of minor administrative changes include adding a modifier, changing the number of units, adding a CPT code, etc.

 

Method 2

For anything other than minor administrative changes, the claim must be submitted as a redetermination request. You need the proper Medicare Redetermination Form, the corrected claim form that you print at the practice, the original EOB, and any supporting documentation.

 

The practice cannot use "force drop to paper: yes-athena" with the reason of "Corrected claim for insurance rebill" because if they do, rule 2725 will fire stating "Medicare paper submissions are disallowed. Per HIPAA, initial Medicare claims should be submitted electronically as of October 16, 2003. Please choose another means of submitting this claim."

 

The practice cannot kick to CBOHOLD with the kick code CORRECT because these clients are their own CBO.

 

The practice can send a corrected claim on paper if it is sent as a redetermination request with all the proper forms and documents, but calling is the easiest and fastest way.