Insurance Package Requests

 

Note: If you want to create a Corporate Contract or Legal Contract insurance package, see "To add a locally administered insurance package."

1. Display the Insurance Package Requests page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Insurance Packages, click Insurance Package Requests.
2. Request type — Select Case policy or Standard insurance.
   Note: If you displayed this page from the insurance search, this field defaults to the same type as your search.

Insurance Details

3. Insurance name — Enter the name of the insurance package.
4. Product type — Select the product type for the package (for example, HMO, PPO). This field appears for Standard insurance requests only.
5. Insurance type — Select the insurance type for the package (for example, Commercial, Medicare, Medicare Replacement). This field appears for Standard insurance requests only.
6. Case type — Select the case type for the package (for example, Auto Insurance, Mental Health, or Worker's Comp). This field appears for Case policy requests only. 
   Note: If you select Corporate Contract or Legal Contract, this insurance package is added to athenaOne immediately, and only your practice will use this contract. Verify all data that you enter.

Insurance Contact Information

7. Address line 1 — Enter the claims send-to address for the insurance package.
   Note: For standard insurance packages, you can select the Not available option, which disables the address fields.
8. Address line 2 — If you need a second line for the claims send-to address, enter the information in this field.
9. ZIP code — Enter the claims send-to address ZIP code.
10. City — Enter the claims send-to city.
11. State — Select the claims send-to state.
12. Country — Select the claims send-to country.
13. Phone — Enter the main phone number of the insurance package. For standard insurance packages, you can select the Not available option.
    Note: You must enter the address or the phone number for athenahealth to process your insurance package request; therefore, you can select the Not available option for either the address or the phone number, but not both.
14. Fax — Enter the fax number of the insurance package, if available.
15. Contact name — Enter a contact name for the insurance package, if available.

Request Information

16. Reason for request — Select the reason for your insurance package request.
17. Request details — Enter any notes for athenahealth about this insurance package, including the patient's first name, last name, and ID, if applicable.
    
18. Click Submit.
    Your request is submitted to athenahealth. We will process it within 5 business days.

 

Locally administered insurance packages — Corporate Contract and Legal Contract — are added directly to athenaOne.

Important: Make sure that all information is accurate before you submit it. Your insurance package is automatically added to athenaOne without review by athenahealth.

Note: The athenaOne system checks locally administered insurance requests against the global insurance list. If there is a potential duplicate, your request is sent to the Payer Configuration team for review.

1. Display the Insurance Package Requests page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Insurance Packages, click Insurance Package Requests.
   Note: You can also display this page by clicking Request new insurance package on the Locally Administered Insurance Package page.
2. Request type — Select Case policy.

Insurance Details

3. Insurance name — Enter the name of the insurance.
4. Case type — Select the case type for the package: Corporate Contract or Legal Contract.

5. Create corporate account profile — This field appears if you selected Corporate Contract as the Case type. To create a corporate account profile for this package on the Corporate Accounts page, select Yes.

Insurance Contact Information

6. Address line 1 — Enter the claims send-to address for the insurance.
7. Address line 2 — If you need a second line for the claims send-to address, enter the information here.
8. ZIP code — Enter the claims send-to address ZIP code.
9. City — Enter the claims send-to city.
10. State — Select the claims send-to state.
11. Country — Select the claims send-to country.
12. Phone — Enter the main phone number of the insurance package.
13. Fax — Enter the fax number of the insurance package, if available.
14. Contact name — Enter a contact name for the insurance package, if available.

Request Information

15. Notes — Enter any notes about this insurance package for your reference, including the patient's first name, last name, and ID, if applicable.

Billing Preferences

16. Delivery format — Select the format for claims: Invoice or CMS1500.
17. Delivery method — Select the delivery method: Paper or Email.
    If you select Email, enter the recipient's email address.

If the Delivery format is set to Invoice, the following fields appear.

18. Frequency — Select the frequency for claim submission: Monthly, Weekly, or Daily.
19. Send overdue invoices — Select Yes or No to indicate whether athenahealth should send overdue invoices. If you select Yes, athenaOne automatically rebatches and submits all the claims on the invoice when the # of days before overdue has elapsed.
    Note: The resubmitted invoice retains the same invoice number as the original invoice but displays OVERDUE on the invoice. The overdue invoice displays both the original invoice date and the current billing date.
20. # of days before overdue — If Send overdue invoices is set to Yes, select the number of days (60, 90, or 120) before invoices are overdue.

21. Show allowable adjustments — Select Yes or No.

22. Purchase order number — You can add a purchase order number for the insurance package in this field (up to 20 characters). The purchase order number appears in the header on the first page of the invoice and in the footer of every page on the invoice.

23. Click Submit.

24. The athenaOne system checks your requested insurance package against the global insurance list for potential duplicates.

25. If it does not appear to match an insurance package in the global insurance list, the athenaOne system adds it immediately as a local insurance package. Your newly added local insurance package appears on the Locally Administered Insurance Packages page, where you can edit and delete local insurance packages.

26. If your requested insurance package does appear to match an insurance package in the global insurance list, the athenaOne system alerts you that there is a potential duplicate and asks you to confirm that you want to add this insurance package.

    1. Click the link to view the potential duplicate insurance package.
    2. Click Submit request to add the insurance package, or click Cancel to cancel your request to add this insurance package.

27. If you click Submit request, athenahealth reviews your requested insurance package within 5 business days.

    • Your requested insurance package appears in the Pending Insurance Packages list at the bottom of the page, but it does not appear on the Locally Administered Insurance Packages page until athenahealth approves it as a local insurance package.
    • You can still submit claims to this insurance package while it is under review; these claims will HOLD until athenahealth approves the insurance package.
    • If athenahealth determines that your requested insurance package is a duplicate of a global package, we merge it with the existing global insurance package. By definition, global insurance packages are not eligible for local administration; the Insurance type for global insurance packages is Standard.

28. If you opened the Request New Insurance Package page via the patient insurance workflow, and one of the duplicates is the insurance package you were searching for, select the package to add it for the patient.

1. Display the Insurance Package Requests page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Insurance Packages, click Insurance Package Requests.
2. Under Insurance Package Requests, use one or more filter fields to help you locate the package.
• Policy type — Select Case policy or Standard policy.
• Status — Select Pending, Rejected, or Added. Leave this field blank to see all insurance package requests.
• Requested date — Enter the date range. You can view insurance package requests submitted up to 60 days ago.
• Address — Enter any part of the insurance package address (for example, street, P.O. box, city, or ZIP code) to find matching results.
• Request name — Enter part or all of the insurance package name that you submitted.

3. Click Filter.

   
   Note: If an insurance package you requested is Rejected or Added, you can view specific notes from athenahealth in the Athena Request Review Note column.

1. Display the Quickview page for a patient that had an insurance package requested.
2. Scroll to the Insurances section and review the note from the athenahealth review team.

 

It is the practice's responsibility to submit foreign claims. If a package from a country other than the United States is selected on a claim, athenahealth sends paper claims to the practice for submission.