Credentialing Errors

athenaCollector

A credentialing error occurs when the payer receives provider information on a claim that does not match the information that the payer has on file for the given provider.

 

Credentialing is confidential information between a provider and payer. Payers use this information to confirm that partners such as athenahealth have been authorized to discuss claims on behalf of the provider.

 

Per ANSI 5010 standards, athenaOne requires that individual providers bill claims using their Social Security number and that medical groups bill claims using their federal tax ID.

 

Note: It is against industry policy for a payer to release this information to anyone outside the provider's office.

 

 

 

 

The payer's provider information must match the provider's information recorded in athenaOne.

 

First, contact the payer and verify that your practice's information is correct in the payer's file:

Medical group/Billing provider is on file with the payer and linked with:

Group Name:

Group Billing NPI#:

Tax ID#:

Taxonomy Code:

Physical Address:

Pay-To Address:

 

Rendering provider/Supervising provider is on file with the payer and linked with:

Provider Name:

Individual NPI#:

Taxonomy Code:

 

Service facility is on file with the payer and linked with:

Facility Name:

NPI#:

Address:

 

 

Contact the CSC by selecting Support > Create Case or Call in the Main Menu. Please provide the correct information now on file with the payer and request that your settings in the athenaOne payer enrollment table be verified/updated to match:

Medical group/Billing provider is linked with:

Group Name:

Group Billing NPI#:

Tax ID#:

Taxonomy Code:

Physical Address:

Pay-To Address:

 

Rendering provider/Supervising provider is linked with:

Provider Name:

Individual NPI#:

Taxonomy Code:

 

Service facility is linked with:

Facility Name:

NPI#:

Address:

 

 

After making the appropriate changes, please resubmit all affected claims, or contact the CSC by selecting Support > Create Case or Call in the Main Menu to request that we do this on your behalf.