Balance Forward Type

A Balance Forward remittance record is created when athenahealth receives a notification from the payer that the affected claims are undergoing readjudication and that the payer will be taking money back. Balance Forward remittance records differ from Readjudication Notice records in that the payer does not use Payer Control Numbers (PCNs); therefore, the PCN matching process cannot be used.

Balance Forward records are also created when a payer rolls a balance; that is, the payer readjudicates the claims at the start of a roll and establishes a credit, from which the payer deducts several future adjudications but does not provide any posting information that correlates to the initial readjudication.

Balance Forward remittance records not only serve as a tool to reconcile and balance the batch, but reflect an accurate audit history of the reconciliation being processed by the payer. These remittance records account for previous balances held with the payer, as well as ongoing balances due to the payer.

The Balance Forward remittance record is created for reconciliation purposes to account for these scenarios:

• Takebacks itemized on an individual EOB exceed payments, resulting in a non-pay or negative balance.
• Practice/provider has a previous negative balance owed to the payer from a previous EOB, which is offset by current payments on the current individual EOB.
• Positive payments and negative takebacks on an individual EOB balance to zero.
  Note: This scenario applies only in situations where it can be determined that the takeback is the result of an existing outstanding balance to the payer that cannot be identified at the claim level. Takebacks that can be identified at the claim level are posted accordingly to the affected claims.

athenaOne puts Balance Forward records into PEND status for 30 days. If athenaOne does not match the record to a balancing record within the PEND period, athenaOne automatically assigns the Balance Forward record to the athenahealth Follow-Up team. The Follow-Up team reviews the record and contacts the payer as needed to determine the status of the recoupment. The Balance Forward record is set to OPEN status in PRACTICE responsibility under the following circumstances:

• The Follow-Up team confirms that your practice needs to send a refund to the payer.
• The record is determined to be for a non-athenaOne claim.
• The payer will not provide any information to the Follow-Up team.

The record is assigned to practice responsibility with an event such as "Refund Required," "Refund Required - Interest Payer," "Balance Forward for Non-athena Claim," "Balancing Information Not Available From Payer," "Balancing Information Not Available from Web Portal," or "Calls Not Answered by Payer."

Do not change a Balance Forward record to any other remittance record type. A change to this record type removes the record from the normal athenaOne matching process. If the record is your responsibility, it means that athenahealth was unable to match the record to its balancing counterpart and the record now requires your review.

Balance Forward records include two important parts to review.

Review the EOB

1. On the Remittance Record page, scroll down to the Source Data field.
2. Click the For this remittance link.
3. Review the EOB information.

Review the History section

1. On the Remittance Record page, scroll down to the History section at the bottom of the page.
2. Review the information in the Note column.
   Note: If you need to take an action on the remittance record, the action is listed in the Note column.
3. If action on your part is being requested, follow the instructions in the notes.

Use your resources with the payer to determine whether the funds have been recouped.

• If the payer states that they have not completed the recoupment, set the record to PEND status to allow the payer more time to complete the recoupment. When athenahealth receives the Provider Takeback from the payer, the Balance Forward and Provider Takeback records are matched, closed, and removed from your worklist.
• If the payer indicates that the recoupment is complete, request the check/EOB number in which the recoupment occurred, and return the record to athenahealth with the specific recoupment details so that athenahealth can attempt to match and close these records on your behalf.

During your review, you may determine that the record is for claims in your legacy system. In this case, record the information in your other system and close the record in athenaOne. During your review, you may also choose to close the record at your discretion.

1. Display the Find Unpostables page: On the Main Menu, click Financials. Under PAYMENTS, click Unpostables. In the left menu, under UNPOSTABLE REMITTANCE, click Find Unpostables.
2. Unpostable status — Select OPEN.
3. Responsible party — Select Practice.
4. Unpostable type — Select Balance Forward.
5. Click Generate Worklist.
   The Unpostables Worklist appears in the Task Bar.

Display the unpostable record

6. From the worklist in the Task Bar, click the Balance Forward bar to expand the worklist.
7. Click the linked unpostable ID number for the remittance record/unpostable in the worklist.
   The Remittance Record page appears in the Workspace.

In the Status section

8. Review the notes provided by athenahealth.
9. Take the required action described in the notes.
10. Under Select an action to resolve or reassign record, select the Update status and reassign record option.
11. Update status — Select Client Pend Review In Progress.
12. Note — Enter detailed information about the actions you've taken (for example, calling the payer).
13. Click Submit.

1. Display the Find Unpostables page: On the Main Menu, click Financials. Under PAYMENTS, click Unpostables. In the left menu, under UNPOSTABLE REMITTANCE, click Find Unpostables.
2. Unpostable status — Select OPEN.
3. Responsible party — Select Practice.
4. Unpostable type — Select Balance Forward.
5. Click Generate Worklist.
   The Unpostables Worklist appears in the Task Bar.

Display the unpostable record

6. From the worklist in the Task Bar, click the Balance Forward bar to expand the worklist.
7. Click the linked unpostable ID number for the remittance record/unpostable in the worklist.
   The Remittance Record page appears in the Workspace.

In the Status section

8. Review the notes provided by athenahealth.
9. Take the required action described in the notes.
10. Under Select an action to resolve or reassign record, select the Update status and reassign record option.
11. Update status — Select Additional Information Provided.
12. Note — Enter detailed information about the actions you've taken (for example, calling the payer and information about the payer recoupment).
13. Click Submit.

1. Display the Find Unpostables page: On the Main Menu, click Financials. Under PAYMENTS, click Unpostables. In the left menu, under UNPOSTABLE REMITTANCE, click Find Unpostables.
2. Unpostable status — Select OPEN.
3. Responsible party — Select Practice.
4. Unpostable type — Select Balance Forward.
5. Click Generate Worklist.
   The Unpostables Worklist appears in the Task Bar.

Display the unpostable record

6. From the worklist in the Task Bar, click the Balance Forward bar to expand the worklist.
7. Click the linked unpostable ID number for the remittance record/unpostable in the worklist.
   The Remittance Record page appears in the Workspace.

In the Status section

8. Review the notes provided by athenahealth.
9. Take the required action described in the notes.
10. Under Select an action to resolve or reassign record, select the Update status and reassign record option.
11. Update status — Select Posted to Foreign System.
12. Note — Enter detailed information about the actions you've taken.
13. Click Submit.

1. Display the Find Unpostables page: On the Main Menu, click Financials. Under PAYMENTS, click Unpostables. In the left menu, under UNPOSTABLE REMITTANCE, click Find Unpostables.
2. Unpostable status — Select OPEN.
3. Responsible party — Select Practice.
4. Unpostable type — Select Balance Forward.
5. Click Generate Worklist.
   The Unpostables Worklist appears in the Task Bar.

Display the unpostable record

6. From the worklist in the Task Bar, click the Balance Forward bar to expand the worklist.
7. Click the linked unpostable ID number for the remittance record/unpostable in the worklist.
   The Remittance Record page appears in the Workspace.

In the Status section

8. Review the notes provided by athenahealth.
9. Take the required action described in the notes.
10. Under Select an action to resolve or reassign record, select the Update status and reassign record option.
11. Update status — Select Reviewed - Fully Worked.
12. Note — Enter detailed information about the actions you've taken.
13. Click Submit.