Provider Takeback Type

athenaCollector

A Provider Takeback record represents funds deducted from a current payment amount due to a redetermination of benefits. This type of remittance is a recoupment of a previously issued claim payment that has since been redetermined. A Provider Takeback can be received with or without charge-level detail. When the information received contains charge-level details, athenaOne matches the record to its associated balance forward readjudication notice, or posts the amount to the affected claims. When no charge-level detail is included, the record is reviewed by athenahealth for the next appropriate steps.

 

Payers often recoup all or a portion of a prior payment in the form of a takeback. These takebacks can occur for a number of reasons, including prior overpayments and readjudication of claims. Typically, provider takebacks automatically match earlier Readjudication Notice or Balance Forward record types, and the offsetting pairs are closed.

 

Often, the information provided by the payer on the EOB is insufficient to accurately post the record in athenaOne. In these cases, the amount of the takeback in question is created and tagged with identifying information.

 

 

 

If athenahealth is unable to obtain information from the payer regarding the takeback, athenahealth will forward the record to you, and you will have the opportunity to review and provide any necessary posting information.

 

If you receive a provider takeback remittance record from athenahealth, please look at the notes section for the appropriate next steps.

 

 

 

Do not change a Balance Forward or Provider Takeback record to any other remittance record type. A change to these record types removes the record from the normal athenaOne matching process; these record types include events that move the record appropriately through the workflow.

 

Takeback information not available from payer

 

Review the record to determine whether you have information that can resolve the provider takeback. If you are able to locate the related information or claims, return the remittance record to athenahealth by using the Find matching charge function.

 

If a refund has been sent to the payer, contact the payer and request a rebate check. Next, match the provider takeback record to the related claim for posting. This action changes the claim status (awaiting the rebate check from the payer). After the rebate check is received from the payer, athenahealth posts it to all associated claims.

 

  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. Unpostable type — Select Provider Takeback.
  4. Click Generate Worklist.
    The Unpostables Worklist appears in the Task Bar.

Display the unpostable record

  1. From the worklist in the Task Bar, click the Provider Takeback bar to expand the worklist.
  2. 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

  1. Under Select an action to resolve or reassign record, select the Find matching charges option.

  2. Click the Find matching charge link or the Find matching patient link.
    The Match Unpostable to Charge page opens in a new window.
  3. Enter the patient information in the search fields (for example, Claim ID, Patient ID, etc.).
  4. Click Find. The search results appear below the Find button.
  5. Select the patient. The Possible Charges section appears.
    Note: Charges highlighted in yellow have the highest probability of a match.
  6. Select the appropriate charge for the patient.

Add optional instructions

  1. If additional instructions are required, select the Add a note or instructions option to display the Note field, and enter a note. For example, you may want to specify that only a subset of the unpostable's value should be posted to that charge or that multiple claims/patients should be posted with the record amount.

Save the updated unpostable

  1. Click Select under the charge. The charge or patient that you selected appears in the Unpostable Update box.
  2. Click Submit.

One of the following will occur:

  • athenaOne zeroes out and closes the unpostable with the event "Match Identified and Posted."
  • athenaOne opens a new corrections payment batch in which the payment posts to the selected charge or patient. The notes on the unpostable specify the payment batch, for example, "Unpostable will be processed in ERA Batch: ____, Corrections Payment Batch: ____."
  • athenaOne queues the batch for posting. The payment batch remains out of balance until it is posted and closed. athenaOne imports the images from the unpostable into the new payment batch for viewing when the batch is closed and the payment posts. The notes in the new payment batch reference the unpostable from which the payment batch is being processed: "Corrections batch for unpostable ____."

    Note: If the unpostable does not meet the criteria, the unpostable returns to athenahealth for manual review and posting.

 

  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. Unpostable type — Select Provider Takeback.
  4. Click Generate Worklist.
    The Unpostables Worklist appears in the Task Bar.

Display the unpostable record

  1. From the worklist in the Task Bar, click the Provider Takeback bar to expand the worklist.
  2. 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

  1. Under Select an action to resolve or reassign record, select the Update status and reassign record option.
  2. Update status — Select Posted to Foreign System.
  3. Click Submit.

 

 

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