Kick Code Lookup
This page allows you to select the appropriate kick reason for a claim. You can:
- Enter a kick code in the Search field to display the associated kick reason.
- Select a kick reason category from the Show kick reasons related to list to display a list of kick codes and descriptions that pertain to the selected category.
- Determine the resulting claim status for a kick code.
This lookup tool provides access to all athenahealth kick codes. If you select the "From EOB" option in the Action taken/note source menu, all the denial codes specific to the payer on the claim also appear in the list of kick reasons.
Kick reasons and kick reason categories
A payer kick reason (also called a denial reason) describes why a claim has not yet been paid or communicates the reason for a change in the status of an unpaid claim.
A denial code is the payer's unique alphanumeric code that identifies the denial reason — the reason that a claim was denied payment. Each payer uses its own set of denial codes to specify the denial reason. Some payers may have more than one set of denial codes: one set for paper format, a different set for electronic format. This makes it extremely difficult to determine the reason that a claim was denied, just by looking at the payer's denial code.
Therefore, for each set of payer denial codes, athenahealth created a "kick reason category" and mapped each payer denial code in the category to a standardized athenaOne kick reason and athenaOne kick code.
An athenaOne kick code is an athenahealth proprietary, unique alphabetic code that identifies a kick reason, regardless of the payer.
Kick reasons are stored in a global athenaOne database. athenaOne displays the athenaOne kick code and kick reason in the Claim Notes section of claim-related athenaOne pages, to make it easier to follow up on claims.
On the Claim Edit and Claim Action pages, practice users and athenahealth staff select kick reasons to enter in the Kick reason field to change the claim status during denial management and claim follow-up. Each kick reason is tied to a claim status; for example, "Invalid CPT code" results in a HOLD status. A warning message appears if you enter a kick code that is not appropriate for the selected status. You can also type a period in the Kick reason field to access the Kick Code Lookup tool. This lookup tool displays only those kick codes that correspond to the claim status selected.
Field Reference
| Show kick reasons related to: |
Select from a hierarchical outline of kick reason categories to display a list of kick code reasons and descriptions.
The outline has two tiers, with the second tier indented. The top-level categories are issues that you want to convey about a claim. For example, you may wish to convey something about the payment level on the claim, or you may wish to send a message to athenahealth. Indented beneath each top-level category are the specific issues that belong to that category. When you click any selection, the list of kick reasons appears below. |
|---|---|
| Column Headings on Results List | |
| Description |
The description of the associated problem or cause. The text is intended to help you identify the appropriate situation for using the code. |
| KickCode |
The kick code. |
| KickCode Category |
The category of the kick code. The DEFAULT category contains the entire set of athenahealth kick codes. The other category that may appear is the entire set of denial codes specific to the claim's payer. |
| Name |
The kick reason or the denial message. |
| Next Status |
The claim status that results from selecting this kick code. |