Locally Administered Insurance Packages

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This page allows you to manage insurance packages that are specific to your practice for corporate contracts and legal billing. These insurance packages do not require review and approval by athenahealth, so your changes are effective immediately.

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.

Step-by-step instructions

To add a locally administered insurance package

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.

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.
Request type — Select Case policy.

Insurance Details

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

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

Request Information

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

Delivery format — Select the format for claims: Invoice or CMS1500.
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.

Frequency — Select the frequency for claim submission: Monthly, Weekly, or Daily.
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.
# 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.
Show allowable adjustments — Select Yes or No.
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.
Click Submit.
The athenaOne system checks your requested insurance package against the global insurance list for potential duplicates.
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.
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.
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.
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.

Features and workflows

You add locally administered insurance packages on the Insurance Package Requests page.

Set the Request type option to Case policy.
Set the Case type option to Corporate Contract or Legal Contract.

After you add a Corporate Contract or Legal Contract package, you can update it using the Locally Administered Insurance Packages page.

Legal notice: When a practice user creates a locally administered insurance package, the practice understands that it is wholly responsible for verifying the accuracy and completeness of the insurance package information, including the accuracy of the address. By choosing to create and use the locally administered insurance package, the practice understands that it may be using the package when sending/receiving protected health information (PHI) and is accepting any risk involved in using the package.

Learn more about insurance packages for corporate, legal, and contract payers

athenahealth sends invoices and claims directly to corporations, law firms, and other non-health insurance payers; we call this "corporate billing," "legal billing," or "contract billing," depending on the type of payer. If athenahealth classifies a payer as a corporate, legal, or contract payer, we post their payments but do not follow up on unpaid claims or invoices, research denials, or verify overpayments. Unpaid or denied corporate, legal, or contract claims and invoices are your responsibility.

athenaOne provides several advanced options for managing Corporate Contract and Legal Contract local insurance packages. You can set these options when you request a new insurance package using fields on the Insurance Package Requests page and when you edit an existing package using fields on the Locally Administered Insurance Packages page. These fields are:

Delivery format — Set the claim delivery format to Invoice or CMS1500.
Frequency — Set the invoice frequency (available for Invoice delivery format only).
Delivery method — Set the delivery method to Paper or Email.
Send overdue invoices — Send overdue invoices (available for Invoice delivery format only).
Purchase order number — You can add a purchase order number for the insurance package in this field. This field accepts alphanumeric and special characters, up to a maximum of 20 characters. The purchase order number appears in the header information on the first page of the invoice and in the footer of every page of the invoice.

To take advantage of the corporate billing features, please create a support case by selecting Support > Create Case or Call in the Main Menu and request that advanced corporate billing be enabled for your practice.

Field Reference

Filter fields
Name	Name of the insurance package.
Insurance package ID	Insurance package ID.
Case type	Select Corporate Contract or Legal Contract.
Address	Insurance package address.
City	Insurance package city.
State	Insurance package state.
Country	Insurance package country.
Phone number	Insurance package phone number.
Contact name	Insurance package contact name.
Purchase order number	P.O. number associated with this insurance package.
Created/ Requested date	Date that the insurance package was requested.
Edit Locally Administered Insurance Package view
Case type	This read-only field is set on the Insurance Package Requests page.
Insurance name	Name of the insurance package.
Create corporate account profile	This field appears for Corporate Contract policies. To create a corporate account profile for this package on the Corporate Accounts page, select Yes. You can use the corporate account profile to track contracted services, upload account-specific documents, and review financial information associated with the account.
Address line 1	First line of the address.
Address line 2	Second line of the address.
Zip code	ZIP code.
City	City.
State	State.
Country	Country.
Phone	Main phone number.
Fax	Fax number.
Contact name	Contact name.
Practice notes	Enter any notes about this locally administered insurance package. Only your practice can see these notes.
Delivery format	This field appears if your practice has the Corporate Billing feature enabled. The default value is Invoice, but you can also send your batches in CMS-1500 format. Invoice — This format itemizes charges by patient. Additional options for this format include overdue invoices and configurable invoice frequency. CMS1500 — This format groups charges by patient on the standard paper claim form. This format is useful if your corporate billing client requires a claim form or prefers to have each patient's charges on a separate page.
Frequency	This field appears if your practice has the Corporate Billing feature enabled with Invoice format only (CMS1500 format charges are always batched and sent daily). Defaults to Monthly. You can also send invoices Weekly or Daily.
Delivery method	Select the delivery method: Paper or Email. If you select Email, enter the recipient's email address. Note: If you select Email, your client will not receive a paper bill.
Send overdue charges	This field appears if the Delivery format is set to Invoice. Select Yes or No to indicate whether athenahealth should send overdue charges. If you select Yes, athenaOne automatically rebatches and submits all the claims on the invoice when the # of days before overdue has elapsed. 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. Note: We submit a maximum of two overdue invoices. Any additional submissions are the responsibility of the practice.
# of days before overdue	If Send overdue charges is set to Yes, select the number of days (60, 90, or 120) before invoices are overdue.
Purchase order number	This field appears if the Delivery format is set to Invoice. You can add a purchase order number for the insurance package in this field. This field accepts alphanumeric and special characters, up to a maximum of 20 characters. The purchase order number appears in the header information on the first page of the invoice and in the footer of every page of the invoice.
Column Headings for Insurance Package Requests table
Insurance Name	Name of the locally administered insurance package.
Type	Type of locally administered insurance package: Corporate or Legal.
Address Line 1	Address of the locally administered insurance package.
Submit Claim Format	Format of submitted claims, for example, CMS1500, Corporate Account Invoice, or Corporate Billing - Monthly.
Delivery Method	Delivery method for claims: Paper or Email.
Phone Number	Phone number for this locally administered insurance package.
Contact Name	Contact name for this locally administered insurance package.
Created Date	Date that the locally administered insurance package was created.