Medical Groups

athenaCollector + athenaClinicals

This page allows you to view a list of medical groups for your practice, and to add, update, and delete medical groups in your practice. A medical group is a collection of physicians who have come together contractually or in partnership for the purposes of managing a practice and sharing the care of patients. The medical group is a legal entity and holds a tax ID. Every provider must be associated with a medical group. athenaOne must have accurate medical group information for every provider so that providers can receive accurate payment from insurance companies, other third-party payers, and self-pay patients.

Note: If you use the athenaMailbox service, your patient statements have this address printed on them: PO BOX 14000, Belfast, ME. This P.O. box is a central location for all patient statements received by athenahealth.

Step-by-step instructions

To add a medical group

WARNING: Adding a new medical group can adversely affect claim processing for your practice. Please contact your Customer Success Manager before adding a new medical group to your practice.

Display the Medical Groups page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Medical Group, click Medical Groups.
Medical group name — Enter the legal name for this medical group.
Entity type — Select an option. Person indicates that this medical group bills as an individual; Non-person entity indicates that this medical group bills as a group. (If a group's EIN is the same as any provider's SSN, it is a good indicator that the group bills as an individual and that Entity type should be set to Person.)

Contacts

Billing contact — Enter the name of the billing contact for this medical group. This field is for reference only and is currently not used.
Billing contact phone — Enter the billing contact phone number. This phone number is printed on the billing slip. If the Statements contact phone field (below) is blank, this phone number is also printed on patient statements.
Billing contact fax — Enter the fax number printed on the billing slip.
Statements contact phone — Enter the statements contact phone number. This phone number is printed on patient statements. If left blank, the Billing contact phone is printed on patient statements.
Medicare authorized representative — Enter the full name of the Medicare authorized representative associated with your practice or medical group. This is the representative who is authorized by CMS to sign Enrollment & Credentialing agreement forms on behalf of their organization.
Medicare authorized representative phone — Enter the contact phone number for this representative. Please be sure to keep this information current so that the athenahealth Enrollment Services Team can expedite your Medicare-related enrollments.

Default Pay-To Address

Statement pay-to name — Enter the official pay-to name of the medical group as it should be printed on CMS-1500 Block 33 and on patient statements. If you leave this field blank, the name in the Medical group name field is used. If set, this name overrides the claim pay-to name in the return address section on patient statements.
Note: Only the first 35 characters of the statement pay-to name are printed on patient statements.
Pay-to address — Click the lookup link to access the Pay-To Address Lookup tool.
When the Lookup tool appears, click the Add New Address link. The Add Pay-To Address fields appear.
Reference Name — Enter a short, one-line name. This name will appear in the Pay-To Address menu. Because you can store any number of pay-to addresses in the Pay-To Address Lookup tool, the reference name allows you to distinguish one address from another in the list.
Enter the complete address in the fields provided.
Click Add. The pay-to address now appears listed in the Lookup tool.
Click the select link for that address to populate the Pay-to address field.
Physical address — Select a physical address. This is the default physical address that will appear on the ANSI 5010 electronic claim form.
If the address that you want to use is not in the Physical Address list, click the lookup link. A list of stored addresses appears in a new window.
Click the select link next to an address.
If the address that you want to use is not in the list, click the Add New Address link.
Enter the address into the form.
Note: A physical address cannot be a P.O. box.
The text you enter in Reference name will appear in address drop-down lists. Choose a reference name that you will easily recognize.
Use existing department address — Select a department if you want to use an existing department address as your physical address, or enter a new address into the form.
Note: A physical address cannot be a P.O. box.
The text you enter in Reference name will appear in address drop-down lists. Choose a reference name that you will easily recognize.
Click the select link next to the new address.
Click Add.
The Physical Address Lookup window closes.
Click Save.

Return Address (for patient statements)

Statement return address name — If you want to use an alternate medical practice name on the patient statement (typically, to guard patient privacy), enter the alternate name for the practice. If you enter a name in this field, it appears on patient statements instead of the default Statement pay-to name when patients are billed. The patient statement includes the instruction to make checks out to the Statement return address name.
If the practice uses a lockbox address, you can enter the practice address in the Return address fields provided. If you do, patient statements that are undelivered (due to bad address information) will be routed directly to this return address (instead of to the practice lockbox address).

Enrollment Forms Address (used during the implementation phase)

Enrollment forms address name — Enter the medical group name.
Address enrollment forms fields — Enter the complete mailing address where the medical group receives payer enrollment forms that require signatures from athenahealth.
Note: To comply with CMS requirements, this ZIP code field requires nine digits. Please use the adjacent USPS zip lookup link to obtain the ZIP+4 ZIP code on the USPS website.
Enrollment forms contact person (attn to:) — Enter the name of the person in this medical group who is responsible for receiving payer enrollment forms that require signatures from athenahealth.
Enrollment forms contact phone — Enter the phone number for the person in this medical group who is responsible for receiving payer enrollment forms that require signatures from the athenahealth Enrollment Services Team.
Enrollment forms contact email — Enter the email for the person in this medical group who is responsible for receiving payer enrollment forms that require signatures from the athenahealth Enrollment Services Team. Many enrollment forms require an email address for the contact person at the practice.
Click Save. The medical group appears in the list below.

Field Reference

Contacts (the following fields apply to athenaCollector)
Medical group name	The legal name of the medical practice.
Entity type	Person or non-person entity. Indicates whether this medical group bills as an individual or as a group. If a group's EIN (Employer Identification Number) or TIN (Tax Identification Number) is the same as a provider's SSN, it is a good indicator that the group should have this set to Person.
Federal ID number	The tax ID number printed in CMS-1500 Block 25 and on the billing slip. If Entity Type is set to Person, this ID is usually the physician's SSN.
Wholly owned or operated by hospital	Select Yes if your practice is wholly owned or operated by a hospital. Note: Effective July 1, 2012, CMS is expanding the scope of the Medicare 3-Day Rule to include entities wholly owned or operated by a hospital that provide Medicare Part B outpatient services. When this field is set to Yes, you can select groups of claims to HOLD for review under Medicare's 3-Day Rule on the Medicare 3-Day Payment Window page. According to Medicare, an entity is wholly owned or operated by a hospital if the hospital is the sole owner of the entity, and/or if the hospital has exclusive responsibility for conducting and overseeing the entity's routine operations, regardless of whether the hospital also has policy-making authority over the entity. When your practice enrolled with Medicare, you indicated on your Medicare Enrollment Application (form CMS-855B) whether your practice is wholly owned or operated by a hospital. Please review CMS guidelines for additional information regarding the 3-Day Rule and wholly owned or operated by hospital designations.
Billing contact	The name of the billing contact for this medical group. This is for reference only and is currently not used on the claim, but it is typically filled out for reference.
Billing contact phone	The phone number printed on the billing slip. If the Statements contact phone field (below) is blank, this phone number is also printed on patient statements.
Billing contact fax	The fax number printed on the billing slip.
Statements contact phone	The phone number printed on patient statements. If you do not enter a value in this field, this field defaults to the Billing contact phone number. The Statements contact phone number can be overridden by entering a number in the Phone number field in the Patient Communication section of the Departments page.
Medicare authorized representative	Enter the full name of the Medicare authorized representative associated with your practice or medical group. This is the representative who is authorized by CMS to sign Enrollment & Credentialing agreement forms on behalf of their organization.
Medicare authorized representative phone	Enter the contact phone number for this representative. Please be sure to keep this information current so that athenahealth Enrollment Services Team can expedite your Medicare-related enrollments.
Medicare authorized representative email	Enter the email address for this representative. Please be sure to keep this information current so that athenahealth Enrollment Services Team can expedite your Medicare-related enrollments.
Default Pay-To Address (the following fields apply to athenaCollector)
Statement pay-to name	The official pay-to name of the medical group as it should be printed on CMS-1500 Block 33 and on patient statements. If you leave this field blank, the name in the Medical group name field is used. If set, this name overrides the claim pay-to name in the return address section on patient statements. Note: Only the first 35 characters of the statement pay-to name are printed on patient statements.
Pay-to address	The pay-to address for the medical group. Only the "reference name" is visible in the list, but you can click the lookup link to access the Pay-To Address Lookup tool to view and edit the entire address, or add and select a new pay-to address. You can create and store any number of pay-to addresses.
Physical address	Select a physical address. This is the default physical address that will appear on the ANSI 5010 electronic claim form. Note: A physical address cannot be a P.O. box.
Statement Return Address (the following fields apply to athenaCollector)
Statement return address name	If set, overrides the Statement Pay-To Name in the return address section on patient statements.
Statement return address	If set, overrides the Pay-To Address in the return address section on patient statements.
Statement return address (ctd)	If set, overrides the Pay-To Address (ctd) in the return address section on patient statements.
Statement return address zip	If set, overrides the Pay-To Address ZIP in the return address section on patient statements. athenahealth recommends that you use the 9-digit ZIP code. Find 9-digit zip code
Statement return address city	If set, overrides the Pay-To Address City in the return address section on patient statements.
Statement return address state	If set, overrides the Pay-To Address State in the return address section on patient statements.
Enrollment Forms Address (the following fields apply to athenaCollector)
Enrollment forms address name	Used during the implementation phase. The name of the medical group.
Enrollment forms address	Used during the implementation phase. The mailing address where the medical group receives payer enrollment forms that require signatures from athenahealth.
Enrollment forms address (ctd)	The second line of the enrollment-related correspondence address (optional).
Enrollment forms address zip	The ZIP code for the enrollment-related correspondence address (see above). To comply with CMS requirements, this ZIP code field requires nine digits. Please use the adjacent USPS zip lookup link to obtain the ZIP+4 ZIP code on the USPS website.
Enrollment forms address city	The city for the enrollment-related correspondence address (see above).
Enrollment forms address state	The state for the enrollment-related correspondence address (see above).
Enrollment forms contact person (attn to:)	Used during the implementation phase. The name of the person in this medical group who is responsible for receiving payer enrollment forms that require signatures from athenahealth.
Enrollment forms contact phone	Used during the implementation phase. The phone number for the person in this medical group who is responsible for receiving payer enrollment forms that require signatures from the athenahealth Enrollment Services Team.
Enrollment forms contact email	Enter the email for the person in this medical group who is responsible for receiving payer enrollment forms that require signatures from the athenahealth Enrollment Services Team. Many enrollment forms require an email address for the contact person at the practice.
Column Headings on Medical Groups List
ID	The system-assigned ID number of the medical group.
Name	The practice-internal name for this medical group.
Phone	The phone number printed on the billing slip.
Contact	The name of the billing contact for this medical group.
Fed ID	The tax ID number printed in CMS-1500 Block 25 and on the billing slip.