Non-Participating Providers

1. Display the Non-Participating Providers page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Providers, click Non-Participating Providers.
2. Name — Enter a name for the posting override. The name should reflect the relevant payers and providers (for example, Aetna: All Providers Non-Par).
3. Description — Enter a description of the posting override.

Enter start and end dates for the non-par posting override

 

The Start Date and End Date fields help you manage non-participation status when current payer contracts are set to expire without renewal, or contract negotiations are underway and your non-participation status is expected to be affected on a date in future.

4. Start Date — By date of service on the claim. Enter an effective date for the posting override. If the date of service on a non-par claim is within the Start and End date range, the override will apply to the claim.
   
5. End Date — Enter the date that athenaOne will stop applying the non-participating provider override. If a non-par provider is scheduled to enter into a contract with a payer, the End Date you enter here must be the effective date for the new contract. The End Date cannot be later than December 31 of the calendar year in which you enter or update the non-par provider.
6. Automatically Bill Next Payer — This field allows your practice to control which non-par overrides require practice review before billing the next payer.
• Select Yes to have athenaOne automatically bill the next payer when transferring a contractual to the next payer.
• Select No - Send to MGRHOLD to place the claim in MGRHOLD when transferring a contractual to the next payer.

Select the set of providers for the non-par posting override

7. Under the Provider Filter section, select the providers for the override. Additional options appear, depending on your selection.
1. Click Selected to indicate that all the providers or groups you select are non-participating with the payers you will select in the next filter.
2. Click All Except to indicate that all the providers or groups do not apply to the non-participation arrangement you are creating.
3. From the Provider, Provider Group, or Medical Group list, select the providers or groups you need for the non-par override.
8. Review your selections to confirm that you have accurately selected the desired providers or groups and have accurately indicated Selected or All Except.
9. Under the Insurance Filter section, select the insurance packages or insurance reporting categories for the override. Additional options appear, depending on your selection.
1. Click Selected to indicate that all the insurance packages or categories you select are non-participating with the payers you will select in the next filter.
2. Click All Except to indicate that all the insurance packages or categories do not apply to the non-participation arrangement you are creating.
3. In the Insurance Package or Insurance Reporting Category text boxes, enter the insurance package IDs you need for the non-par override, or enter a period in the box to access the Insurance Package Lookup tool and select the packages that you need.
4. From the Insurance Reporting Category list, select the insurance categories you need for the non-par override.
10. Review your selections to confirm that you have accurately selected the desired insurance packages or categories and have accurately indicated Selected or All Except.  
    Note: The non-participating arrangements you create will affect the posting of EOBs and the billing of next parties. Incorrectly representing your providers' non-participation status may result in inaccurate billing of the next responsible party (this includes secondaries, tertiaries, and patients). Inaccurate billing is illegal.
11. Click Save.

1. Display the Non-Participating Providers page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Providers, click Non-Participating Providers.
2. Scroll down to the Existing Non-Participating Providers list at the bottom of the page, and locate the non-par provider override you want.
3. Click the update link for the non-par provider override. The information appears at the top of the page.
4. Update the fields as desired.
5. Click Save to update or Cancel to preserve the original information.

1. Display the Non-Participating Providers page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Providers, click Non-Participating Providers.
2. Scroll down to the Existing Non-Participating Providers list at the bottom of the page, and locate the non-par provider override you want. The list is ordered first by ordering number, then alphabetically by last name.
3. Click the delete link for the non-par provider override. A warning message appears. Click OK to delete the non-par provider override, or click Cancel to preserve it.
   
   Note: Deleted non-par provider overrides appear disabled in the list of providers. To restore a deleted non-par provider override, click the undelete link. The audit history of the provider is preserved.

 

The athenaOne Posting Engine references the non-participating provider data that you enter on the Non-Participating Providers page to ensure that any inferred contractual adjustments are represented on the claim as a transfer to the next responsible party. Your non-participating provider entries assist in the correct posting of the claim adjudication found on the EOB whenever the EOB infers a contractual adjustment, but you have indicated that the billing provider is non-participating with the payer.

Note: You cannot add workers compensation packages to the list of non-participating providers because claim amounts for these packages cannot be transferred to a next responsible party.

 

Non-par posting overrides affect patient billing. You cannot create a non-par override with any government payer, including Medicare and Medicaid programs and Medicare and Medicaid replacements.

 

Entering a non-participating provider on this page informs the athenaOne posting engine that you do not have a contract with the specified payers; therefore, you do not accept any contractual adjustments that may be inferred from the remittance advice supplied by the payer. Use caution when adding non-participating providers. The non-participation information you enter on this page informs a posting override to transfer to the next responsible payer any contractual amount that is reported on the payer's remittance advice.

 

 

 

 

Your practice is configured in one of two ways:

• To bill all non-par claims directly to the next responsible payer, or
• To send all non-par claims to Manager Hold (MGRHOLD) for review before billing the secondary insurance or the patient. If you want to review your non-par claims before billing the next responsible payer, select this option. First, athenaOne automatically overrides any contractual amount reported by any payers listed as non-par on your Non-Participating Providers page and posts this amount as a transfer to the next responsible payer. Then, athenaOne kicks the claim with the non-participating provider kick code NPP, which sends the claim to MGRHOLD for review. Here, you can review the claim and make any required adjustments before billing the next payer.

Please contact the CSC by selecting Support > Create Case or Call in the Main Menu if you wish to change your current option.