Payer Enrollment Readiness Dashboard

You can now choose a pre-live view or post-live view of the Payer Enrollment Readiness Dashboard. Both views show your payer enrollment progress and remaining work, but the views show some different data, depending on whether your organization is still in the athenaOne onboarding process or already post-live.

• The dashboard displays the post-live view by default.

• Click Pre-live view under the Payer Enrollment Readiness Dashboard heading to see the pre-live view of the dashboard.
  
  
• From the pre-live view, under the Payer Enrollment Readiness Dashboard heading, you can click Post-live view.

At the top of the dashboard, you can also:

• Click links for dashboard preferences, training videos, FAQs, and giving feedback
• Use the Show data for: filter to select specific readiness data, for example, data for a specific Go live date

What should I focus on? — This section on the left side of dashboard shows the individual, actionable types of work you should focus on.

How ready are we overall? — This section on the right side of dashboard shows your organization’s enrollment completeness, including any work you, your payers or athenahealth must complete. Percentages are weighted by each payer's estimated claim volume.

Together, these sections provide an at-a-glance view of your enrollment readiness and how it may impact your organization.

Use the enrollment detail table below those sections to filter and sort the remaining actionable enrollment work. Robust filtering makes it easy to find and prioritize the work you need to complete. Additionally, you can set dashboard preferences so you're seeing only the most relevant and important work every time you access the dashboard.

The improved Overall Enrollment Progress column appears on the main table of payers on the pre-live dashboard.

The Overall Enrollment Progress column has a link that opens up a new window displaying enrollment progress for that payer:

• An overview showing the progress breakdown of payer enrollment work

• Summary of remaining work for the respective payer

You can see an alert when a payer is at risk of missing your go-live date based on payer turnaround time (TAT).

The alert icon appears in the in the Payer table's Overall Enrollment Progress column.

The alert icon appears next to the link to the payer's enrollment progress window. The link shows the enrollment progress percentage for the payer, for example: 54%.

When you click the enrollment progress percentage link, the alert icon and message appear at the bottom of the payer enrollment progress window. The message informs you which types of enrollment work won't be complete by go-live based on payer turnaround time (TAT).

In the What should I focus on? section, review a graph with color-coded percentage bars that indicate the work types that appear in the filterable enrollment detail table below this section.

Choose one of these views:

• My Top 5 Payers — Shows the work types you need to complete across your top 5 payers (by estimated claim volume).
• All Payers — Shows the work types you need to complete across all of your payers

The improved What should I focus on section allows for better visibility into the categories that your enrollment work is currently in:

• Completed — Dark green color indicates percentage of finished work for the payer

• Submitted to payer — Light green color indicates the amount of work that is with the payer

• With athenahealth — A purple color indicates the amount of work that is with athenahealth

• Pending — A gray color indicates the amount of work that is not currently practice-actionable

• Ready to work — A yellow color shows the amount of work that you can take action on
  Note: The number percentage that appears in each progress bar shows the percentage of work completed. When you hover one of the bars of color, a message about the field appears.

Tip: Each work type that still has remaining work will have a work [#] tasks link in parentheses. Click the link to filter for those specific work types in the enrollment details table.

Click the filter icon to display that work type in the table below. Once you click the filter icon it turns solid blue, the table focuses on that work type, and the work type appears in the table's Filter by section.

In the How ready are we overall? section, you can see your organization’s overall readiness, based on the status of all enrollment tasks, including any work you, your payers or athenahealth must complete. Percentages are weighted by each payer's estimated claim volume.

The section has two percentage bars:

• Claim Submission Readiness — Shows the estimated percentage of claims that should be able to be submitted to and paid by payers based on a weighted completion of payer enrollments
• Revenue Cycle Efficiency Readiness — Shows the estimated amount of EOBs and payments that you'll receive electronically versus on paper

The number of completed payers versus the total number of payers is listed below each section.

The enrollment detail table provides a dynamic way to view and understand the work your organization needs to complete to ensure payers, medical groups, and providers are ready to bill.

The table has three views:

• Payers
• Medical Groups
• Providers

After you select a view, you can see all work types or filter by the specific work types that appear in the What should I focus on? section:

• Update Credentialing Statuses
• Update NPIs & Resolve Numbers
• Set Up E-Claims
• Set Up E-Remittance
• Set Up EFT

These columns appear in the table:

• Payer, Medical Group, or Provider — (depending on which view you selected) The name of the payer, medical group, or provider
• Estimated Claim Volume — This value is based on hospital referral region (HRR) which is determined by ZIP code.
• Claim Submission Tasks — The total number of workable practice enrollment tasks involving electronic claim submission to this payer, medical group, or provider.
• Revenue Cycle Efficiency Tasks — The total number of workable practice enrollment tasks involving electronic payments for claims to this payer.
• Task Deadline Approaching — The first date that any task for this payer will be overdue, based on athenahealth network data about payer turnaround times.
• Overall Enrollment Progress — The percentage of all tasks completed. Has a link that opens up a new window displaying enrollment progress for that payer:

  • An overview showing the progress breakdown of payer enrollment work

  • A summary of remaining work for the respective payer

1. Display the Payer Enrollment Readiness Dashboard.
2. Show data for: athenaOne defaults the selection to all Go live dates. Click Go live dates to open the filter options. Select the Go live dates you want to view. The dashboard refreshes to show data for the selected Go live dates only.
   
3. Select the view of the enrollment detail table: Payers, Medical Group, or Provider.
   
4. Filter by: — Click All work types to filter for the type of work you want to complete.
   
5. Check the boxes next to the work types and click Save.
6. Review the list. Payers/ Medical Groups/ Providers (depending on which view you selected) that have work tasks to complete will have an Expand icon to the left of the first column.
   • Click the Expand icon to see the detailed Work Types and tasks.
     
     
   • Click the Collapse icon to close the detailed view.
     
     
7. Review the information. Enrollment tasks are broken out into the claim submission readiness and revenue cycle efficiency categories.
8. Click the task that you want to resolve.
   • In most cases, the Enrollment Worklist opens.
   • You may also see another page, such as the Provider Credentialing page, depending on the appropriate page needed to complete the work.
   • Only the tasks in the category of work you selected appear.
     
9. Complete the tasks.
10. On the enrollment task page:
    • Click View Full Enrollment Worklist to view all tasks on the Enrollment Worklist
    • Click Go Back to Enrollment Dashboard to return to the Payer Enrollment Readiness Dashboard.

1. Display the Payer Enrollment Readiness Dashboard.
   
2. Click Dashboard Preferences.
   The My Dashboard Preferences window appears.
   
3. Medical groups — Select the medical group(s) you want to view.
4. Work types — Select the type of work you want to view (e.g., credentialing work, billing and numbers work, and so on).
5. Click Open email reminder settings in a new tab to set up enrollment email reminders on the Enrollment Email Reminder Settings page.
6. Default graph view — Select how you want the graph in the Claim Submission Readiness section to display claim data.
7. Default table view — Select the view of the enrollment detail table.
8. Restore settings to their recommended defaults — Check the box to restore the settings to the recommended defaults. You can't undo this option after you click Save.
9. Click Save.
   athenaOne applies your dashboard preferences every time you access or refresh the dashboard.

1. Selena Test, a billing manager at Seven Hills Medical Group, wants to check on the organization's pre-live enrollment work to ensure that they're ready for their go-live date.
2. She goes to the Payer Enrollment Readiness Dashboard and clicks Go to Pre-live view, where she can check the status of how ready her organization is and complete her outstanding tasks.
3. She filters the enrollment detail table to show the incomplete work for updating credentialing statuses.
4. Selena reviews a credentialing status and completes the work to update it. She finds that the work she completed is reflected in the work type completion percentage in the Update Credentialing Statuses field of the What should I focus on? section.

5. She notices that she still has over 50 credentialing statuses to update as well as NPI numbers to update and numerous E-claims, E-remittance, and EFTs to set up.

6. She clicks the My Top 5 Payers button in the What should I focus on? section, and reviews her progress there.

7. She continues to chip away at the various work types by clicking the percentage bars in the What should I focus on? graph and working tasks from the enrollment detail table.

8. The next day, Selena returns to the pre-live view of the Payer Enrollment Dashboard and sees that overall readiness percentages in the Claim Submission Readiness and Revenue Cycle Efficiency Readiness fields of the How ready are we overall? section have increased, indicating the work she completed greatly impacted the organization's overall enrollment readiness.

1. On the Payer Enrollment Readiness Dashboard page, click Pre-live view.
   

2. Show data for: — To display data for specific medical groups only:

   1. Click All go live dates
   2. Click the checkbox for a specific go live date
   3. Click the checkbox for specific medical groups in the list and then click save.
      
      The dashboard refreshes to show data for the selected medical groups only.

    

A banner appears at the top of the Payer Enrollment Readiness Dashboard when you need to complete US Bank setup tasks so that you're aware of the pending task and have a quick way to get to the task.

A link in the banner brings you directly to the unfinished tasks. The banner appears in both the pre-live and post-live view of the Payer Enrollment Readiness Dashboard.

You can set display preferences on the Payer Enrollment Readiness Dashboard so that you see only the most relevant metrics and work whenever you open the dashboard.

1. Display the Payer Enrollment Readiness Dashboard: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Enrollment and Numbers, click Enrollment Dashboard.
2. Click Dashboard Preferences.
   The My Dashboard Preferences window appears.
   
   
3. Medical groups — To display data for specific medical groups when you open the dashboard, click All to display the list of medical groups. Select the medical groups in the list and then click Save.
4. Work types — To display specific types of enrollment work when you open the dashboard (for example, credentialing tasks or billing and numbers work), click All to display the work types. Select the work types in the list and then click Save.
5. To set up enrollment reminder emails for users at your organization, click Open email reminder settings in a new tab.
   The Enrollment Email Reminder Settings page opens. The emails provide information about incomplete enrollment work and how it affects your organization.
6. Default graph view — Select the default display of the Claim Submission Risk section at the top of the dashboard:
   • Percent — Percentage of claims holding because of enrollment issues
   • Dollars — Dollar amount of claims holding because of enrollment issues

7. Default table view — Select the default view of the enrollment detail table: Payers, Medical Groups, or Providers.
   
   
8. Default table sort — Select the default sorting of the enrollment detail table: % Claim Volume, $ Claims Holding, or Recently Added.
   
   Note: The Recently Added option is not available for the Payers view.
9. Restore settings to their recommended defaults — Select the Restore Settings option to undo your custom settings on this page.
   Note: If you select this option and save, you will need to set any custom preferences again.
10. Click Save.
    athenaOne applies your dashboard preferences every time you access or refresh the dashboard.

You can filter the Payer Enrollment Readiness Dashboard to find enrollment tasks that are holding up claims. From the dashboard, you can display the Enrollment Worklist page, where you can complete the enrollment task.

Note: Depending on the type of enrollment task you select, you may see other pages, such as the Payer Enrollment page or the Provider Credentialing page. From all these pages, you can return directly to the Payer Enrollment Readiness Dashboard.

1. Display the Payer Enrollment Readiness Dashboard: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Enrollment and Numbers, click Enrollment Dashboard.
2. Show data for: — To display data for specific medical groups only:
   1. Click All medical groups to display the list of medical groups.
      
   2. Select the medical groups in the list and click Save.
      The dashboard refreshes to show data for the selected medical groups only.

3. Select the view of the enrollment detail table: Payers, Medical Groups, or Providers.
   
4. Sort by: — To change the sort order of the enrollment work, click % Claim Volume, $ Claims Holding, or Recently Added.
   
   Note: The Recently Added option is not available for the Payers view.
5. Filter by: — To display only specific types of enrollment work (for example, credentialing tasks or billing and numbers work):
   1. Click All work types to display the list of enrollment work types.
      
      
   2. Select the work types in the list and then click Save.

6. Review the enrollment detail table and locate the first task that you want to work on.
7. In the Work Type column, click View Details.
   Additional information appears.
   
   Note: Enrollment tasks are separated into Claim Submission Risk and Revenue Cycle Efficiency categories.
   
8. Click Work to display the task that you want to resolve.
   In most cases, the Enrollment Worklist page opens. On the Enrollment Worklist page, only the tasks in the category of work you selected appear.
   
   Note: You can click View Full Enrollment Worklist on the Enrollment Worklist page to display all tasks on the Enrollment Worklist page.
   
9. On the Enrollment Worklist page, click work to open the enrollment task.
10. Follow the instructions to complete the task and click Save.
    The Enrollment Worklist page appears.
11. Click Go Back to Enrollment Dashboard to return to the Payer Enrollment Readiness Dashboard.

On the Payer Enrollment Readiness Dashboard, you can find claims that are holding because of enrollment issues and then open the claims on the Claim Edit page, where you can complete the work to resolve the issue.

1. Display the Payer Enrollment Readiness Dashboard: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Enrollment and Numbers, click Enrollment Dashboard.
2. Show data for: — To display data for specific medical groups only:
   1. Click All medical groups to display the list of medical groups.
      
   2. Select the medical groups in the list and click Save.
      The dashboard refreshes to show data for the selected medical groups only.
3. Select the view of the enrollment detail table: Payers, Medical Groups, or Providers.
   
   
4. Sort by: — To change the sort order of the enrollment work, click % Claim Volume, $ Claims Holding, or Recently Added.
   
   Note: The Recently Added option is not available for the Payers view.
5. Filter by: — To display only specific types of enrollment work (for example, credentialing tasks or billing and numbers work):
   1. Click All work types.
      
      
   2. Select the work types in the list and then click Save.
6. Review the enrollment detail table and select claims to work on in the table.

7. Click the linked number in the # claims currently holding for enrollment reasons column.
   The list of claims opens.
   
   
8. Click the linked claim ID number in the Claim column.
   The Claim Edit page opens.
9. Review the claim notes related to the hold and edit the claim.

From the Payer Enrollment Readiness Dashboard, you can go to the Payer Enrollment page to correct missing or incorrect billing setup information for a payer. The Clarify Billing Setup worklist on the Payer Enrollment page lists each claim that is in HOLD status because of an incorrect or incomplete billing setup. Suggestions for resolving each incorrect or incomplete billing setup on the Payer Enrollment page include detailed examples, as well as links to the associated claim or enrollment task.

1. Display the Payer Enrollment Readiness Dashboard: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Enrollment and Numbers, click Enrollment Dashboard.
2. Show data for: — To display data for specific medical groups only:
   1. Click All medical groups to display the list of medical groups.
      
   2. Select the medical groups in the list and click Save.
      The dashboard refreshes to show data for the selected medical groups only.
3. Select the view of the enrollment detail table: Payers, Medical Groups, or Providers.
   
   
4. Sort by: — To change the sort order of the enrollment work, click % Claim Volume, $ Claims Holding, or Recently Added.
   
   Note: The Recently Added option is not available for the Payers view.
5. Filter by: — Select Clarify Billing Setup and click Save.
   
   The Clarify Billing Setup work type flags claims in a HOLD status that cannot be sent out due to an incomplete or incorrect billing setup.
6. In the Work Remaining column, click View Details.
   
7. In the Clarify Billing Setup row, click Work.
   The Payer Enrollment page appears with the Clarify Billing Setup worklist open in the Task Bar on the left.
   
   The Clarify Billing Setup worklist lists each claim that is in HOLD status because of an incorrect or incomplete billing setup. For each claim, suggestions for resolving the incorrect or incomplete billing setups appear in a yellow box at the top of the Payer Enrollment page.
8. Select the claim that you want to work on in the Clarify Billing Setup worklist. (The first claim in the list is displayed by default.)
9. View — The Payer Enrollment view appears in the Workspace by default. To display the Claim Edit page for the claim that is affected, click Claim in the View field.
   The Claim Edit page appears in the Workspace.
10. Review the information in the yellow box on the Payer Enrollment page. Click What are my possible actions? in the message to see additional information.
11. Resolve the issue by editing the claim on the Claim Edit page or by editing the billing group on the Payer Enrollment page.
    Note: The Clarify Billing Setup worklist appears on either page.
12. Click Save on the page you edit.
    athenaOne rescrubs the claims in the Clarify Billing Setup worklist (a progress bar appears at the top of the page). A checkmark appears next to a claim if the billing setup issues are resolved.
    Note: athenaOne continues to rescrub the claims even if you leave the Payer Enrollment page.
13. For each claim in the worklist without a checkmark, repeat steps 8 through 12.
    Note: Click Back to Enrollment Dashboard at the top of the Clarify Billing Setup worklist to return to the Payer Enrollment Readiness Dashboard.

At the top left of the Payer Enrollment Readiness Dashboard is the Claim Submission Risk section.

You can toggle between the percentage of claims holding and the dollar amount of claims holding by clicking the dollar sign ($) and the percent sign (%). Hover the cursor over the graph line to display the percentage of claims holding or the dollar amount of claims holding at any point in time. To display the metrics for one or more specific medical groups, click All medical groups, select the medical groups in the list, and click Save.

The Claim Submission Risk section provides this information:

• Dollar amount of claims currently being held due to incomplete enrollment work
• Number of claims currently being held due to incomplete enrollment work
• Percentage of claims holding for enrollment-related reasons over the past five years

The percentage and dollar amount of claims holding for enrollment-related reasons decreases as you complete these enrollment tasks:

• Credentialing statuses
• Pay-to address changes
• NPI verification
• Electronic claim submission
• Legacy number verification

At the top right of the Payer Enrollment Readiness Dashboard is the Revenue Cycle Efficiency section.

The Revenue Cycle Efficiency section displays the percentage of transactions that your organization completes electronically (that is, electronic remittance and electronic payments) versus the percentage of transactions that your organization completes on paper. Typically, organizations receive remittance much faster when they complete transactions electronically.

Note: The Revenue Cycle Efficiency bars include only transactions that can be completed electronically.

The Revenue Cycle Efficiency section also provides this information:

• Average time it takes to receive your remittances and payments
• Estimated time savings if you complete outstanding ERA and EFT enrollment tasks

The percentage of transactions your organization completes electronically increases when you complete these enrollment tasks:

• Electronic remittance
• Electronic payments
• Claim status inquiries

The enrollment detail table on the Payer Enrollment Readiness Dashboard provides a dynamic way to view and understand the work that your organization needs to complete to ensure that payers, medical groups, and providers are ready to bill.

To see a definition of each column in the table, hover the cursor over the column name.

The enrollment detail table has three views: Payers, Medical Groups, and Providers. (You can set the default view on the My Dashboard Preferences page.)

After you select the view, you can sort the results further by claim volume, dollar amount of claims holding due to enrollment reasons, or recently added (this option is not available on the Payers view). You can also filter the table by specific types of work, including credentialing work, billing and numbers work, and so on.

These columns appear in the table:

• Payers, Medical Groups, or Providers — The name of the payer, medical group, or provider
• Claim Volume — Percentage of claims billed to the payer, or billed from the medical group or provider over the past 90 days
• $ claims currently holding for enrollment reasons — Total dollar amount of claims in a HOLD status related to enrollment work
• # claims currently holding for enrollment reasons — Number of claims in a HOLD status related to enrollment work
• ERA Time Savings Available — Average time your organization will save to receive remittance and payment if you complete outstanding ERA enrollment tasks for the payer, medical group, or provider
• EFT Time Savings Available — Average time your organization will save to receive remittance and payment if you complete outstanding EFT enrollment tasks for the payer, medical group, or provider
• Work Type — Enrollment work that you need to complete — either on the claim or on the Enrollment Worklist page — categorized as Claim Submission Risk work or Revenue Cycle Efficiency work