Phone Payer Information

athenaCollector

This page provides a summary of the payer information that you need to contact a payer for claims follow-up.

Features and workflows

You display the Phone Payer Information page from the Claim Action or Claim Edit page. The Phone Payer Information page opens in a separate window, which you can move, resize, minimize, and restore. By default, the Phone Payer Information page displays the information for the primary payer, but if a secondary insurance package exists for the claim, a menu appears at the top of the page that you can use to select the desired package.

Note: You cannot edit the information on the Phone Payer Information page. All fields exist elsewhere in athenaOne (see the Field Reference).

You can click the view additional insurance contact info link on the Phone Payer Information page to display the Insurance Package Contact Info page, which contains additional contact information, if available.

Note: athenahealth recommends that you send your questions for insurance companies to us, so we can resolve them on your behalf. Add the ADNREVIEW kick code to the claim using the Claim Action page and enter your reason for requesting follow-up in the Claim note field.

Medicare Filing Limits

Medicare Filing Limits claims are calculated relative to the date of service. The actual filing limit date can be as short as 15 months or as long as 2+ years. Medicare also reduces payments by 10% for claims submitted over a year from the date of service.

To be eligible for Medicare reimbursement, claims must be filed with Medicare by the end of the calendar year following the fiscal year (October to September) in which the services were provided, or the claim will be denied.

Table of Medicare Filing Limits

Date of Service		Must Be Filed By
From	Through
10-01-2002	9-30-2013	12-31-2014
10-01-2003	9-30-2014	12-31-2015
10-01-2004	9-30-2015	12-31-2016
10-01-2005	9-30-2016	12-31-2017
10-01-2006	9-30-2017	12-31-2018

Note: If a claim is filed more than one year from the date of service, payment to the physician or supplier is reduced for that service by 10%. The provider cannot bill the patient for this reduction. The patient can be charged only 20% of the amount that Medicare would have approved for the service.

Field Reference

Payer Information
Payer Phone #	Administered by athenahealth.
Payer Name	Administered by athenahealth.
Insurance Package #	Administered by athenahealth.
Workers' Comp Case #	Administered via the Add / Update Workers Comp Policy Details page, Workers' Comp claim number field.
Injury/Accident Date	Administered via the Add / Update Workers Comp Policy Details page, Case injury date field.
Adjuster Name	Administered via the Add / Update Workers Comp Policy Details page, Adjuster last name and Adjuster first name fields.
Adjuster Phone #	Administered via the Add / Update Workers Comp Policy Details page, Adjuster phone/contact info field.
Adjuster Fax #	Administered via the Add / Update Workers Comp Policy Details page, Adjuster fax field.
Injured Body Part	Administered via the Add / Update Workers Comp Policy Details page, Injured body part field.
Filing Limit Deadline	The filing limit deadline (primary claims only). Payers specify the length of time you have to file a claim in a timely manner. athenahealth uses these payer limits to ensure that claims are sent to the payer before the filing deadline. Some plans may discount payments if a claim is filed after a certain period but within the filing limit. athenaOne displays filing limits for primary claims only. Although payers do have filing limits for secondary claims, the filing limit may be a variable date, based on information from the primary payer's EOB, such as the denial date. For this reason, athenaOne cannot display the filing deadline date for secondary claims.
Patient Information
Claim ID	System-assigned claim ID number. Appears on the Claim Action and Claim Edit pages.
Date(s) of Service	Appears at the top of the Claim Action page. Administered via the Claim Edit page.
Total Charges	Appears at the top of the Claim Action page.
Patient Name	Appears at the top of the Claim Action page. Administered via the Patient Registration or Quickview page.
Patient DOB	Appears at the top of the Claim Action page. Administered via the Patient Registration or Quickview page.
Patient SSN	Administered via the Patient Registration or Quickview page.
Patient Relationship to Policy Holder	Administered via the Add / Update Policy Details page, using the Patient's relationship to policy holder field.
Policy Holder Name	Administered via the Add / Update Policy Details page, Last name and First name fields under the Policy Holder heading.
Policy Holder DOB	Administered via the Add / Update Policy Details page, DOB field under the Policy Holder heading.
Policy Holder SSN	Administered via the Add / Update Policy Details page, SSN field under the Policy Holder heading.
Member ID #	Administered via the Add / Update Policy Details page, Member ID/certification number field.
Group ID #	Administered via the Add / Update Policy Details page, Policy/group number field.
Employer Name	Administered via the Add / Update Policy Details page, Employer field.
Eligibility Status	The current eligibility status. Indicates the result of the most recent electronic or manual eligibility check.
Eligibility Note	Click the (show detail) link to display the full eligibility note.
Insurance Card Image
	The scanned image of the patient's insurance card is displayed in this section. If no image has been scanned, displays the message: "No card image available at this time." Note: To scan an insurance card, click the add card image link on the Quickview page or use athenaCapture.
Provider Information
Practice Name	Administered via the Medical Groups page, Statement pay-to name field.
Practice #	System-generated ID number of the medical practice.
Supervising Provider Name	Selected via the Claim Edit page, using the Supervising provider menu. Administered via the Providers page, Last Name and First Name fields.
Supervising Provider Legacy #	Administered via the NPIs and Other Numbers page (Update Provider Number view), Number field.
Supervising Provider NPI #	Administered via the NPIs and Other Numbers page (Update Provider Number view), Number field.
Supervising Provider Specialty	Administered via the Providers page using the Specialty menu.
Provider Tax ID #	Administered via the Medical Groups page (for the provider's medical group), Federal ID number field.
Department Legacy #	Administered via the Department Numbers page (Update Department Number view), Number field.
Department NPI #	Administered via the Department Numbers page (Update Department Number view), Number field.
Medical Group Legacy #	Administered via the Medical Groups page, Policy/Group Number field.
Medical Group NPI #	Administered via the Medical Groups page (Update Medical Group Number view), Number field.
Rendering Provider	Selected via the Claim Edit page, using the Rendering provider menu. Administered via the Providers page, Last Name and First Name fields.
Practice Address	Administered via the Medical Groups page (for the provider's medical group), Pay-to address field.
Pay-To Address	Administered via the Medical Groups page (for the provider's medical group), Pay-to address field.
EFT Provider Status	EFT status: Assigned — EFT not set up Completed — EFT is set up NoI — No Information, EFT is not set up InProcess — EFT is in process of being set up With Client — In process, paperwork is with the client With Payer — In process, paperwork is with the payer Not Available — EFT is not set up Refused — EFT is not set up Not Credentialed — EFT is not set up
EFT Group Status	EFT status: Assigned — EFT not set up Completed — EFT is set up NoI — No Information, EFT is not set up InProcess — EFT is in process of being set up With Client — In process, paperwork is with the client With Payer — In process, paperwork is with the payer Not Available — EFT is not set up Refused — EFT is not set up Not Credentialed — EFT is not set up
Credentialing Group Status	Credentialing group status (PAR, Non-Par, etc.).