Wrap Billing Report

athenaCollector

This report applies to federally qualified health centers (FQHCs), rural health centers (RHCs), and similar practices who use wrap billing.

 

You can use this report to discuss claim payment issues with payers without having to do extra navigation to get details like:

  • Patient demographics
  • Claim reference numbers
  • Managed Care Organization (MCO) claim numbers

 

Note: We initially communicated an outdated name for this report. We said it was the Wrap Reconciliation report. The report is actually called the Wrap Billing report.

 

Display the Report Library: On the Main Menu, click Reports. Under General, click Report Library. Click the Other tab. In the Standard Reports section of the tab, click run next to Wrap Billing Report.

 

 

 

There are many roles and permissions related to the Report Library, see Report Library in O-help for more information; once there, see the "User access and permissions"section.

 

 

You can now run the Wrap Billing report. RHCs, FQHCs, and similar practices:

  • Who use wrap billing can now get visibility into the details of those claims more easily

  • Using the two-claim wrap billing workflow can now better identify wrap claims

  • That need to discuss claim payment issues with payers can now save time because they no longer need to do extra navigation to get to claim details like:

    • Patient demographics
    • Claim reference numbers
    • Managed Care Organization (MCO) claim numbers

 

Note: Wrap claims involve different workflows and adjudication that make insight into these claims important for RHCs and FQHCs. This new report provides a look into your practice's wrap claims in one place.

 

 

  1. Display the Report Library page:

    1. On the Main Menu, click Reports.

    2. Under GENERAL, click Report Library.

  2. Click the Other tab.

  3. Under Standard Reports, click run next to Wrap Billing.

  4. From date - To date — Set a date range or select from the list of dates options.

  5. Report Format — Leave the Run as HTML table option selected.

  6. Report Options — Leave the Show Filter Criteria option selected.

  7. Click Run Report.

 

Column Description
Service Department The Service Department indicated on the parent and wrap claims
Rendering Provider The Rendering Provider indicated on the parent and wrap claims
Date of Service The Service Date indicated on the parent and wrap claims
Per Diem Rate The applicable Per Diem Rate based on the Per Diem Rate mapping table, specific to the Service Department and Insurance Reporting category
Patient Last Name Last name of patient on the claim
Patient First Name First name of patient on the claim
Clinical Encounter ID Clinical Encounter ID associated with the claim
Appointment ID Appointment ID associated with the claim
MCO Claim Number The Managed Care Organization Claim Number, which is stored in athenaOne as a claim reference number and useful for discussing specific claims with MCOs.
Total Charges* The total charges on the parent claim
Total Payments* The total payments on the parent claim
Total Adjustments* The total adjustments on the parent claim
Parent Claim Balance The outstanding balance on the parent claim
Parent Claim ID The Claim ID of the Parent Claim
Parent Primary Package The primary insurance package as listed on the parent claim
Parent Secondary Package The secondary insurance package as listed on the parent claim
Parent Paid Amount The amount of insurance payments on the parent claim
Parent Denied (Y/N)

Displays a Y if there was ever a denial on the parent claim, even if the claim is not currently in HOLD status due to a denial.

 

Note: This means that the report may display a Y in the Parent Claim Denied (Y/N) column and an amount in the Parent Paid Amount column (indicating that the claim is not denied).
Parent Capitation (Y/N) Displays a Y if there is a capitated transaction on the parent claim
Wrap Claim ID The Claim ID of the wrap claim
Wrap Insurance Package The primary insurance package listed on the wrap claim
Wrap Paid Amount The amount of insurance payments on the wrap claim
Wrap Claim Denied (Y/N)

Displays a Y if there was ever a denial on the Wrap Claim, even if the claim is not currently in HOLD status due to a denial.

 

Note: This means that the report may display a Y in the Wrap Claim Denied (Y/N) column and an amount in the Wrap Paid Amount column (indicating that the claim is not denied).
Wrap Claim Balance The outstanding balance on the wrap claim

 

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