Claim Formatting & Financial Insight [FQHC] Report

athenaCollector + athenaClinicals

The Claim Formatting & Financial Insight [FQHC] report displays back-end claim scrub data specific to FQHCs and RHCs. This report uses the per diem rate mapping table; the sum of the per diem rate and additional charges (as specified in the claim scrub data) provides the expected payment amount for the FQHC or RHC claim.

To run the Claim Formatting & Financial Insight [FQHC] report

Display the Report Library: On the Main Menu, click Reports. Under General, click Report Library.
Click the Financial tab.
Click run next to Claim Formatting & Financial Insight [FQHC] in the Standard Reports section of the tab.
The Run Report: Claim Formatting & Financial Insight [FQHC] page appears.
Date Range — Enter the start and end dates for the report, or select a date range from the menu.
I want to ... — Create a summary or detailed report by selecting one of these options:

To display aggregated data for each IRC–service department combination, select view a summary of the submitted claim data.
To display one table row for each claim, select view detail for each claim.

Date Type — Select an option from the menu.

Claim Service Date (default)
First Billed Date
Last Billed Date
Most Recent Scrub Date

The date range applies to the option you select in this field. For example, if you select Previous Month from the Date Range menu and select Claim Service Date as the Date Type option, the report includes claims based on the service date for last month.

Note: Some claims do not have a First Billed Date or a Last Billed Date. If you select one of these options, claims without these dates are excluded from the report.

Primary Insurance — To report on claims for specific primary insurance packages only, click Selected, enter text to display a list of matching insurance packages, and then select the packages to include in the report.
Primary Insurance Reporting Category — To report on claims for specific primary insurance reporting categories only, click Selected and then select the IRCs to include in the report.
Secondary Insurance — To report on claims for specific secondary insurance packages only, click Selected, enter text to display a list of matching insurance packages, and then select the packages to include in the report.
Secondary Insurance Reporting Category — To report on claims for specific secondary insurance reporting categories only, click Selected and then select the IRCs to include in the report.
Primary Claim Status — To report on claims associated with specific claim statuses only (for example, Appealed or Billed), click Selected and then select the claim statuses to include in the report.
Note: This claim status applies to the primary insurance.
Secondary Claim Status — To report on claims associated with specific claim statuses only (for example, Billed or Followup), click Selected and then select the claim statuses to include in the report.
Note: This claim status applies to the secondary insurance.
Patient Claim Status — To report on claims associated with specific claim statuses only (for example, Closed or Overpaid), click Selected and then select the claim statuses to include in the report.
Note: This claim status applies to claims assigned to patients.
Service Department — To report on claims for specific service departments only, click Selected and then select the service departments to include in the report.
Place of Service — To report on claims for specific places of service only, click Selected and then select the places of service to include in the report.
Rendering Provider — To report on claims for specific rendering providers only, click Selected and then select the rendering providers to include in the report.
Report Format — Select the format for your report results. (Best practice is to select the Text (comma-delimited) option when running this report.)

HTML table — Display the report results on your screen.
Text (tab-delimited) — Export the report results to a .csv file in tab-delimited format.
Text (comma-delimited) — Export the report results to a .csv file in comma-delimited format.

Report Options — Select report options.

Suppress Column Headings — Select this option to remove column headings from the report results.
Suppress Report Name — Select this option to remove the report name from the report results.
Show Filter Criteria — Select this option to include your selected filter criteria in the report results.
Run Offline (will appear in your Report Inbox tomorrow morning) — Select this option for very long reports. Reports that are run offline appear in your Report Inbox the morning after the request.

Click Run Report.

Features and workflows

Claims for federally qualified health centers (FQHCs) and rural health clinics (RHCs) have some unique claim scrubbing and submission processes that are not visible on the Claim Action or Claim Edit page. To enable accurate FQHC and RHC A/R forecasting, the Claim Formatting & Financial Insight [FQHC] report displays back-end claim scrub data specific to FQHCs and RHCs.

The Claim Formatting & Financial Insight [FQHC] report has two views.

Summary view — The report displays aggregated data for each IRC–service department combination.
Detail view of individual claims — The report displays one row per FQHC or RHC claim.

You select the summary or detailed view when you set the report filters.

Field Reference

Run Report: Claim Formatting & Financial Insight [FQHC] Report
Date Range	Enter the start and end dates for the report, or select a date range from the menu.
I want to ...	To display aggregated data for each IRC–service department combination, select view a summary of the submitted claim data. To display one table row for each claim, select view detail for each claim.
Date Type	Select an option from the menu. The date range applies to the option you select in this field. For example, if you select Previous Month from the Date Range menu and select Claim Service Date as the Date Type option, the report includes claims based on the service date for last month. Claim Service Date (default) First Billed Date Last Billed Date Most Recent Scrub Date Note: Some claims do not have a First Billed Date or a Last Billed Date. If you select one of these options, claims without these dates are excluded from the report.
Primary Insurance	To report on claims for specific primary insurance packages only, click Selected, enter text to display a list of matching insurance packages, and then select the packages to include in the report.
Primary Insurance Reporting Category	To report on claims for specific primary insurance reporting categories only, click Selected and then select the IRCs to include in the report.
Secondary Insurance	To report on claims for specific secondary insurance packages only, click Selected, enter text to display a list of matching insurance packages, and then select the packages to include in the report.
Secondary Insurance Reporting Category	To report on claims for specific secondary insurance reporting categories only, click Selected and then select the IRCs to include in the report.
Primary Claim Status	To report on claims associated with specific claim statuses only (for example, Appealed or Billed), click Selected and then select the claim statuses to include in the report. Note: This claim status applies to the primary insurance.
Secondary Claim Status	To report on claims associated with specific claim statuses only (for example, Billed or Followup), click Selected and then select the claim statuses to include in the report. Note: This claim status applies to the secondary insurance.
Patient Claim Status	To report on claims associated with specific claim statuses only (for example, Closed or Overpaid), click Selected and then select the claim statuses to include in the report. Note: This claim status applies to claims assigned to patients.
Service Department	To report on claims for specific service departments only, click Selected and then select the service departments to include in the report.
Place of Service	To report on claims for specific places of service only, click Selected and then select the places of service to include in the report.
Rendering Provider	To report on claims for specific rendering providers only, click Selected and then select the rendering providers to include in the report.
Report Format	Select the format for your report results. HTML table — Display the report results on your screen. Text (tab-delimited) — Export the report results to a .csv file in tab-delimited format. Text (comma-delimited) — Export the report results to a .csv file in comma-delimited format.
Report Options	Select other options for your report results. Suppress Column Headings — Select this option to remove column headings from the report results. Suppress Report Name — Select this option to remove the report name from the report results. Show Filter Criteria — Select this option to include your selected filter criteria in the report results. Run Offline (will appear in your Report Inbox tomorrow morning) — Select this option for very long reports. Reports that are run offline appear in your Report Inbox the morning after the request.
Column headings — Summary view
Primary Insurance reporting Category	Insurance reporting category (payer) for the primary insurance listed on the claim.
Service Department	Service department listed on the claim.
Count of Claims	Number of FQHC/RHC claims identified for the primary IRC and service department listed in the table row.
Encounter Code Type	Depending on the encounter codes submitted on the claim, this column displays "Medical" or "Behavioral." Behavioral codes include T1015,AJ; T1015,AH; and T1015,HO.
Total Gross Charges	Sum of all charges, as shown on the Claim Action or Claim Edit page.
Total Expected Payments	Sum of all expected payments, based on FQHC/RHC guidelines.
Total Adjustments	Difference between the gross charges and the expected payments.
Column headings — Detail view
Claim ID	Original claim ID for the submission. Each row in the report corresponds to one claim.
Patient ID	ID of the patient on the claim.
Appointment ID	ID of the appointment. This unique number is generated by athenaOne.
Service Date	Date of service on the claim.
First Billed Date	Date of the first BILL claim note action. If no BILL action was taken, this field displays the text "No bill action taken."
Last Billed Date	Date of the most recent BILL claim note action. If no BILL action was taken, this field displays the text "N/A."
Most Recent Scrub Date	Date of the most recent claim scrub. Note: Because of the many back-end claim scrubbing actions for FQHC/RHC encounters, you may not see a corresponding SCRUB claim note on the Claim Action or Claim Edit page.
Primary Insurance	Name of the primary insurance package listed on the claim.
Primary IRC	Name of the insurance reporting category (IRC) for the primary insurance package listed on the claim.
Secondary Insurance	Name of the secondary insurance package listed on the claim.
Secondary IRC	Name of the insurance reporting category (IRC) for the secondary insurance package listed on the claim.
Primary Status	Status of the claim for the primary insurance plan.
Secondary Status	Status of the claim for the secondary insurance plan.
Patient Status	Status of the claim when the claim is assigned to the patient.
Service Department	Name of the service department listed on the claim.
Place of Service	Code and name of the place of service listed on the claim, for example, 11 \| Office.
Rendering Provider	Full name of the rendering provider listed on the claim (last name, first name).
Provider Specialty	Specialty of the rendering provider.
Procedure Codes in aN	This field displays each distinct procedure code shown on the Claim Action or Claim Edit page. Each procedure code in this column is categorized as an encounter code in the scrub data.
Total Charge Amount in aN	Sum of all charges on the claim, as shown on the Claim Action or Claim Edit page.
Encounter Codes Submitted	FQHC/RHC encounter codes submitted on the claim; these codes are typically not visible on the Claim Action or Claim Edit page.
Encounter Rate	Per diem (or encounter) rate specified for the claim (configured on the Custom Report Mappings page). The per diem rate is determined by the primary insurance reporting category, the department, and the encounter code submitted. Note: For Illinois FQHCs, behavior codes G0469 and G0470 display the fee schedule amount by default.
Incidental Codes	Procedure codes shown on the Claim Action or Claim Edit page that are categorized as incidental in the scrub data.
Incidental Charge Amount	Sum of all charges shown on the Claim Action or Claim Edit page that are categorized as incidental in the scrub data.
Additional Codes	Procedure codes shown on the Claim Action or Claim Edit page that are categorized as additional codes in the scrub data.
Additional Charge Amount	Sum of all charges shown on the Claim Action or Claim Edit page that are categorized as additional in the scrub data.
Expected Payment	If the claim's primary insurance reporting category is Medicare and the primary encounter code is a G-code then the Expected Payment will be 80% * (Per Diem Rate + Additional Amount). If the claim's primary insurance reporting category is Medicaid or Medi-Cal and the primary encounter code is NOT a G-code then the Expected Payment will be (Per Diem Rate + Additional Amount). In all other cases the Expected Payment will be 0
Total Insurance Payments	Sum of all payments for this claim from insurance plans (this sum does not include patient payments, which have a transfer type of "p").
Total Patient Payments	Sum of all patient payments for this claim (transfer type of "p").
Interest Adjustments	Sum of all interest adjustments.
Contractual Adjustments	Sum of all contractual adjustments.
All Other Adjustments	Sum of all adjustment transactions other than interest and contractual adjustments.
Notes	If the claim includes a claim note with an action of ERA and a kick code of CO253, this field displays "Sequestration – reduction in federal payment."