View Claim History

athenaCollector

This page allows you to view all old claims for a patient.

Learn more about viewing the claim history

A set of filter fields appears at the top of the page, showing the current filter selections. To change the filter criteria, click Edit filter. To save your selected filters for future use, select the Save as default option. These filters are selected by default the next time you open the View Claim History page.

Note: With Provider-Group-Based Data Permissions enabled, the Provider Group filter defaults to the current provider group if the patient has claims associated with it. Otherwise, the Provider Group filter defaults to All.

Each claim summary consists of a claim header that includes:

Claim number
Patient insurance package associated with this claim
Patient name (last name, first name)
Rendering provider's athenaOne username
Supervising provider's athenaOne username
Diagnosis codes and descriptions

Claim details include service date, procedure, charge, and a Claim Notes section showing the claim status and kick/scrub reasons.

Below the claim number are the following links:

Claim Action page — Display the Claim Action page. This page allows you to review claims in HOLD status and resolve them on the same page. From the Claim Action page, you can appeal denials; adjust and transfer balances; update diagnosis codes, procedure codes, and modifiers; and add kick reasons.
Edit — Display the Claim Edit page.
View claim forms — Display the Claim Form page. This page displays a simplified view of the submitted claim with the option to view the claim in ANSI format. You can view previous submissions of the claim (see "To display the claim form window").
Preview primary form — View the claim in the appropriate primary claim format as it would look now.
Preview secondary form — View the claim in the appropriate secondary claim format as it would look now.
Post — Display the Post Payment page for this patient.

Field Reference

Column Headings for Charge History
Service date	Service date for each charge.
Procedure	Procedure code and description of the procedure.
Charge	Charge for each procedure or service.

Column headings for Claim Notes
Date	The date the action occurred.
User	The username of the person who took the action. AUTO indicates an automated system function. Usernames that belong to your practice appear in regular font, but athenahealth usernames are italicized. Perot users have the prefix "vhs" in front of their usernames.
Action	The action taken on the claim. Highlighting indicates a system-generated action. SCRUB — Claim rule fired for this claim APPEAL — Appeal EOB — From EOB INQUIRY — Electronic Claim Status Inquiry MAILRETURN — Mail Return NOTE — Generic Note/From Other Source PHONE — Phone Call PRINT — Print Claim/View Printable Claim CLEARINGHOUSE — Claims Clearing-House File Check ERA — Electronic Remittance Advice TRACERESP — Claim Trace Response ACK PAYOR — Acknowledgement response from the payer, either direct or through a clearinghouse ACK PAYOR BATCH — Acknowledgement response from the payer, either direct or through a clearinghouse ACK INTERMEDIARY — Acknowledgement response from the clearinghouse ACK INT BATCH — Batch-level acknowledgement from the clearinghouse (usually a standard batch-level report) CLWIZARD — Claim Wizard CSI — Claim Status Inquiry (CSI) transaction; these Claim Notes are the default CSI history. CSIINFORM — Claim Status Inquiry (CSI) transaction; these Claim Notes plus the items marked CSI in the Action column are the full CSI history.
Claim Status	The status of the claim following this action.
Kick/Scrub/Note	A brief note describing the action, generally including a kick reason. Notes that appear here also appear under the Claim Notes section of the Claim Review, , View Claims for Charge Entry Batch, and the View Claim History pages. For older claim notes, click [expand text] to see the text as it appeared when the rule fired on the claim. Claim rules: Are always associated with the Action SCRUB and the User AUTO listed in the claim notes section Have a unique number identifier listed in brackets in the description Are designed and built by athenahealth based on payer rules, client input, format rules for claim submission, and previous denials The following types of claim notes are the result of claim rules. Note: To override a review claim note, you must have the Claim Note Override: Review role or permission. To override an advice claim note, you must have the Claim Note Override: Advice role or permission. Rule — Claim rules that appear with bold red Rule at the beginning of the claim note text require that the claim error be corrected before the claim is assigned DROP status and submitted to the payer. Review — The Review type of claim rule is designed for use by billing managers and provides an override link. The billing manager reads the review claim note, decides whether any action is needed, and then updates the claim (or not) as appropriate. Review rules are based on local claim rules created for your practice, which allow us to hold certain claims for review by your billing manager. These rules typically hold claims for issues such as medical coding or other workflow-related reasons. The Claim Note Override: Review permission controls access to the override function. Custom claim rules that you create for your practice are also designated as Review notes and include an override link. If overlapping custom rules of the same type are holding the claim (for example, multiple custom rules created on the Custom Rule: Invalid Modifiers page), you can override all the rules of that type by clicking the override all custom rules from same category link in the claim note. Advice — The Advice type of claim rule (or "claim advice") also provides an override link that allows you to override the advice without editing the claim. The text describes potential problems with the claim and still allows for outcomes contingent upon knowledge that we do not have when the rules engine scrubs the claim. The advice allows athenahealth to apply our billing knowledge on a much broader scale. What happens when you act on the advice and edit the claim? If you act on the advice claim note and the rule is cleared as the result of correction to the claim, the advice claim note appears gray. The claim is then assigned to the next appropriate status. (If there are no additional claim rule violations, the next appropriate status is DROP.) What happens when you use the override? If you read the text of the advice claim note and determine that the advice action is not needed, you can click the override link. athenaOne then bypasses the advice, re-scrubs the claim, and assigns the next appropriate status. (If there are no additional claim rule violations, the next appropriate status is DROP.) The override event is logged in the claim note history (overridden by username, date). The Claim Note Override: Advice permission controls access to the override function. The "advice" type of claim rule is not available for practices that use athenaCollector (No Posting) and athenaCollector (No Follow-Up). Note: An override link may also appear when a "predictive rule" fires. A predictive rule is a type of claim advice that uses historical data in athenaOne to predict likely denials, so that you can adjust them off to zero before they appear in your denial work queues. Predictive rules cover Medical Necessity Denials and Benefits Coverage (charges expected to be denied for a benefit limitation or exclusion). Kick codes: Appear in green bold in brackets. Example: [CPT]. May be preceded by the associated denial code found on the EOB. Example: [0145:CPT]. Are assigned during payment posting and follow-up. Are tied to a claim status (for example, Benefits Terminated goes into HOLD). Each payer has its own denial codes. athenaOne associates different payer denial codes to the athenahealth standard set of kick codes, which determines the appropriate next steps. Note: When you add a claim note that sets a claim alarm, athenaOne displays the date of the alarm beneath the text of the claim note. The date appears as long as the claim alarm remains active. Claim alarms are reset every time a claim note puts a claim in — or LEAVES a claim in — BILLED status. When claim acknowledgment applies an EMCRCVD or PAYORRCVD claim note, the original alarm is cleared and a new one is set. Claim Status Inquiry transactions: Claim Status Inquiry (CSI) is an ANSI-standard electronic transaction very similar to calling payers to track claims. When a claim goes to BILLED status, athenaOne automatically sends an initial claim status inquiry, then follow-up inquiries at set intervals. The CSI transaction results are parsed and translated into an English-language format for inclusion in the Claim Notes. The transaction response tells the user the claim level status, the amount paid on the claim, the payment date and method, and the check number (if applicable). Note: CSI transactions are supported for athenaCollector clients only. For more information about CSI, please refer to Claim Status Inquiry.