View Claims Worklists

1. Generate the claims worklist: On the Main Menu, click Claims and then click Claims Worklists. The View Claims Worklists appear in the Task Bar, with links to worklist categories.
2. In the Task Bar, click the link for the worklist that you want to view.
   
   • The MISSING worklist is worked in the Task Bar.
   • Other worklists are worked in the Workspace (see To use claims worklists in the Workspace).
3. Click a linked item (such as a dollar amount or claim number) in the list.
   If you click an item in one of the HOLD or MGRHOLD lists, the Visit & Claim Update page appears in the Workspace.
4. Perform the necessary actions to process the claim.
5. Repeat the process for every linked item in the worklist.

Note: As you edit HOLD claims or enter MISSING claims, they remain on the worklist until you refresh the list. To refresh, right-click and select Refresh from the option menu, or regenerate the worklist.

 

 

1. When you click a worklist link in the View Claims Worklists Task Bar, the worklist appears in the Workspace.

2. View By — Select how you want to view the claims on hold: by Outstanding Amount, Reason, Payor, or Method. By default, the worklist will display with View By: Outstanding Amount.
   

   

   
   

3. Show — (You'll see this field if you View By: Method) Select the method:
   

   

4. If the view you selected does not show any claims, you'll see a message "No claims are on hold for the above selection. Try updating the filters to see other claims on hold."
5. Your selected view of the worklist appears in the Workspace.
6. Service Department — Select a Service Department from the list.
   • If you selected the All departments HOLD worklist, the worklist will display with all departments. You can select a different department from the list.
   • If you selected the Current service department HOLD worklist, the worklist will display with the department you logged into. You can select a different department from the list.
   • If you selected the Current patient department HOLD worklist, the worklist will display with Patient Department set to the department you logged into. You will not be able to change the department.
7. Date Range —
   • Select a specific From Date and To Date

   • Use the menu to select a relative day. The default is Last 1 Year. The From Date and To Date are automatically calculated based on your selection.

8. To sort the worklist by a specific column, click the arrows next to the column heading.
   

   Click the arrow to switch between ascending and descending sort order.

 

 

 

 

If the claim has an open balance, it will not print the CMS-1500 lines. To print an open claim on a CMS-1500 form, you can purchase blank CMS-1500 forms from an office supply company. If the claim is closed, it will print with the red CMS-1500 form lines. You can adjust your printer settings to print in black and white.

 

Note: The PDF Claim Printing feature must be enabled for your practice.

1. Display the Claim Action page for a claim in HOLD status.
2. Actions — Select Add Kick Reason from the menu.
3. Kick reason — Enter "printonly" (or "PRINTONLY") and click outside the box.
   The message "Print claim informational only; no status change" appears next to the Kick reason field.
4. Click Submit.
   The claim appears below the View Attachments/EOBs button.
5. Format — You can select a different format from the menu and click Go.
6. You can use the menu next to the Realign Claim button to select a different printer setting and then click Realign Claim.
7. Click the Print icon .
   A print version of the claim appears in a new window.
   Note: To save the claim as a PDF document, click the Save icon.
8. Select the printer and then click Print.

 

If your practice uses an insurance card scanner, athenahealth routes claims with certain eligibility-related denials to CBOHOLD instead of HOLD, and we work the claims for you.

Note: athenahealth also reviews IPN and NEREVIEW denials for claims without an insurance card image (see "Automatic review of claim denials" on the Billing Follow-Up page).

 

 

 

 

 

 

Sorting by outstanding amount ensures that practices focus the majority of follow-up effort on high dollar claims.

 

Often the research to fix one claim can be applied to claims with similar errors. Working on claims sorted by "reason" or by "payer by reason" can help you move more efficiently through problem claims.

 

Centralizing billing follow-up across your practice can shorten the follow-up process and lag time.

 

 

The MISSING List is one of the claim worklists. It contains a list of appointments that were checked in, but do not have charges entered (that is, the billing slips appear to be missing). You can access this list using the View Claims Worklists and click By Department, By Provider, or Current Service Department. You can also click a linked number under the Missing Slips column on the Workflow Dashboard.

 

Note: If you have the appropriate user permissions, you can change your current department of login using the pop-up list at the lower right corner of your screen.

 

 

You can view worklists for each hold status (HOLD, MGRHOLD, CBOHOLD, ATHENAHOLD, and APPEALED).

 

The worklist appears in the Workspace.

 

View By — Select a sort option:

• Outstanding Amount — This view sorts the worklist by dollar amount, with the high-dollar items displayed at the top.
• Reason — This view sorts the worklist by kick reason.
• Payor — This view sort the worklist by payer, and within payer, by kick reason.
• Method — This view sorts the worklist by the claim rule type.

Show — (You'll see this field if you View By: Method) Select: Review, Rule, Kickcode, Others.

 

Note: Types of claim rules:

• Review — The "review" type of claim rule is designed for use by billing managers, with an override link in the Claim Status column.
• Rule — Traditional claim rules begin with bold red Rule at the beginning of the claim note text.

Note: Whatever you choose to View By is saved as your preferred view. If you go to other pages and come back to the claim worklist, your preferred view will be displayed by default.