Workflow Dashboard

On the Workflow Dashboard, click a linked number in the Hold column to display the HOLD queue for that department.

The Workflow Dashboard HOLD queue reflects the total dollar amount of claims in HOLD status plus patient account holds for the department. This list can include patients whose statements are being held and patients who have charges sent to collections.

Note: The dollar amount in the Hold column of the Workflow Dashboard may exceed the Hold amount for the same department in the A/R Aging Wizard or Activity Wizard report (the Hold amount in the A/R Aging Wizard and Activity Wizard reports does not include patient account holds).

This work queue should be worked daily by billing staff. The claims in this work queue may include the following types of errors:

• Demographic errors, such as missing patient address or incorrect date of birth.
• Patient insurance errors, such as incorrect member ID or ineligible status.
• CPT code errors, such as procedure codes that do not match the patient sex or age, or procedure codes that do not match the diagnosis code.

Best Practice: Resolve items within 2 days.

On the Workflow Dashboard, click a linked number in the Mgr Hold column to display the MGRHOLD queue for that department.

This work queue should be worked daily. The MGRHOLD work queue can be worked primarily by billing or work queue office managers. The claims in this work queue have more complex problems than the claims in the HOLD work queue and may require more extensive billing knowledge.

The claims in this work queue may include the following types of errors:

• Provider number issues, such as provider number missing or pending.
• Credentialing issues, such as provider number is not correct or is not credentialed with the payer.
• Denials requiring a policy decision (such as a denial for medical necessity).

Best Practice: Resolve items within 6 days.

Best practices for reducing the MGRHOLD queue for enrollment and credentialing issues

 

When you add departments, providers, and payers in your practice, follow these best practices to help avoid MGRHOLD claims associated with credentialing and enrollment issues.

 

Department configuration

 

When you add a department in athenaOne, the following key pieces of information must be added for that department at the same time.

 

NPI

Enter the "group" NPI associated with the department in the department numbers table. Depending on the department being added, this NPI may be a hospital NPI or the respective group's NPI.

 

CLIA (if applicable)

Enter the CLIA number associated with the department in the department numbers table. Make sure that the appropriate CLIA type is selected when you enter the CLIA: CLIA — Compliance/Accred/Regis, CLIA — PPMP, or CLIA — Waiver.

Note: Enter the effective and expiration dates for the CLIA numbers (claims will hold if the dates are not present).

 

NPIs and Other Numbers — Department Specific Configuration

If the practice bills ALL payers under each department's specific NPI in box 33 of the CMS-1500, the department must be configured on the NPIs and Other Numbers page.

 

You must create an entry on the NPIs and Other Numbers page and apply it to the specific department by selecting that department. Next, you enter the respective NPI number and save.

 

Payer Enrollment — Department Specific Configuration

If the practice has been assigned payer-specific legacy numbers for the department, this information — such as Medicare Group Number (PTAN) or Railroad Medicare Group Number (PTAN) — is stored on the Payer Enrollment page.

 

If the department is being linked to an existing PTAN on the Payer Enrollment page, you can simply "edit" the existing billing group and add the new department.

 

If the department has a brand-new PTAN, the practice will need to add a new billing group and make the billing group department specific. Select "apply only to this specific billing situations" and select the appropriate department.

 

 

Provider configuration

 

When you add a provider in athenaOne, the following key pieces of information must be added for that provider at the same time.

 

NPI Number

Enter the provider's individual NPI on the NPIs and Other Numbers page for the respective provider.

 

Medical License Number

Enter the provider's medical license number on the NPIs and Other Numbers page for the respective provider.

 

DEA Number

Enter the provider's DEA number on the NPIs and Other Numbers page for the respective provider.

 

DEA-X Number

Enter the provider's DEA-X number on the NPIs and Other Numbers page for the respective provider. A DEA-X number is issued to a qualifying provider to permit the provider to prescribe, administer, or dispense approved Schedule III-V controlled substances to treat narcotic dependence.

 

NPIs and Other Numbers — Provider Specific Configuration

If the practice has specific billing NPIs based on providers (typically seen when group NPI is specialty specific), the NPI must be entered on the NPIs and Other Numbers page with the parameter of "providers" chosen (select the appropriate providers).

 

Payer Enrollment — Provider Specific Configuration

Enter any payer-specific group legacy numbers provided to the group of providers on the Payer Enrollment page. A new billing group must be created (select "applies to providers"). Next, the affected providers must be selected and the group legacy number must be entered.

 

Credentialing Information

It is extremely important to set each provider's credentialing status for every payer. After the provider is created, click Save and Go to Credentialing. On the Provider Credentialing page, you see all credentialing statuses that need to be set, based on which payers the group submits claims to.

 

 

Payer configuration

 

When you add a new payer in athenaOne, the following key pieces of information must be added to the billing groups on the Payer Enrollment page.

 

Group Taxonomy Code

If the payer requires the group taxonomy code to be submitted on claims, this code must be added to the billing group on the Payer Enrollment page for that payer.

 

Legacy Numbers

If the payer issues group- or provider-specific legacy numbers (Medicare (PTAN), Railroad Medicare (PTAN), Medicaid, etc.), this information must be added to the specific payer and affected providers/groups on the Payer Enrollment page.

 

ZIP Code

If the payer requires a specific ZIP+4 to be submitted with each legacy number, this information must be configured for the corresponding billing groups on the Payer Enrollment page. This information is referred to as a physical address override.

 

Credentialing Statuses

It is very important to set the appropriate credentialing status as new payers are added to athenaOne. Claims will hold in Rule Hold 7760 (Medical Group Credentialing status required), as well as Rule Hold 7759 (Provider Credentialing status required). These two rule holds indicate that athenahealth does not know the credentialing status for the group, the provider, or both. Claims will also hold in Rule 6487 if the group or provider has a blank credentialing statuses.

 

The credentialing status affects which enrollments are completed on behalf of the group or provider for the specific payer.

• Payers that the practice is contracted with as "in-network" should be set to "par."
• Payers that the practice is contracted with as "out-of-network" should be set to "non-par."
• If work is being done with that payer for credentialing purposes, any affected group or provider should be set to "credentialing-hold."
• If claims should not be billed to this payer, a safeguard is to set the credentialing status to "not billing."

 

On the Workflow Dashboard, click a linked number in the Missing Slips column to display the Missing Slips queue for that department.

Items appear on the Missing Slips worklist only if:

• Missing Slips Worklist option is selected on the Providers page for the provider.
• Billing slip required option is set to Yes on the Appointment Types page for the appointment.

  Note: By default, athenaOne creates a billing slip for each appointment for the same patient on the same day. If you want athenaOne to create a billing slip only for the first of multiple appointments, contact the CSC by selecting Support > Create Case or Call in the Main Menu.

This work queue should be worked daily. Charges should be entered daily after services are performed. The Missing Slips worklist shows the number of charges that have not yet been entered. The worklist appears in the Task Bar, where you can also see a count of missing slips by provider.

Note: Color-based icon on each missing slip card to indicate the new Encounter status on the Claim Billing tab:

• If your practice uses athenaClinicals, a green bar indicates that the missing slip was marked reviewed by the provider

• A blue bar on a missing slip means the encounter is closed, which can appear both by itself and alongside the green bar (for Provider Review Complete)

• A purple bar means save on Charge Entry, which overrides the other two icons

Best Practice: Enter charges daily (within 3 days of service).

To filter the Missing Slips worklist

1. Display the Missing Slips worklist: On the Workflow Dashboard, click any linked number in the Missing Slips column.
   By default, the list is sorted by provider name.
2. To sort the Missing Slips worklist by department, click the Department link.
3. To filter the worklist, click Edit.
   Additional fields appear.
4. Appointment Status — Select Checked In or Checked Out.
5. Encounter Status — Select Open, Closed, Deleted, or No Encounter.
   Note: A blue bar on a missing slip means the encounter is closed, which can appear both by itself and alongside the green bar (for Provider Review Complete) on the Claim Billing tab.
6. Provider Review — Select Complete or Incomplete.
   Note: This field is available only for practices that use athenaClinicals. With athenaClinicals, a green bar on a missing slip means that it was marked as "Reviewed by provider" on the Claim Billing tab.
7. Charge Entry Status — Select Unsaved or Saved.
8. Department — Click Selected and then select one or more departments.
9. Provider — Click Selected and then select one or more providers.
10. Dates of Service — Set from and to dates. You can enter dates manually or use the date picker.
11. Click Filter.

To display advanced filters on the Missing Slips page

1. Display the Missing Slips worklist: On the Workflow Dashboard, click any linked number in the Missing Slips column.
2. Click Edit.
   Additional fields appear.
3. Click Advanced filter.
   The Missing Slips page opens in the Workspace.
4. Appointment Status — Select Checked In or Checked Out.
5. Encounter Status — Select Open, Closed, Deleted, or No Encounter.
   Note: A blue bar on a missing slip means the encounter is closed, which can appear both by itself and alongside the green bar (for Provider Review Complete) on the Claim Billing tab.
6. Provider Review — Select Complete or Incomplete.
   Note: This field is available only for practices that use athenaClinicals. With athenaClinicals, a green bar on a missing slip means that it was marked as "Reviewed by provider" on the Claim Billing tab.
7. Charge Entry Status — Select Unsaved or Saved.
8. Department — Click Selected and then select one or more departments.
9. Provider — Click Selected and then select one or more providers.
10. Date of service — Enter or select a date range for the missing slips.
11. Appointment type — Click Selected and then select one or more appointment types.
12. Day of week — Click Selected and then select one or more days of the week.
13. Click Filter.

The Workflow Dashboard Medical Coding queues are for ambulatory customers who have contracted with athenahealth for athenaOne Medical Coding services. These queues show the total number of encounters in each stage of Medical Coding for each department.

athenaOne displays a reminder message on the Workflow Dashboard if you have missing slips stuck in the Unmet Criteria for Medical Coding queue for several days.

• " athenaOne® Medical Coding: To accelerate claim creation, please handle pending tasks for missing slips. See the Unmet Criteria for Medical Coding column (below) or use the athenaOne® Medical Coding Worklist"
  
  

  Conditions	Message type
  If at least one missing slip (in any department contracted with athenaOne Medical Coding) has Unmet Criteria for Medical Coding for more than 3 business days	Info
  If at least one missing slip (in any department contracted with athenaOne Medical Coding) has Unmet Criteria for Medical Coding for more than 5 business days	Warning (highlighted in yellow)

  
  

• Clicking the athenaOne® Medical Coding Worklist link in the message displays the e Unmet Criteria worklist tab, where you can review task details and take action to resolve issues.

• The Medical Coding worklist will default to the departments selected in the Workflow Dashboard.

Worklist: athenaOne Medical Coding - Unmet Criteria

 

The athenaOne Medical Coding — Unmet Criteria worklist is available to ambulatory customers who have contracted with athenahealth for athenaOne Medical Coding services and have automated routing enabled.

 

This worklist displays the list of missing slips that failed to meet the billing integrity criteria for automatically routing work to athenaOne Medical Coding, and allows you to review and take action so they can be routed.

 

Missing slips are scanned for the following Billing Integrity conditions:

• Encounter — signed and closed
• Billing Tab — review completed
• Valid primary insurance package attached to the missing slip
• Valid Supervising Provider attached to the missing slip
• Patient Check-out — completed

Once missing slips have met all the above conditions, a charge validation is also done to check for:

• Charges entered but not yet defined in the practice's Fee Schedule

• Charges entered without a Diagnosis code

The Unmet Criteria worklist allow you to manage any missing slips that require practice attention:

• See a list of missing slips that need follow-up by practice staff
• Use Filters to select by Date of Service, Provider, Service Department, Specialty, or Category of action needed
• Click a link under Action Needed to go directly to the athenaOne page where you can resolve the issue.
• Download the list to a CSV file if needed

Note: Once you complete the actions needed, those missing slips will automatically be sent to athenaOne Medical Coding during the next hourly execution of the auto routing engine.

Worklist: athenaOne Medical Coding - Practice Input Needed

 

On the Workflow Dashboard, click a linked number in the Practice Input Needed for Medical Coding column to display the athenaOne Medical Coding worklist.

 

The athenaOne Medical Coding — Practice Input Needed worklist is available to ambulatory customers who have contracted with athenahealth for athenaOne Medical Coding services.

 

The worklist displays the list of encounters with questions from the athenaOne Medical Coding team, and allows you to review and take action to resolve the queries directly from the worklist.

 

Encounters appear in the Practice Input Needed worklist if athenaOne Medical Coding needs information from your practice before they can complete the coding. A query might be sent due to:

• Illegible content

• Incomplete documentation
• Incomplete/Inaccurate visit details
• Missing Provider authentication

 

The Practice Input Needed worklist:

• Lists encounters with queries from the athenaOne Medical Coding team
• Displays the key information for each encounter, the date when the query was created to request missing information, the query category, and the action needed
• Allows you to open the Patient Quickview by clicking on Patient ID, in order to view and update documentation
• Enables you to resolve the blocked encounters and reply to medical coders directly from this worklist

Note: A reply is required before athenaOne Medical Coding can continue working on the visit bill.

 

On the Workflow Dashboard, click a linked number in the Eligibility column to display the Eligibility Worklist queue for that department.

The Eligibility Worklist should be worked daily to confirm eligibility — that is, insurance coverage — for patients who have appointments in the next 3 days. At a minimum, eligibility should be confirmed for patients who have appointments the next day.

Best Practice: Resolve eligibility issues prior to the patient's arrival. You can also use the Eligibility and Phone page to verify appointments and patient eligibility.

On the Workflow Dashboard, click a linked number in the Appts to Resched column to display the Appointment Processing queue for that department.

The appointments to reschedule worklist should be worked daily. This worklist contains appointments that were marked as requiring cancellation and rescheduling due to a change in the provider's schedule.

On the Workflow Dashboard, click a linked number in the Appts to Schedule column to display the Appointment Ticklers queue for that department.

The appointments to schedule worklist should be worked daily. This worklist contains appointment ticklers for the next 60 days.

Note: Appointments appear on the Workflow Dashboard only if they are scheduled to occur within the next 60 days. The display is also limited by provider-based data permissions. You can view the complete list of all appointment ticklers or ticklers for a specific date range on the View Appointment Ticklers page.