Quick Reference — To correct OVERPY1MRY claims

athenaCollector

Worklist: MGRHOLD

 

Issue: Two different insurances have provided payment on this claim under the status as primary payer.

 

Next Steps: Determine and/or correct the coordination of benefits for the patient. Once primary insurance is confirmed, refund charges with the other payer and resubmit to the correct primary insurer.

 

Note: At least one change must be made to the claim before it can be resubmitted. It is not compliant to resubmit a claim without changes only to see whether the claim will be paid if you resubmit it to the payer.

  1. Display the Claim Action page: Select a claim from the Workflow Dashboard, Claim Worklist, or click the Claim Action Page link on the Claim Edit page.
  2. Review the claim information.
  3. Actions — If the claim needs to be resubmitted to the payer, select Add Kick Reason.
  4. Make any necessary changes to the claim details.
  5. Kick reason — Enter DRPBILLING.
  6. Claim note — Enter a clear, detailed note for athenaOne users, describing what actions have just been taken.
  7. Click Submit.

 

 

Note: At least one change must be made to the claim before it can be resubmitted. It is not compliant to resubmit a claim without changes only to see whether the claim will be paid if you resubmit it to the payer.

  1. On the Claim Edit page, scroll down to the Claim Notes section at the bottom of the page.
  2. Review the claim notes.
    1. If athenahealth has researched the denial with the payer, a detailed description is included.
    2. If there is an EOB or letter from the payer, click the link to review it.
  3. If further clarification is needed, contact the payer directly.
  4. Applies to — Select the correct insurance type.
  5. Status — Select DROP.
  6. Kick reason — Enter DRPBILLING.
  7. Claim note — Enter a clear, detailed note for athenaOne users, describing what actions have just been taken.
  8. Click Save.

 

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