Charge Entry — Advanced View (Enhanced Page)

 

The following features available on the classic Charge Entry page are currently not supported on the enhanced Charge Entry page.

• Some service type add-ons are unavailable.
• These policy custom formats are unavailable (policy custom formats are claim forms other than CMS-1500/ANSI 837P that payers require in certain situations).
  • HCFA
  • UB-92
  • LAKIDMED

You can display a saved draft of a claim, make edits, save your progress, and return later to finalize your updates without losing your place.

• Access saved drafts of claims from the:
  • Missing Slips worklist or
  • Today's Appointments worklist (or section of the homepage)
• The Missing Slips worklist updates to show you when an draft claim was saved with pending changes.
• When you return to enter charges via the Missing Slips or Today's Appointments worklists, you'll skip the Billing Tab and see all your saved information on the Charge Entry page so you can pick up where you left off.

 

 

 

You can enter charges and create a new claim outside the 5-stage patient encounter by selecting the Billing > Create New Claim option from the Patient Actions Bar. (The Patient Actions Bar appears on many athenaOne pages, including the Quickview.)

 

Charge entry outside the encounter differs from charge entry when you create a claim at the end of an encounter, as follows:

• You need to enter the date of service for the charges to be entered.
• You may need to change the service department (the Service department field defaults to your login department).
• You need to select the appropriate rendering and supervising providers (the Rendering provider and Supervising provider fields default to null values).

If you enter a claim for the same patient, department, and date of service as an appointment with a missing slip, athenaOne alerts you that you may be entering charges that should be associated with that appointment.

Note: athenaOne checks for duplicate claims and alerts you if your new claim could be a duplicate claim (a claim for the same patient and date of service as a previous claim).

1. Display the Charge Entry page: On the Patient Actions Bar, click Billing, and then click Create New Claim.

2. Click the Advanced tab.

Service fields

3. Date of service - Required — Verify the date of service for the charges. This field is populated based on the date of the appointment.
4. Patient department - Required — Verify or select the patient department (usually the department where the patient's chart resides). The default value is the patient's primary department (from the Quickview page).
5. Service department - Required — Verify or select the service department, that is, the department where the services were performed.
6. Place of service — This field displays the place of service type for the department where the services were rendered (for example, 11 | Office or 12 | Patients home). The place of service is printed in CMS-1500 Block 24B.

Insurance fields

7. Primary payer - Required — Verify the primary payer. By default, the patient's current primary policy appears in this field. This field determines which policy the claim should be billed under.
8. ID/Cert — This field displays the ID/cert number of the primary insurance policy.
9. Status — This field displays the insurance eligibility status of the patient.
10. Primary accept assignment — Select an option to indicate whether the provider accepts assignment of benefits from the primary payer for this claim (this field determines whether the Accept Assignment box will be checked off (CMS-1500 Block 27) for the primary claim).
    • Assigned
    • Not assigned
    • Assigned on Clinical Lab Only
    • Patient Refuses to Assign
11. Primary print zero dollar charges? - Required — Select Yes to include any $0 charges on the claim when it is printed or submitted electronically. This setting applies to charges of $0 and to outstanding balances for a charge that result in $0. If all charges on the claim are $0, the claim is set to DROP status (or HOLD status, if appropriate) until the claim is submitted, at which time the claim is closed. This option defaults to No.
    Note: If this field does not appear on the Charge Entry page and you want to use it, contact the CSC from athenaOne > Support > Success Community > Contact Client Support Center.
12. Secondary payer - Required — Verify the secondary payer. By default, the patient's current secondary policy appears in this field.
    Note: If the patient has no secondary policy, this field defaults to No Insurance/Self-Pay.
13. ID/Cert — This field displays the ID/cert number of the secondary insurance policy (if the patient has a secondary policy).
14. Status — This field displays the insurance eligibility status of the patient (if the patient has a secondary policy).
15. Secondary accept assignment — Select an option to indicate whether the provider accepts assignment of benefits from the secondary payer for this claim (this field determines whether the Accept Assignment box will be checked off (CMS-1500 Block 27) for the secondary claim).
16. Medicare secondary qualifier — Select the factor that qualifies Medicare to be the secondary payer for the patient. This menu appears only when Medicare is the primary or secondary payer.

17. Authorization — If applicable, select the authorization number from the list.
    Note: You can select authorizations with a status of Not Required.
18. Or manually enter auth # — If the authorization number does not appear in the Authorization menu, you can enter it in this field.
    Note: You can enter additional information about a new authorization on the Quickview.
19. Reserved (19) remarks — Use this field only for information that pertains to the entire CMS-1500 claim. Report charge-level information elsewhere.

Signature fields

20. Signatures on file — Verify that the following forms are selected (these signatures must be on file for payers, such as Medicare, that require such a release).
• Release of information — Signed statement by the patient authorizing the release of medical data to other organizations. This field corresponds to CMS-1500 Block 12.
• Assignment of benefits — Indicates whether the insured or authorized person authorizes the primary payer to assign benefits to the provider (that is, authorizes the payer to remit payment to the provider directly). This field corresponds to CMS-1500 Block 13.
21. Signature source — This field indicates how patient signatures (for release of information and assignment of benefits) were obtained and how they are being stored by the provider. This field defaults to Signed form for both HCFA-1500 block 12 & 13 on file.
    Note: To change the default value for this field, please contact the CSC from athenaOne > Support > Success Community > Contact Client Support Center.

Provider fields

22. Rendering provider - Required — Verify or select the rendering provider. This provider actually provided the services to the patient during the appointment.
    Note: This provider typically does not appear as the rendering provider on the claim.
23. Supervising provider - Required — Verify or select the provider that you want to submit on the claim. The provider you select using the Supervising provider field typically appears as the rendering provider on the claim. This can be the provider who supervised the services or an individual who was supervised by another provider. The default selection in the Supervising provider - Required field is as follows:
    
• Rendering provider — If the rendering provider is classified as a supervising provider on the Providers page.
• Patient's usual provider — If the rendering provider is not classified as a supervising provider on the Providers page.
  Note: If the patient's usual provider is not indicated as such in athenaOne, a link to the Quickview appear, so that you can add the usual supervising provider for the practice.

For more information about the Supervising provider - Required field, see the Field Reference.

24. Scheduling provider — Verify or select the scheduling provider. This provider was originally scheduled for this appointment. (This provider does not generally appear on claims.)
25. Referring provider — Verify or select the provider who referred this patient for services. This field defaults to the referring provider from the primary insurance policy. If you select an authorization/referral, the referring provider of the authorization overrides the selection for this field. You can click Find a provider to display the referring provider lookup tool.
26. Ordering provider — Select the provider ordering services or supplies; if different from the rendering provider, click Find a provider to display the referring provider lookup tool.

Illness/Injury fields

27. Current illness date — If applicable, enter the date of onset of the current illness.
28. Same or similar illness date — Enter the date that the patient had the same illness or a similar illness.
29. Hospitalization dates — Enter the date range for the period when the patient was hospitalized as a result of the condition related to this claim.
30. Patient unable to work — Enter the date range for the period when the patient was unable to work as a result of the condition related to this claim.
31. Condition related to — Select the condition that is related to the injury or illness: Employment, Another party responsible, or Accident.

32. State where accident occurred — If you select Accident and Auto in the Condition related to field, select the state in which the accident occurred.

Service Type Add-On fields

33. If service type add-ons are enabled for your organization, select one or more add-ons from the menu. The fields for the service type add-ons appear below the menu.
    Note: You can remove a service type add-on you added by clicking the x icon next to its name in the menu.
34. Enter the appropriate information in the additional fields for the service type add-on.
    Note: For more information, see the Service type add-ons section of the Field Reference.

Charges fields

35. Procedure— Enter the first procedure code. A second Procedure field appears.
    Note: If you enter more than six procedure codes and the claim is generated on paper, athenaOne generates additional claims to accommodate the charges (paper forms do not allow more than six procedure codes).
36. Modifier(s)— Enter any modifiers for the CPT code.
37. Units— Enter the number of units.
38. Diagnoses— Enter the ICD-10 diagnosis code reference number that justifies the procedure code. (Enter only one code per text box.) You can enter a period to activate the Procedure Lookup tool.
    Note: After you enter the first charge, the Copy diagnoses from previous row option appears in the Diagnoses field for all subsequent procedure codes (athenaOne selects this option automatically). You can select and deselect this option. If you change a diagnosis code that you entered, athenaOne deselects the Copy diagnoses from previous row option for each subsequent row.
39. FP — If this line item is for family planning, enter the two-character family planning code for this procedure (this field is used for some Medicaid programs).
40. POS — Click this field to select a place of service (POS) from the menu.
41. EPSDT — Select this option if an Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) referral was given to the patient for this procedure.
42. EMG — Select this option if the procedure was related to an emergency. This option corresponds to CMS-1500 Block 24I.
43. Click Add Note to enter a note about this charge.

Other Diagnoses fields

44. Use these fields to record additional diagnosis codes that may be required by a payer to support value-based reimbursement, but are not tied to a specific charge line or CPT code (for example, codes for pre-existing conditions). You can also use Other Diagnoses fields to:
• Record any diagnoses entered on charge integration (Billing tab in athenaClinicals) that are not associated with a procedure code.
• Enter diagnosis codes to submit these codes on the claim without tying them to a specific charge line.

45. Click Validate Codes to check the validity of procedure and diagnosis code combinations. When you click Validate Codes, all the diagnosis and procedure codes on the claim are automatically passed into the "Part B" form.
    Note: The appropriate state and CCI version corresponding to the date of service are also selected automatically.

Note:

• You can enter up to 12 diagnosis codes per claim. If the total number of diagnosis codes exceeds 12, athenaOne does not send all the diagnosis codes entered in this section on the claim. After you click Create Claim, athenaOne creates a new claim note to indicate which codes it was not able to add to the claim.

• However, if your practice has the Automatically Split Claims with Excess Diagnoses Codes setting enabled, athenaOne automatically splits claims with more than 12 diagnosis codes when the additional diagnoses are not associated with a procedure billed on the claim.

Internal Information fields

46. Internal Diagnoses — Enter any other diagnosis related to this claim.
    Note: You can click Validate Codes to check the validity of the diagnosis codes you enter.
47. Post date - Required — This field displays the post date of the charges. The default value is the current date.
    Note: A charge whose post date is in any subsequent month following the service date is considered late even if the service was at the very end of a month and the post date is at the beginning of the next month. You can back-date the charge to the earliest open date in the system or to the charge's (from) date of service, whichever is later.
48. Claim Note — Enter a claim note.
49. Click Create Claim to submit the claim.
    The Claim Preview page appears, showing you claim information including service details, insurance information, diagnoses, and charges.

Entering more than 12 diagnosis codes on a claim

You can enter up to four diagnosis codes per procedure code and up to 12 diagnosis codes per claim. If you enter more than 12 diagnosis codes associated with the procedures billed on the claim, athenaOne automatically generates an additional claim to accommodate the additional codes after you click Create Claim (this is called "splitting" the claim).

 

However, if the total number of diagnosis codes exceeds 12 and the additional diagnosis codes are not associated with a procedure, athenaOne does not send all the codes entered in this section on the claim. After you click Create Claim, athenaOne creates a new claim note to indicate which codes it was not able to add to the claim and moves these diagnosis codes to the Internal Use - Other Diagnoses section, so that you can review them on the Claim Edit page.

 

If you enter more than six procedure codes and the claim is generated on paper, athenaOne also splits the claim and generates an additional claim (or claims) to accommodate the charges (paper forms do not allow more than six procedure codes). See Paper Claims to learn more about diagnosis pointers and paper claims.

 

 

1. Display the Charge Entry page: On the Patient Actions Bar, click Billing, and then click Create New Claim.

2. Click the Advanced tab. If the corporate billing custom format does not appear by default, select it from the Primary custom formats menu in the Policy Custom Formats area (above the Service Type Add-ons).
   Note: If Corporate Billing is not an available selection in the menu, or if the Primary custom formats menu does not appear on charge entry, please contact the CSC from athenaOne > Support > Success Community > Contact Client Support Center to have the Corporate Billing feature enabled.
3. Follow the usual steps to create a claim.
4. To enter a test/specimen number, click the plus sign (+) next to the Corporate Billing heading, located right under the CPT line. Enter the test/specimen number in the field provided.
5. To enter additional notes, click edit (upper right corner of the charge line) and then click Add next to Line note.
6. Click Create Claim to submit the claim. The Claim Preview page appears, showing you the status of the claim and summary information.

Note: Up to four unique diagnosis codes can appear on a corporate billing claim form. You can enter more than four diagnosis codes, but they will not appear on the claim.

 

View our sample corporate invoice

 

 

Note: Your practice must have the Courtesy Billing practice setting enabled for this feature to work correctly. Please ensure that the setting is enabled before you proceed!

 

Government payers are excluded from the athenaOne automatic courtesy billing functionality. Because Medicare and other government payers do not allow practices to charge patients more than a limiting amount (either the allowed amount or a percentage of the allowed amount), athenaOne must prevent automatic transfers to patient responsibility that exceed the limiting amount. If your practice has the automatic courtesy billing feature enabled, you receive a pop-up warning when declining primary or secondary assignment on the Claim Edit page for a government payer.

 

1. Display the Charge Entry page: On the Patient Actions Bar, click Billing, and then click Create New Claim.
2. Click the Advanced tab at the top of the page.
3. Primary accept assignment — Select Not assigned. (This selection maps to CMS-1500 Block 27.)
4. Primary print zero dollar charges? — Select Yes.
   Note: If this field does not appear on the Charge Entry page and you want to use it, contact the CSC from athenaOne > Support > Success Community > Contact Client Support Center.
5. Follow the usual steps to enter the charges for the claim (see "To enter charges and create a claim that is not the result of an appointment").
6. Click Create Claim to submit the claim. The Claim Preview page appears, showing you the status of the claim and summary information.

 

athenahealth provides corporate billing functionality, used to send invoices or CMS-1500 claim forms to employers and companies. If your practice would like to enable this feature, please contact the Client Support Center (CSC) from athenaOne > Support > Success Community > Contact Client Support Center.

 

Charges for a corporate account's contracted services appear on the invoice with a returnable coupon that contains key identifiers to ensure that athenahealth processes the remittance correctly. A corporate invoice includes the corporate account's claims that enter DROP status in a defined accounting period. Claims in HOLD status are not invoiced until the reason for the hold is resolved.

 

athenaOne automatically applies any contractual adjustments to charges based on the associated allowable schedule. If you want to also apply manual adjustments to the charges you bill to your corporate payers, you must contact the CSC (from athenaOne > Support > Success Community > Contact Client Support Center) to request this feature.

Note: To include contractual or manual adjustments in the invoices you send to your corporate payers, the Show allowable adjustments field on the Insurance Package Requests page must be set to Yes.

 

Each corporate account invoice contains this information:

• Invoice ID number — Unique identifier for a given batch of claims in the defined accounting period. Editing or re-dropping claims does not change the invoice ID.
• Invoice date — The date on which the first invoice was sent.
• Payment due — The amount outstanding on the invoice.
• Payments processed in the last 30 days — The sum of all payments made to the corporate account in the last 30 days.
• Pay online — The Online Statement-based Experience (formerly QuickPay Portal) is available at https://payment.athenahealth.com. Each invoice includes a unique code to facilitate online payment. Payment can be made via credit card.
• Patient information — Name, patient ID, date of birth, claim ID, service location, and provider name.
• Service information — Includes:
  • Date of service, procedure, description, and charge.
  • Charges in accordance with the fee schedule that was selected for the corporate account. If a contracted service with a price override was used, the override price appears on the claim and subsequent invoice.
  • Notes added to the charge line of a claim.
• Returnable coupon — A perforated, detachable coupon is included on the first page of the invoice, which the corporate payer must return to athenahealth. This coupon includes the return address for payment, the invoice ID, and a barcode that athenahealth scans for identification purposes. This coupon helps us process the payment correctly, so returning it is important.
• Contested charges — On the back of the returnable coupon is a section where the corporate payer can contest charges. This allows the corporate payer to communicate to athenahealth which charges are being denied and why.

See a sample corporate invoice.

 

 

athenaOne automatically checks the claim date of service against the earliest date of service for your practice. A warning message appears if you enter a claim that has charges with dates of service prior to the earliest date of service on file. The earliest date of service is recorded in the Earliest Date Of Service practice setting.

 

 

If the claim includes purchased service components, use modifier 90 to indicate purchased services.

 

For self-pay patients, you can use the Check Fee Schedule page as a quick reference tool to look up fees for procedure codes.

 

 

 

After you enter charges and click Create Claim, the Claim Preview page shows you a summary of claim information while athenaOne creates the claim and runs its rules engine. If the newly created claim is not in DROP status, you can view and override rule holds or act on claim advice.

Note: For more information about claim management after you submit a claim, see Billing Follow-Up.

 

After the claim is created, the Claim Preview page displays the claim status and gives you the option to display:

• The Claim Action page for the claim you just created
• The next appointment, the next missing slip, or the Quickview, depending on the path you took to the Charge Entry page

Note: After you create a claim, you can return to the Billing tab in the Checkout stage of the encounter and display the Claim Preview page again by clicking the Review Claim button (next to the Save button) at the bottom of the Billing tab.

 

Claim information on the Claim Preview page

While athenaOne creates the claim and runs the rules engine on the claim, you can review and double-check claim information such as the service details, insurance information, diagnoses, and charges.

 

After the claim is created, the status bar appears at the top of the page. In the following example, the claim was created successfully and dropped to the payer.

 

If the claim could not be dropped to the payer, the number of claim holds appears below the claim number and the action buttons. To display the Claim Notes section of the Claim Preview page, where you can review and act on claim holds, click the View holds in claim notes option.

 

The Claim Notes section appears at the bottom of the Claim Preview page and displays the claim notes and charge audit histories. If the claim is in DROP status, the Claim Notes section is closed by default. If the claim is in HOLD status, the Claim Notes section is open by default. Click the arrow next to Claim Notes to hide or display the section.

 

 

 

Note: See User Guide — Link Appointments Together for Multi-Encounter Billing for more information.

 

 

 

 

Note: This is an opt-in feature. To enable the "Diagnosis Risk Model Information Display on Billing Pages" setting, reach out to the CSC or your CSM. There are three options:

• HCC Only

• HCC and ID (the corresponding HCC number)

• HCC, ID, and RAF Score

 

This feature is only available on Enhanced Charge Entry.

 

 

 

 

Charge Entry Batch Fields (Appear only if charge entry batch is open)
CURRENT CLAIM BATCH#	The system-assigned charge entry batch number.
# claims target	The target number of claims for the charge entry batch.
# claims entered	The number of claims created in the charge entry batch.
charge amount	The total amount of charges entered in the charge entry batch so far.

Service
Date of service - Required	The date of service for the claim. The Date of service field must be populated before you can enter procedure and diagnosis information on the Charge Entry page. Note: If you arrive at the Charge Entry page through the appointment workflow, this field is pre-populated based on the appointment date.
Patient department - Required	The patient's current department of care, usually the department where the patient's chart resides. The default value is the patient's primary department as shown on the Quickview. This field is sometimes used to determine the contents of the 33A (PIN) (currently used only for Medi-Cal).
Service department - Required	The department where the service was performed.
Place of service	The place of service type for the department where the services were rendered (for example, 11 | Office or 12 | Patients home). The place of service is printed in CMS-1500 Block 24B.
Insurance
Primary payer - Required	Determines which policy this claim should be billed under. By default, the patient's current primary policy is displayed. Note: Deactivated payment plans do not appear in this menu unless the charge is currently assigned to that plan. You cannot assign the primary charge to a cancelled plan using this page.   For anesthesia claims generated from time sheets: When you change the primary payer for an existing anesthesia primary claim, athenaOne can re-create a claim's charges according to the new destination payer's anesthesia settings. athenaOne re-creates the charges using the original time sheet data. Claim data is otherwise preserved, including claim notes, original claim ID, prior authorization number, etc. When charges are re-created from the time sheet as a result of changing payers, all time sheet data is refreshed. This refresh includes, but is not limited to, data such as diagnosis codes, service department, referring provider, surgeon, etc. Data entered on the charge entry page, such as Reserved 19 comments and Prior Authorization data, is not affected by changing payers.
ID/Cert	The ID/cert number.
Status	The patient's eligibility status.
Primary accept assignment	Indicates whether the provider accepts assignment of benefits from the primary payer for this claim and determines whether the Accept Assignment box will be checked off (CMS-1500 Block 27) for the primary claim. Y — Assigned N — Not Assigned B — Assigned on Clinical Lab Only P — Patient Refuses to Assign
Primary print zero dollar charges? - Required	If set to Yes, indicates that any $0 charges should be included on the claim when it is printed or submitted electronically. This setting applies to charges of $0 and to outstanding balances for a charge that result in $0. If all charges on the claim are $0, the claim is set to DROP status (or HOLD status, if appropriate) until the claim is submitted, at which time the claim is closed. This option defaults to No. Note: If this field does not appear on the Charge Entry page and you want to use it, contact the CSC from athenaOne > Support > Success Community > Contact Client Support Center.
Secondary payer - Required	Determines which secondary policy this claim should be billed under. By default, the patient's secondary policy is displayed. If the patient has no secondary policy, defaults to No Insurance/Self Pay.
Secondary accept assignment	Indicates whether the provider accepts assignment of benefits from the secondary payer for this claim and determines whether the Accept Assignment box will be checked off (CMS-1500 Block 27) for the secondary claim. Y — Assigned N — Not Assigned B — Assigned on Clinical Lab Only P — Patient Refuses to Assign
ID/Cert	The ID/cert number.
Status	The patient's eligibility status.
Medicare secondary qualifier	The factor that qualifies Medicare to be the secondary payer for the patient. This menu appears only when Medicare is the primary or secondary payer.
Authorization	The authorization or referral number used for the services. Typically, this number is assigned by the payer or utilization management organization to authorize a service prior to its being rendered.
Or manually enter auth #	If the authorization is not listed in the Authorization menu, you can enter the authorization number in this field.
Reserved (19) (remarks)	Use this field only for information that pertains to the entire CMS-1500 claim. Report charge-level information elsewhere.
Signatures
Signatures on file	Indicates whether the provider has on file a signed statement by the patient authorizing the release of medical data to other organizations. This field corresponds to CMS-1500 Block 12.   Indicates whether the insured or authorized person authorizes the primary payer to assign benefits to the provider (that is, authorizes the payer to remit payment to the provider directly). This field corresponds to CMS-1500 Block 13.
Signature source	Indicates how patient signatures (for release of information and assignment of benefits) were obtained and how they are being stored by the provider. This field defaults to Signed form for both HCFA-1500 block 12 & 13 on file.   To change the default value for this field, please contact the CSC from athenaOne > Support > Success Community > Contact Client Support Center.
Provider
Rendering provider - Required	The provider who renders services to the patient. This field is typically used for internal tracking and reporting purposes; the selected provider will generally not appear as the rendering provider on the claim.
Supervising provider - Required	The provider whose credentials you intend to submit on the claim. This can be the provider who supervised the services or an individual who was supervised by another provider. In either case, use this field to identify the provider that you want to submit on the claim. The provider you select using the Supervising provider field typically appears as the rendering provider on the claim. For example, on a CMS-1500 claim form, the provider you select using the Supervising provider field typically appears in Box 24J, and the provider's name appears in Box 31. Note: If the selected Rendering provider has a supervising provider, a note appears next to the Supervising provider field.   If you arrive at the Charge Entry page through the appointment or missing slips workflow, the default selection in the Supervising provider - Required field is as follows: Rendering provider — If the rendering provider is classified as a supervising provider. Patient's usual provider — If the rendering provider is not classified as a supervising provider. Note: If the patient's usual provider is not indicated in athenaOne, a link to the Quickview appear, so that you can add the usual supervising provider for the practice. Important: Any provider whose credentials you intend to submit on claims must be configured as a supervisory provider type on the Providers page so that you can select that provider using the Supervising provider field. For example, you cannot select a physician's assistant with a provider type of PA, but you can select a physician's assistant with a provider type of PASUP.   The provider selected as the Rendering provider appears by default as the Supervising provider if the Rendering provider is one of the following provider types: OPTOMETRIST (OD) PHYSICIAN'S ASSISTANT, SUPERVISING LICENSED PROFESSIONAL COUNSELOR (LPC) DOCTOR OF PODIATRIC MEDICINE CLINICAL PSYCHOLOGIST (PHD) PHYSICAL THERAPIST (OTR) NURSE PRACTITIONER, SUPERVISING (NP,S) MD MS/RD Licensed Social Worker (LCSW) LICENSED PRACTICAL NURSE DOCTOR OF OSTEOPATHY (DO) CLINICAL PSYCHOLOGIST (EDD) See the Providers page for more information about rendering and supervising providers.   Note: If the supervising provider is non-participating with a payer listed on the claim, their non-participation status is indicated.
Scheduling provider	The provider or resource that was originally scheduled for this appointment. Principally recorded for reporting purposes, this provider does not generally appear on claims.
Referring provider	The provider who referred this patient for services. This field defaults to the referring provider from the primary insurance policy. If you select an authorization/referral, the referring provider of the authorization overrides the selection for this field. You can click Find a provider to display the referring provider lookup tool.
Ordering provider	Select the provider ordering services or supplies; if different from the rendering provider, click Find a provider to display the referring provider lookup tool.
Illness/Injury
Current illness date	The date of onset of the current illness. LMP = Date of last menstrual period. ED = Estimated date of delivery. If the EDD is given, the LMP is automatically calculated using the OB feature.
Same or similar illness date	Enter or select the date that the patient had the same or a similar illness. Prints in CMS-1500 Block 15.
Hospitalization dates	Enter the date range for the period when the patient was hospitalized as a result of the condition related to this claim. Prints in CMS-1500 Block 18.
Patient unable to work	Enter the date range for the period when the patient was unable to work as a result of the condition related to this claim. Prints in CMS-1500 Block 16.
Condition related to	Select the condition that is related to the injury or illness: Employment, Another party responsible, or Accident. Note: If your practice has the "Date of Accident" feature enabled, a Date of Accident field may appear. You can record the accident date in this field.
State where accident occurred	If you select Accident and Auto in the Condition related to field, select the state in which the accident occurred.
Policy Custom Formats
Primary custom formats	Select the custom format for the primary insurance if it's required for claim submission. athenaOne uses the custom format you select for additional data collection during claim submission.   Policy custom formats are claim forms other than the CMS-1500/ANSI 837P that payers require in certain situations. These custom formats contain additional fields that may be required. All your custom formats appear in the menu.
Secondary custom formats	Select the custom format for the secondary insurance if it's required for claim submission. athenaOne uses the custom format you select for additional data collection during claim submission.   Policy custom formats are claim forms other than the CMS-1500/ANSI 837P that payers require in certain situations. These custom formats contain additional fields that may be required. All your custom formats appear in the menu.

Procedure	Enter the procedure code that best identifies each medical service or medical supply provided. Important: For exploding codes with modifiers, enter both the procedure code and the modifier (separated by a comma) in the Procedure field. If you enter the procedure code without the modifier in the Procedure field, the procedure code will explode before you enter the modifier in the Modifier(s) field.   Note: If you enter more than six procedure codes and the claim is generated on paper, athenaOne generates additional claims to accommodate the charges (paper forms do not allow more than six procedure codes).
Modifier(s)	Enter the modifiers for the procedure code.
Units	Enter the number of units.
Diagnoses	Enter the ICD-10 diagnosis code reference number that justifies the procedure listed. (Enter only one code per text box.) You can enter a period to activate the Procedure Lookup tool.
Copy diagnoses from previous row	After you enter the first charge, the Copy diagnoses from previous row option appears in the Diagnoses field for all subsequent procedure codes (athenaOne selects this option automatically). You can select and deselect this option. If you change a diagnosis code that you entered, athenaOne deselects the Copy diagnoses from previous row option for each subsequent row.
FP	If this line item is for family planning, enter the two-character family planning code for this procedure (this field is used for some Medicaid programs).
POS	Click this field to select the place of service.
EPSDT	Select this option if an Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) referral was given to the patient for this procedure.
EMG	Select this option if the procedure was related to an emergency. This option corresponds to CMS-1500 Block 24I.
Note	Click Add Note to enter a note about the charge.
Other Diagnoses	Use this section to record additional diagnosis codes that may be required by a payer to support value-based reimbursement but are not tied to a specific charge line or CPT code (for example, codes for pre-existing conditions). This section records any diagnoses entered on charge integration (Billing tab in athenaClinicals) that you have not associated with a procedure code. Also, you can manually enter diagnosis codes in this section to submit these codes on the claim without tying them to a specific charge line.   You can enter up to 12 diagnosis codes per claim. If the total number of diagnosis codes exceeds 12, athenaOne does not send all the diagnosis codes entered in this section on the claim. After you click Create Claim, athenaOne creates a new claim note to indicate which codes it was not able to add to the claim, and these codes move to the Internal Use - Other Diagnoses section, so that you can review them on the Claim Action or Claim Edit page.   If your practice has the Automatically Split Claims with Excess Diagnoses Codes setting enabled, athenaOne automatically splits claims with more than 12 diagnosis codes when the additional diagnoses are not associated with a procedure billed on the claim You can enter up to 12 diagnosis codes per claim. If the total number of diagnosis codes exceeds 12, athenaOne automatically generates additional claims to accommodate the excess diagnoses which are not associated with a procedure billed on the claim, and links the diagnoses to placeholder procedure code 99499. After you click Create Claim, athenaOne automatically splits the claim and you can see a note automatically appear on Claim Edit.   When this feature creates a claim with related claims, the athenaOne system holds all claims together (and releases them together as well).   Setup instructions Ask athenahealth to enable the Automatically Split Claims with Excess Diagnoses Codes setting. Contact the CSC or your onboarding project team. On the Main Menu, click Support then Create Case or Call.   Before you can use this feature, you must add placeholder procedure code 99499 in your fee schedule with a cost value greater than $0.00 and less than $1.00. For more information about Fee Schedules, see Fee Schedules in O-help. Important If the placeholder procedure code 99499 is not in your fee schedule with a cost value greater than $0.00 and less than $1.00: You’ll see an error when the athenaOne system tries to automatically split a claim. The claim will be created with a claim note explaining that overflow diagnoses were dropped
Mark Appointments as Not Requiring Charge Entry
Appointments	Checkboxes appear for any appointments scheduled for the patient on the same day and department, listed chronologically, including multi-resource slots.   These checkboxes reflect any selections made on the Check-in page. On the Charge Entry page, you need to select a reason for not requiring charge entry for any selected appointments.
Reason	Before you click the Mark Appointments As Not Requiring Charge Entry link, select the reason why this claim does not require charge entry. Tip: You can create custom "no charge entry reasons" via the No Charge Entry Reasons page.

Information entered below will not appear on the claim
Internal Diagnoses	Enter any other diagnosis related to this claim.
Post date - Required	The post date of the charges. The default value is the current date. Note: In athenaOne, a charge whose post date is in the month following the month of its service date (or any subsequent month following the service date) is considered late even if the service was at the very end of a month and the post date is at the beginning of the next month. You can choose to back-date the charge to either the earliest open date in the system or the charge's (from) date of service, whichever is later.
Claim Note	Enter a claim note.

 

To enable service type add-ons, you must contact the CSC from athenaOne > Support > Success Community > Contact Client Support Center.

Note: Some service type add-ons are available only on the Claim Edit page (not on the Charge Entry page).

 

Service Type Add-On — Abortion
Special program code	Select the reason the abortion services were performed. Compliant use of this field is applicable according to the state laws of each practice and may be provider-driven. Consult your legal adviser or state healthcare agency for compliance guidelines.
Service Type Add-On — Anesthesia
Concurrency	A claim-level field typically populated by the value calculated in the anesthesia time sheet. When entering charges outside the anesthesia workflow, however, the practice user can enter the concurrency level, calculated manually, in this numeric field.
Anesthesia type	This value is typically populated from the anesthesia time sheet. However, a practice user can complete this field on the charge entry page. Further, rules can be conditioned on the anesthesia type selected. For example, if the practice user identifies the services as a monitored anesthesia case (MAC), a rule could be created to require the user to modify the anesthesia services with a MAC modifier.
Surgeon	Select the primary surgeon from the menu. This menu is populated from the Referring Providers page.
Service Type Add-On — Breast Care (Available on the Claim Edit page only)
TPL Denial Date	The date that the primary insurance denied the claim. Note: TPL = third party liability.
Result Code (Breast)	Select the result code for the breast or cervical procedures from the menu of acceptable values provided by the program.
Recommendation Code (Breast)	Select the recommendation code for the breast or cervical procedures from the menu of acceptable values provided by the program.
Result Code (Cervical)	Select the result code for the breast or cervical procedures from the menu of acceptable values provided by the program.
Recommendation Code (Cervical)	Select the recommendation code for the breast or cervical procedures from the menu of acceptable values provided by the program.
Months for Short-Term Follow-Up	Select the number of months for short-term follow-up (this field is required if the recommendation code is 2).
Tumor Size (cm)	Enter the size of the tumor in cm. This field is required for procedures 19160, 19162, 19180, 19240.
Tumor Stage	Select the tumor stage from the menu (this field is required if tumor size is present).
Treatment Started?	Select Yes if surgery, chemotherapy, or radiation has been started; otherwise, select No.
Reason Code for No Treatment	Select a reason code if treatment has not started.
Pap Smear Adequacy Code	Select an adequacy code for the pap smear, if provided.
Service Type Add-On — Consultation
Second opinion for surgery	Select Yes if the claim is for a second opinion for surgery; otherwise, select No.
Service Type Add-On — Corporate Billing (Available on the Claim Edit page only)
Test/Specimen Number	Enter the test/specimen number in the field provided. Note: To enter additional notes in the Line note field, click edit (upper right corner of the charge line) and then click Add next to Line note.
Service Type Add-On — COVID-19
Was the patient suspected of having, diagnosed with, or tested for COVID-19 at the time of the encounter?	Select Yes or No to indicate whether the claim is for services related to COVID‑19 care. If you select No, you cannot select answers in the remaining fields.   The athenahealth rules engine uses the answers to these questions to determine which COVID-19 related rules should fire on the claim, particularly when the patient is COVID-19 presumptive positive. You may notice a change in hold volume for claims related to COVID-19 care as rules adapt to changing payer requirements and as athenahealth gains more information about COVID-19 federal grant requirements. Note: You can use the Report Builder to report on the answers to this question in the COVID-19 service type add-on. The COVID-19 Suspected display column and filter are available in the Claim category of these report types in the Report Builder: Appointment, Claim, FCC Activity, Transaction Activity, and Transaction Aging.
Does this claim include services related to COVID‑19 testing?	Select Yes or No.   The COVID-19 service type add-on appears on claims created with or without an appointment. Note: You can use the Report Builder to report on the answers to this question in the COVID-19 service type add-on. The COVID-19 Testing display column and filter are available in the Claim category of these report types in the Report Builder: Appointment, Claim, FCC Activity, Transaction Activity, and Transaction Aging.
Is the provider or medical group out-of-network with the patient's insurance?	Select Yes or No.   You can use the answer to this question in conjunction with the COVID‑19 related patient balance hold to help you meet the CARES Act Provider Relief Fund grant requirements. For information about the COVID-19 related patient balance rule, see COVID-19 Management: Patient Balance Hold Rules Request on the Success Community. Note: You can use the Report Builder to report on the answers to this question in the COVID-19 service type add-on. The COVID-19 Out of Network display column and filter are available in the Claim category of these report types in the Report Builder: Appointment, Claim, FCC Activity, Transaction Activity, and Transaction Aging.
Service Type Add-On — Diagnostic Services (Available on the Claim Edit page only)
Purchased Services?	Select Yes for claims with modifier -90 (Reference (Outside) Laboratory). This option indicates that your practice purchased testing kits from an outside party (CMS-1500 line 20 or equivalent).
Purchased Services Provider	Select the provider that supplied the purchased services. For example, a physician may purchase a diagnostic exam from an outside entity. Click Choose/view to display the Referring Provider Lookup tool. This field is required if Purchased Services? is set to Yes.
Purchased Services Amount	Enter the total cost (dollar amount) of the purchased services included on the claim. This field is required if Purchased Services? is set to Yes.
Service Type Add-On — Dialysis
Patient's weight (pounds)	Enter the patient's weight in pounds. This information is required for EPO claims for patients on dialysis.
Hematocrit level	Enter the patent's hematocrit level.
Hemoglobin level	Enter the patent's hemoglobin level.
Last HCT/Hgb test date	Select the date of the patient's last hematocrit and hemoglobin test.
Serum creatinine level	Enter the patent's serum creatinine level.
Last serum creatinine date	Select the date of the patient's last serum creatinine test.
Epoetin starting dose	Enter the patient's starting dose of Epoetin.
Chemo drug name	Enter the name of the chemotherapy drug.
Last chemo drug admin date	Select the date the patient was last administered chemotherapy.
Receiving AZT?	Select Yes if the patient is receiving AZT, also known as Zidovudine (ZDV), for HIV treatment or prevention.
Service Type Add-On — DME (Available on the Claim Edit page only)
DME section	Use this section of the add-on to report the length of need and certification type for DMERC CMNs (excluding O2). Complete the DME section fields only for procedures where a certificate of medical necessity (CMN) from the provider is required. Note: Do not complete these fields for oxygen therapy claims.
DME Certification Type	Select the type of certification from the menu (Initial, Renewal/Recertification, or Revised).
DME Certification Revision Date	Enter the date that the last certification was obtained from the provider. You must enter the DME certification revision date if you indicated a DME certification type of Renewal/Recertification or Revised.
DME CMN Quantity (months)	This field is used to report the length of need for this CMN. Enter the quantity in months. Note: To submit the DME information with a DME claim, you must complete both the DME certification type and the DME CMN quantity.
DME Therapy Begin Date	Enter the date that the DME therapy began.
Oxygen Therapy	Use this section to report O2 CMN information. This information is required for all home oxygen therapy claims.
Oxygen Therapy Certification Type	Select the type of certification from the menu (Initial, Renewal/Recertification, or Revised).
Oxygen Therapy Certification Revision Date	Enter the date that the last certification was obtained from the provider. You must enter the oxygen therapy certification revision date if you indicated an oxygen therapy certification type of Renewal/Recertification or Revised.
Oxygen CMN Quantity (months)	This field is used to report the length of need for this CMN. Enter the quantity in months. Note: To submit the oxygen therapy information with a DME claim, you must complete both the oxygen therapy certification type and the oxygen therapy CMN quantity.
ABG Test Results	Use this field to report arterial blood gas result.
ABG Test Date	Enter the date of the arterial blood gas test.
Oxygen Test Condition	Select an option from the menu to report the condition under which the ABG test occurred .
Oxygen Saturation Test Results	Use this field to report oxygen saturation blood result.
Oxygen Saturation Test Date	Enter the date of the oxygen saturation test.
Oxygen Flow Rate	Enter the oxygen flow rate. Valid values are 1 — 999 liters per minute and X for less than 1 liter per minute.
Oxygen Test Findings	Used to answer question 8, 9, 10 of the Oxygen CMN. User can select multiple findings from the list.
Oxygen Therapy Begin Date	Enter the date that the oxygen therapy began.
DMERC Condition Indicators	Use this section to report conditions related to all DMERC CMNs. If you completed the DME section or the Oxygen Therapy section, this section of the add-on is required.
Type of Condition Indicator	Select Durable Medical Equipment or Oxygen Therapy Certification from the menu.
Conditions Apply?	Select a value for the ANSI Certification Condition Code Applies indicator. Yes — The condition codes in the Condition Indicators field apply. No — The condition codes in the Condition Indicators field do not apply.
Condition Indicators	Select one or more condition codes describing either the patient or the equipment status.
Date Certification Signed by the Physician	If you selected the condition code "38 - Certification signed by the physician is on file at the supplier's office," you must provide the date that the certification was signed by the physician.
Patient's Weight (pounds)	Enter the patient's weight in pounds. The patient's weight is required when submitting claims to Medicare Durable Medical Equipment Regional Carriers with certificates of medical necessity.
Supporting Documentation	Use this section to report responses to CMN questions.
Form Identifier	Use this field to report the CMN form number. (must be a valid OMB approved CMN form number, excluding alpha characters).
Question Number/Letter	This field is used to report a CMN question number. (You can enter multiple questions, if needed.) Type a question mark, the number and letter, and then press the Tab key. Additional fields (Response, Date, etc.) appear. Note: For multi-part questions that are not numbered individually, assign letters left to right, top to bottom, keeping the question number constant. Must include both number and letter together in this field.
Response	Select the response to the CMN question (Yes, No, or Not applicable).
Date	Enter the date (if the CMN question requires a date response).
Percent	Enter the percentage (if the CMN question requires a percent response).
Additional Information	Enter the required information (if the CMN question requires a text or uncodified response). Note: These fields of information do not appear until a number is provided in the question number/letter field.
Service Type Add-On — Drug/Injectibles
Patient's weight (pounds)	Enter the patient's weight in pounds.
Service Type Add-On — EPSDT
Complete EPSDT screen?	Select Yes to indicate that the physician completed the EPSDT screening. Select No to indicate that the physician did not complete the EPSDT screening.
Service Type Add-On — Family Planning
Purpose of visit	Select the purpose of this visit from the menu.
Interpreter needed	Select Yes if the patient requires an interpreter.
Number of pregnancies	Enter the number of pregnancies the patient has had.
Number of births	Enter the number of times the patient has given birth.
Last pregnancy ended	Select the date when the patient's last pregnancy ended.
Contraceptive (prior to visit)	Select the type of contraception (if any) used by the patient before the visit.
Contraceptive (after visit)	Select the type of contraception (if any) that the patient will use after the visit.
Give reason for "none"	If you selected none from the Contraceptive (after visit) menu, select the reason for this option from the menu.
Pregnancy test	Select the result of the administered pregnancy test (negative or positive). If no test was given, select not tested.
Pregnancy desirability	Select the appropriate option for pregnancy desirability.
Routine medical services provided	Select all routine medical services provided.
Other medical services provided	Select all other medical services provided.
Lab services provided	Select all lab services provided.
Referring for non-family planning services	Select all referred non-family planning services.
STD tests/diagnoses	Select all STD tests and diagnoses administered.
STD treatments	Select all STD treatments given.
HIV pre-test counseling	Select Yes if HIV pre-test counseling was provided.
HIV test	Select Yes if an HIV test was administered.
HIV test result	Select the result of an administered HIV test (negative or positive). If no test was given, select not tested.
HIV post-test counseling	Select Yes if HIV post-test counseling was provided.
Provider of medical services	Select all providers of medical services.
Counseling services provided	Select all counseling services provided.
Provider of counseling services	Select all providers of counseling services.
Service Type Add-On — Foreign System Identifier
Client system identifier	The value in this field is controlled by the interface; however, users can manually modify this value.
Service Type Add-On — Hearing/Vision
Prescription date	Enter the date of the patient's prescription.
Service Type Add-On — Hospice/HHA
Patient is homebound?	Select Yes if the patient is homebound; otherwise select No.
Hospice/Home Health Agency	Click Find a hospice or HHA to select a hospice or home health agency. Note: A claim rule assigns HOLD status to all claims billed with procedure codes 99374, 99375, 99377, 99378, G0179, G0180, G0181, and G0182 that do not contain the complete name and address of the Hospice/HHA facility and Medicare ID number.
Provider is a hospice employee?	Select Yes if the provider is an employee of the hospice. This flag is necessary for all Medicare claims involving physician services to hospice patients.
Service Type Add-On — Immunization
Immunization lot number	Enter the serum lot number if required by state law for health data reporting. Note: You can report only one serum lot (or batch) number per claim. You must create an additional claim if you need to report a second serum batch number.
Service Type Add-On — Maternity
Delivering provider?	Select Yes to indicate that the rendering provider on the claim is also the delivering provider. Select No to indicate that the rendering provider on the claim is not the delivering provider. Note: When the provider of antepartum care is the same as the delivering provider, denials are common because of global coverage for pregnancies. For antepartum care, it is important to indicate when this care is provided by the delivering provider.
Pregnant?	This field is automatically populated with the information from the OB episode. This information is required in some states — for example, Indiana Medicaid — or if the Last menstrual period field is populated.
Estimated delivery date	This field is automatically populated with the date from the OB episode.
Last menstrual period	This field is automatically populated with the date from the OB episode.
Service Type Add-On — Medicaid TX
Benefit code	Enter the benefit code specific to Medicaid TX. The code is required for certain types of claims only.
Service Type Add-On — Miscellaneous Fields
Service auth exception code	Select the reason why a provider did not obtain a service authorization for a service that state law (for example, New York State Medicaid) requires an authorization for.
Delay reason code	Select the reason why a claim was filed past the filing date or the reason why a claim transmitted in response to a request for information was delayed.
Special program code	Select the program under which services provided to the patient were performed.
Investigational device exemption number	Enter the investigational device exemption number. This number is required on claims associated with clinical trial participation.
Medicare ICN	Enter the internal claim number (ICN) that Medicare provides for a single submission of a claim.
Clinical trial registry number	Enter the clinical trial registry number. CMS requires a clinical trial registry number on claims associated with clinical trial participation.
TPL code	Enter the third party liability (TPL) code. The TPL code is a unique, payer-specific code.
Emergency certification statement	Enter the emergency certification statement. This information is required if you're billing Medi-Cal for emergency services.
Service Type Add-On — NDC (Available on the Claim Edit page only)
NDC number	National Drug Code (NDC) information is copied from your practice's fee schedule, unless you enter it manually.   When you enter a valid number in the NDC number field, athenaOne displays the corresponding athenaCodesource trade name below the field. This information allows you to confirm that the NDC number entered is correct for the procedure code.   NDC is an 11-digit number with the format "xxxxx-xxxx-xx." If one segment is not formatted correctly, add a leading "0" to that segment (for example, 12345-123-12 becomes 12345-0123-12). For more information, see NDC number formatting.   Note: To edit the NDC number or dosage for a procedure code, click the edit procedure fees link on the Fee Schedules page.
Drug name	The name of the drug. Unless entered manually, this field is populated automatically from your practice's fee schedule.
Unit price	The unit price that your practice paid for this drug. Unless entered manually, this field is populated automatically from your practice's fee schedule.
Dosage	The total amount dispensed, measured in the units selected in the menu to the right of the field.
Service Type Add-On — Newborn Care
Patient's weight (pounds)	Enter the patient's weight in pounds.
Service Type Add-On — No Surprises Act Consent
Consented amount ($)	If a patient’s Out-of-Network Billing consented amount was entered in the appointment AND a signed consent form was attached, you’ll see that amount in this field.   Note: If no signed consent form was uploaded, the cost estimate will NOT carry over to the consented amount in Charge Entry, as it is assumed that the patient did not consent to paying Out-of-Network rates.   If a patient’s consented amount is missing at Charge Entry or Claim Edit: you can check the patient’s appointment to see if a signed consent form was attached, and then enter the consented amount.   For details, see the O-help topic: To view and edit patient's Out-of-Network Billing consented amount at Charge Entry or Claim Edit .
Service Type Add-On — Ordering Provider (Available on the Claim Edit page only)
Ordering Provider	Provider ordering services or supplies, if different from the rendering provider. You can type a period to access the Referring Provider Lookup tool.
Service Type Add-On — PT/OT
Date last seen	Enter the date that the patient was last seen by the physician supervising care for the underlying condition.
Prior authorization tracking number	Enter the prior authorization tracking number for the patient's original $3,700 worth of care. This number is required when a patient exceeds $3,700 worth of therapeutic care in one year, but the patient is re-authorized for more therapy.
Service Type Add-On — Paperwork (Available on the Claim Edit page only)
Paper work	Select Yes to indicate that additional documentation is required.
Attachment Control Number	Enter a control number for the required attachment.
Attachment Type	Select the type of paperwork attachment from the menu.
Attachment Transmission	Select the method of transmission for the additional paperwork from the menu (for example, By Fax, Email, or Electronically Only).
Service Type Add-On — Podiatry
Date last seen	Enter the date that the patient was last seen by the physician supervising care for the underlying condition.
Service Type Add-On — Post-Operative Care
Assumed care date	Enter the date that care was assumed by another provider during post-operative care if the claim has Modifier 54 (for Surgical care only) or Modifier 55 (for post-operative care only). Required on Medicare claims involving shared post-operative care. See Relinquished care date (below).
Relinquished care date	Enter the date that the provider filing the claim ceased post-operative care — that is, the last day of care by this provider — if the claim uses Modifier 54 (for Surgical care only) or Modifier 56 (for Pre-op management only). Required on Medicare claims involving shared post-operative care. See Assumed care date (above).
Service Type Add-On — Programs
Program	Select the appropriate program from the menu.
Service Type Add-On — Radiation Therapy
Number of treatment sessions	Enter the number of radiation treatment sessions for the patient.
Supervising provider	Select the name of the supervising provider.
Interpreting provider	Select the name of the interpreting provider.
Number of patients served	Select the number of patients served from the menu.
Service Type Add-On — Reference Lab
Reference Lab ID	Click Find a provider to search for the reference lab.
Service Type Add-On — Rehabilitation Services (Available on the Claim Edit page only)
Ordering provider	Select the provider ordering services or supplies if different from the rendering provider (the Referring Provider Lookup tool is available).   Required for procedure codes (HCPCS) that describe: Diagnostic radiology Diagnostic laboratory Durable Medical Equipment (DME) Orthotics Prosthetics Medicare claims are placed in HOLD status if you do not enter either a referring provider or an ordering provider for the types of service described above.
Service Type Add-On — Spinal Manipulation
Initial treatment date	Enter the date of the initial treatment for the patient's underlying condition.
Last X-ray date	Enter the date that the last X-ray was taken (for example, to demonstrate a subluxation of the spine).
Spinal man. patient condition	Select the nature of the patient's condition necessitating spinal manipulation from the menu.   A - Acute Condition C - Chronic Condition D - Non-acute E - Non-Life Threatening F - Routine G - Symptomatic M - Acute Manifestation of a Chronic Condition
Spinal man. patient condition description	Enter a description of the patient's underlying condition.
Acute manifestation date	Enter the date of acute manifestation for the patient's underlying condition.
Service Type Add-On — Telehealth
Were services rendered via a live telehealth distant site visit?	Select Yes or No. The Telehealth service type add-on appears only when the claim is created without an appointment. If an appointment is associated with the claim, the appointment should have the Telehealth Distant Site Visit appointment type class applied (see To add Telehealth Distant Site Visit to your available appointment types). Note: The athenahealth rules engine uses the Telehealth Distant Site Visit appointment type class or the Telehealth service type add-on information to identify the claim as telehealth and apply the appropriate billing rules per payer guidelines.
Service Type Add-On — Title X Family Planning
English proficiency	Select Yes if an interpreter is needed.
Primary method of family planning	Select the patient's primary method of family planning.
Clinical breast exam (CBE)	Select the Received option if the patient received a clinical breast exam during the visit.
Credited family planning encounter provider	Select the provider credited for the family planning encounter.
Service Type Add-On — UDS Reporting (Available on the Claim Edit page only)
UDS Visit Type	Visit type selected by athenaOne based on procedure code and provider.
UDS Visit Type Override	Select the override type from the menu. To exclude the visit from UDS reporting, select Non-UDS Visit. Note: The UDS service type add-on works only on claims. If you create a clinical encounter with no associated claim, athenaOne automatically flags the encounter as a UDS visit type for reporting, and you cannot change the visit type in athenaOne. Your UDS report details (filtered and raw files) will include all encounters, in addition to claims.
Clinic or Virtual	Visit type (Clinic or Virtual) selected by athenaOne based on the department's place of service code (POS 02 - Telehealth), certain modifiers on procedure codes on the claim or encounter (.GT, .G0, or .95), or certain procedure codes. Virtual visits are reported on UDS Table 5 - Staffing and Utilization. Note: You can find the list of virtual-only procedure codes on the 2019 CPT inclusion and exclusion list on the Success Community.
Clinic or Virtual Override	To override the value in the Clinic or Virtual field of the UDS STAO, select Clinic or Virtual from the menu.
Internal note	Enter a note to document the UDS visit override.
Service Type Add-On — Well Child Care
EPSDT referral given?	Indicates whether an EPSDT referral was given to the patient.
EPSDT referral reason	Indicate a reason why an EPSDT referral was given. Required if an EPSDT referral was given.
EPSDT referral reason	Indicate a second reason why an EPSDT referral was given.
EPSDT referral reason	Indicate a third reason why an EPSDT referral was given.
Are these services the result of an EPSDT referral?	Select Yes to indicate that the services are the result of an EPSDT referral. Select No to indicate that the services are not the result of an EPSDT referral.