Claim Creation via Billing Dashboard
Click on the Dashboard tab and select Billing
In the Billing Filters, put the correct parameters to pull up your list of claims
Under the Billing Records, you’ll see your list of claims for the selected month
“Mark all records as billed” allows you to select all claims to be sent to your EHR/EMR
“Select records to mark as billed” allows you to select individual claims to be sent to your EHR/EMR
Once you’ve selected your claims, under Select Billing Record, click “Review and Mark as Billed”
In the Mark as Billed window, review the billing codes, charges to mark, and number of patients. If it looks correct, click the blue “Mark Billed” button
You’ll get the following message confirming it’s been successful
You also have the option to download a CSV of the Billing Records
Claim Creation via Monthly Billing Report
Review the Guide for Creating Claims in AthenaHealth document for detailed instructions.
CCIQ creates claims in Athena for billing patients for monitoring and care management services provided by their care team. Sending claims data to AthenaHealth is performed when end-users select specific patients and billing codes that they wish to generate claims from the Monthly Billing Report.
Once claims are selected and sent to Athena, staff can review the status of the claim drop to AthenaHealth by clicking “Create Claims in EMR” again to review. Clicking on the status icon will tell staff what Athena’s API message regarding the claim says.
Claim Troubleshooting
If a claim has a “red triangle” icon after being sent, here are common reasons why the claim might have been rejected by Athena and the actions to be taken to address these rejects:
Reason for error: The CPT codes may not be in the Athena fee schedule or the fee schedule is not configured correctly for your department. The client needs to update their fee schedule for that CPT code
Reason for error: the department ID of the patient does not match the department ID CCIQ submitted or CCIQ has submitted a blank dept ID. The client needs to provide CCIQ with the correct department ID for the patient for CCIQ developers to update (this can not be done at a per-patient level within the UI).
Reason for error: the insurance information for the patient is not entered into Athena therefore there is no place to send the billing claim. The client must update patient insurance information in Athena
Reason for error: a diagnosis code for the patient is missing on the Athena Problem List to generate the claim within Athena (global rules checker for Athena stopping the claim from going through). RPM requires at least one diagnosis and CCM requires at least two diagnoses.
NOTE: The CCIQ/Athena demographics feed must be updated before the claim will sync correctly.