At a Glance
The Claim Reconciliation page provides a high level overview into the reconciliation process and organizes all claims requiring manual review, allowing you to take actions in bulk. The goal here is to simplify the manual review process as much as possible. Ideally, it will give you the clarity you’ll need to implement new rules to take care of even more claims automatically.
Under Construction
Please excuse our dust while we continue to process older cases with this new feature.
You may notice minor things like login information that you previously mapped not showing up, or portal information displaying (erroneously) as valid, when a claim recon group indicates that it is blocked by invalid portal information.
If you run into such cases, please go ahead and double check the information in that recon group’s Reason column, and you can always flag any issues to us!
Which claims populate this page?
Claims go into Claim Reconciliation only after 30 days have passed without receipt of a remittance.
Exceptions
- Claims that your practice marked as “Allow to post EOB with missing details.” You can complete EOBs on the EOB Creation page.
Page Overview
The Claim Recon page divides claims into two categories, seen as tabs at the top of the page:
Site Responsibility
Claims requiring manual review by staff at your practice.
Athelas Responsibility
Claims requiring manual review by Athelas staff.
The Site Responsibility tab contains actionable claims.
You may see a warning banner just below these tabs. This banner is simply informative, showing the specific dollar amount that remains uncollected due to missing portals and failing logins.
It’s important to note that these are not outstanding payments.
Filters
The filters available are shown below. Please take a moment to familiarize yourself with the options—they will decrease your search time considerably.
Claims by Months
This section acts as its own filter. Click on a row to see only claims requiring reconciliation from that month in the Recon Group section below.
Recon Group
This is where all claims matching the filters you’ve set will appear, organized by Reason as well as Mapped Insurance (i.e. insurance name established in Insights).
Most Common Reasons for Manual Recon
Missing EOB Information
When EOB information has not yet been received, entered, or is incorrect, you’ll likely go through a process similar to this walkthrough.
In the example below, we can see that these claims are all blocked because they’re “Awaiting (your practice’s) upload of EOB.” We’ll click View to see more details.
In the ‘Actions’ column, you’ll notice that you can click View or the triple-dot menu. The menu is where we’ll go later to ‘Mark as Athelas Responsibility,’ ‘Leave notes,’ or ‘Bulk write off.’
After clicking View, we see information populating the Missing Logins section. This is a good time to double check the login and make any updates, if necessary. More information on missing portal login information is available in the next section.
Each claim in the Claims section allows you to View the original claim.
They also have notes detailing the issue.
In this example, clicking into the note shows that the Recon team contacted the payer, but the payer mailed a physical EOB to your practice. You need to enter that information before this claim can be processed.
EOBs cannot currently be uploaded from this page. To upload an EOB, visit the EOB Creation page and see this guide.
Missing/Invalid Portal Login Information
Claims in categories related to missing or invalid login information will likely occupy a great deal of room in your Claim Recon page. Fortunately, they are relatively easy to fix.
The short version:
- Update invalid or missing portal login information
- Mark updated claims as Athelas Responsibility
In this example, we have 19 claims blocked due to invalid or expired portal login credentials. We’ll click View to see more details.
For this walkthrough, we’ll click Add Custom Login.
If a suggested login exists, we recommend clicking Add Suggested Login and updating its information. If there were a login listed that required updates, we would click Edit Login and go through this same flow.
If we flag that a login is failing, but you see that it’s actually working in your My Practice page, please go ahead and re-enter the login information here while we continue to map existing information into this feature—these kinds of cases will disappear soon!
Fill in the information in the modal, then click Confirm.
Note that the login URL must link to a real portal or you will not be able to Confirm.
Your new login credentials will appear in the list of logins, both here and on the My Practice page.
Now, we’ll look at the notes on one of the claims. We can see that the Recon team requested updated login credentials, with two-factor authentication (2FA) set to a given number.
We’ll update the login credentials again with the 2FA information.
Once that’s complete, this claim and all others in this group should be good to go! You can take a look at each note to confirm before marking them as Athelas Responsibility in bulk.
To do this, check the boxes for all relevant claims, then click on Bulk Actions and select Move to Athelas Responsibility.
Note that you can also leave notes and write off claims in bulk from the Bulk Actions menu within each claim group.
These claims will then flow into our work list and we’ll take care of them.
📢 Further Assistance
We’re here to help! Please get in touch with support@getathelas.com if you’d like some hands-on assistance.
Powered by