At a Glance
The Claim Details page will likely be one of your practice’s most utilized pages in Insights. It provides essential information about each encounter at a glance, with all details of a given encounter readily available within a click or two.
This overview will cover the information you can find on the Claim Details page. Guides related to specific claim-related actions you may want to take are linked below.
🌐 Main Page
Filter
As your practice will likely have several thousand claims listed here, the many filters available will drastically decrease the time you spend sorting through them manually.
Please take a moment to familiarize yourself with these filters. Knowing which sorting options are available to you will save a lot of headaches down the road.
You can also always simply start typing in the Search bar to find what you’re looking for.
For example, this list has been filtered to show only claims with an Encounter Status of ‘Approved.’
Headings
Each encounter displayed on the Claim Details page will include the following information:
- Patient Name
- Rendering Provider
Date of Service
Claims are organized by most recent date of service.
Mapped Insurance
This refers to the most up-to-date insurance that Athelas has on file for this patient. In case of a discrepancy between the insurance in your practice’s EHR and the insurance listed here, please confirm which source is correct and update accordingly.
- Encounter Status
Encounter Stage
This displays which payer is currently responsible for taking action on this claim.
- Charges
- Insurance Paid
PR Paid
PR that has been fully paid.
- Total Adjustments
- Balance
PR Posted
PR that may change depending on a remittance.
- Encounter ID
Individual Encounter Details
Clicking into an encounter will allow you to view and edit a wide range of information about that encounter.
To see the Member ID, hover your cursor over the patient’s corresponding Insurance information. You can click to copy the Member ID to your clipboard.
Actions Menu
Details on each of the actions available in this menu are as follows:
Modify & Resubmit
This action allows you to edit and resubmit an encounter’s associated claim.
See these guides for full details.
Edit Encounter
This action will take you away from Claim Details into the Encounter Details page, where you can make any edits you like to this encounter.
Send Documentation
Use this action to send supporting documentation for this encounter. Full details available in this how-to guide.
Posting
Write Off
This feature enables you to write off outstanding payer balance and requires a written reason for the write off. If there is no outstanding payer balance, this feature will be inactive, as in the above example.
PR Write Off
This feature enables you to write off outstanding PR balance and requires a written reason for the write off. If there is no outstanding PR balance, this feature will be inactive, as in the above example.
Push to PR
Specify an amount of the outstanding payer balance to push to PR.
Upload EOB
A quick way to upload an EOB without going to the EOB Creation page.
Refresh Status
Use this to see the most recent update to an encounter’s status.
Copy Link
This action will allow you to paste and send this exact window to coworkers so that you can be sure you’re looking at the same thing.
Mark as needs arbitration
Label this claim as in need of a decision from a payer and write a note explaining the situation.
Mark as in arbitration
Label this claim as currently under payer review.
Mark as reprocessing
Label this claim as reprocessing.
Notes
To leave a note, click the speech bubble icon in the top right corner.
You can write notes specific to the encounter in question, or you can check the box in the bottom left of the pop-up to make a universal note that will show on all pages of information relating to this patient, such as their profile and appointments.
Individual Encounter Tabs
Each tab is detailed below.
Payment Overview
The Payment Overview tab features a summary of the claim and whether it has been balanced or not.
It is organized both ‘per payer,’ just below the summary, and also ‘per procedure.’ By expanding these sections, you can dig into the reasons for its status, as shown in this example.
Submissions
From the Submissions tab, you can expand a submission to view more details. You can also click on the ‘x rules applied’ button to view which rules were applied to this claim.
You can also click ‘View’ on the right-hand side of a submission to see the original paperwork for the claim.
Patient
This tab displays all touch points (texts or emails) between your practice and the patient regarding PR collection, as well as their results.
You can also use this feature to assess the effectiveness of PR collection through these methods for a given patient, and adjust PR collection strategy accordingly to ensure your practice gets paid.
Remittances
View details about all remittances related to this encounter here. You can also download them in bulk in the top right corner.
Timelines
Claim Timeline
The Claim Timeline displays all events that have occurred in relation to that claim, including payment updates. This is a particularly useful visualization tool when there is some question about a claim’s status, or how much time elapsed between two events.
You can Shift+click on an event’s expansion icon to expand or collapse the details of all events listed.
PR Timeline
The PR Timeline chronologically displays every event related to PR and Payments for a particular Date of Service (DoS). It functions as a snapshot of PR for a given DoS, at any point in time. You can view when the appointment took place, when claims were submitted, all the way through to when balances were updated and payment was fully applied.
See this guide for full details on the PR Timeline.
There are toggles for showing or hiding credits transactions as well as other hidden events. Some events are hidden due to their relatively inconsequential nature. For example, if a partial refund is required, then a full refund may be issued and then credits will be used to make up the difference. This event will exist, but it will be hidden from the PR Timeline to make the data more intuitive and readable.
Micro Timeline
The Micro Timeline displays basic information about PR charges, including Date and Time, Event, Patient Charges, Paid, Ending Balance, Locked Credits associated with a corresponding event.
Change History
This is a handy tab for tracking all updates made to a claim. You can view when the update was made, which fields were changed, and who made the changes. If you’d also like to see instances of updates with no change, you can click the toggle to ‘Show all imports.’
Click ‘View’ for more details on a given update.
Additionally, you can check the boxes on two or more rows, then click ‘Compare’ to compare all selected updates.
Eligibility Status
View the patient’s eligibility status here. To run a current eligibility check, you may do so on the Appointments page. See this guide for details.
📢 Further Assistance
We’re here to help! Please get in touch with support@getathelas.com if you’d like some hands-on assistance.
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