At a Glance
This guide will help you understand the flow and lifecycle of an encounter in Insights, from creation to finalization, with explanations of all statuses and stages in between.
Summary of the Encounter Stage/Status Journey
Encounters are created for each appointment. If the claim submission is successful, then primary insurance—or Payer 1—will either deny the claim or send a remittance and pay at least part of the claim.
Once Payer 1 pays everything they’re going to pay, any remaining balance is pushed to the next payer. This process repeats either until the claim is balanced or any remaining balance is pushed to PR.
Definitions of Stage and Status Terminology
Encounter Status
- Import Error
- Import errors can occur for several reasons, including unrecognized or missing insurance, missing procedures or ICD-10, etc.
- Self-Pay
- The patient is self-pay, so the full balance is PR.
- Queued for Submission
- The encounter will be submitted in its corresponding batch.
- Submission Error
- There was a problem with submission. Athelas is working on it.
- Submission Success
- The claim was successfully submitted and awaits either approval or denial.
- Approved
- The current payer has paid, or the next payer balance is > 0. In other words, if any payer has paid any amount.
- Rejected
- Claims can be rejected by a clearinghouse for a number of reasons before they are sent to insurance companies for either approval or denial.
- In rare cases, an error will slip past a clearinghouse and be rejected directly by the payer.
- See this guide for more information on Rejections.
- Denied
- Claims can also be denied by a payer for numerous reasons.
- See this guide for more information on Denials.
- Voided
- Athelas voids claims when they contain so many errors that it would be easier to create and submit an entirely new claim, rather than revising the current one.
- Pre-Launch
- These are claims that Athelas imported from the time prior to our partnership with your practice (before the ‘Go Live date’).
Encounter Stage
- Payer 1, 2, 3
- The current payer responsible for adjudicating the remaining balance on the claim.
- Patient
- The balance is now PR.
- Finalization Pending
- If there are any pending/manual review remittances, the encounter will enter the ‘Finalization Pending’ stage instead of the ‘Finalized’ stage. Posting the remits or archiving them will lead to finalization.
- Finalized
- No further actions will be taken on this encounter.
PR is generated only after a remittance is balanced across all payers on a patient’s profile
Encounter Lifecycle Flowchart
Here is a flowchart going into greater detail on the encounter lifecycle.
Click the image to expand it.
📢 Further Assistance
We’re here to help! Please contact your account manager for some hands-on assistance.
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