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.

Main Page

How to Filter Results to Speed Up Your Search

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.’

Viewing Denials from the Claim Details page

Because many people also use the Claims Details page to analyze denials, there’s a filter to let you see any denials visible in the Denials Worklist:

This is slightly different from filtering to the Encounter Status of Denied, which includes denials that have been worked and omits partial and secondary denials.

There is an explanatory alert to help clarify the distinction between the two:

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 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

• Total Adjustments

• Balance

• PR Posted

  PR that may change depending on a remittance.

• Encounter ID

Individual Claim Details

Click into a claim to view its details.

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:

• Edit Encounter & Resubmit

  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.

  
  

• Edit Claim Form & Resubmit

  This action allows you to edit and resubmit an encounter’s associated claim.

  

  
  

• Send Documentation

  Use this action to send supporting documentation for this encounter.

  

  
  

• Posting

  Check out the 🛠️ How to Use Athelas Posting Tools guide to learn about this feature.

• 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 Claim 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.

  
  

  

We support electronic and paper mail claim submissions

• 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.

  
  

  

  
  

  You can decide whether to sort both the Claim and PR timelines by oldest to newest or vice versa.

  
  

  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.

  
  

  

  
  

  Configuration

  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.