At a Glance

This overview will cover the main features of the Rejections page on Athelas Insights, as well as some of the reasons for rejection and, when applicable, which subsequent courses of action are available to you.

Overview of Rejections

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.

Here is a visual reference for the flow of this section of a claim’s life cycle.

Rejection Categories

Rejections are sorted into four categories, all visible within their corresponding tab on the page:

• More Info Required

  This is where all rejected claims will appear that require timely further action by your practice.

• Athelas Responsibility

  Athelas already has the necessary information to handle these rejections and resubmit them.

• Not Workable

  Rejections can be deemed ‘Not Workable’ for a variety of reasons. For example, sometimes a duplicate claim has already been processed by an external source, or perhaps information was not provided to the payer within their mandated time frame. More on these rejections later in this overview.

• Written Off

  For these rejections, someone in your practice has voluntarily chosen not to pursue collection from either the patient or payer.

❗ Note: The only rejections requiring timely further action by a practice are those in the ‘More Info Required’ category. Clearing out the ‘Not Workable’ category is also important but not as time-sensitive.

Common Features and Functions Across Category Tabs

Filters

When you click into a tab, you will see a section of filters at the top, followed by rejected claims organized by month.

Clicking into one of these months will automatically apply a filter covering that month. To see all rejected claims again, simply click the X on the filter.

Rejection Groups

Lower on the page you can see groups, categorized according to their insurance name, rejection reason, and listed in order of greatest to least total affected charges.

Clicking into one of these groups will provide further information on the exact claims affected, the full reason for rejection, and how to fix the claims for resubmission.

In this example, your practice would need to provide the subscriber, policy, and contract numbers for this group of claims before resubmitting.

Actions Menu

When you tick the box next to at least one rejected claim in a group, the ‘Actions’ menu will become available. This menu allows you to recategorize the selected claim(s) within Rejections, or resubmit them.

Bulk Resubmission

Once you are confident that you have made all necessary changes to the claims you would like to resubmit, you may resubmit them in bulk.

More Info Required tab

This tab contains rejections that require your practice to provide further information in a timely manner.

Filters

You can filter results by initial submission date, billing type, patient name, etc.

Below the standard filters, you will see the following tabs for rejections:

• Not Started

  When a claim is rejected because it requires further action from your practice, it will land in this ‘Not Started’ category.

• Updated in EHR

  These are rejections that your practice has touched and a staff member has marked as ‘Updated in EHR.’ Please update rejected claims in your EHR before marking them as ‘Updated in EHR.’ This will create less confusion later if a claim marked as such is resubmitted and rejected again for mismatched EHR information.

• Blocked

  Claims in the ‘Blocked’ category have been moved here by your practice. These are rejections that your practice has indicated it cannot take action to fix, and help from Athelas is required. To indicate that these rejections cannot be salvaged, move them to ‘Written Off’ status. More on that at the end of this guide.

You can also choose to view all rejections at once.

Take Action to Fix a Rejection

To find out what changes are required, click the dropdown icon next to a group and look at the ‘Rejection Reason.’

In this case, we can see that 42 claims have been rejected due to patient ineligibility for benefits for the submitted dates of service. The total charges associated with these rejections amount to $9.5k.

The rejection reason then directs you to double check that patient and subscriber information on the claim is identical to that on their ID card before attempting resubmission.

Athelas Responsibility tab

This section allows you to view the rejections on which Athelas is working. You can click the dropdown to view the rejection reason for each group of claims here as well and see the next steps Athelas will take before resubmitting the claims.

In this example, 64 claims were rejected due to missing property and casualty claim numbers, which are required for worker’s compensation and auto accident bills. Athelas will work to reduce this number to 0.

❗ Athelas aims to clear rejected claims in the ‘Athelas Responsibility’ category within 15 days (for denied claims in the same category on the Denials page, the clearance target is 21 days).

Not Workable tab

The two kinds of rejections that fall into the ‘Not Workable’ category can be described as either Standard or Regrettable.

• Standard applies to claims that are unworkable due to a technicality, such as a duplicate claim or a claim already processed by an external source.

• Regrettable applies to claims that could have been salvaged but were not, by either Athelas or the practice. For example, claims for which further information was required but not provided in a timely manner per a payer’s specifications would fall into this category.

❗ Claims are only explicitly categorized this way after a denial, not a rejection. Therefore, you will not see these categories listed until a claim is on the Denials page.

In this example, we can see that this claim was rejected as it is a duplicate of a previously processed claim.

Written Off tab

Generally, claims will be denied before they are written off, but in some cases rejections will also be written off. Charges are written off when a practice voluntarily chooses not to collect payment from either the patient or payer. Writing off a rejection is essentially the same as declaring that it will never be pursued and closing it out.

We can see in the dropdown that this claim was submitted with a formatting issue that was not fixed.

In Conclusion

The Rejections page will help your prioritize your most actionable rejections and generate more revenue for your practice. It allows you to take decisive action to resubmit claims, giving you the best chance capture revenue you are owed.

Features Supported

• Denials reviewed and worked by the Athelas team within 21 days from the claim’s posted date

• Rejections reviewed and worked by the Athelas team within 14 days from the rejection

• Dedicated Denials Expert assigned to each account to monitor metrics and trends on the backend for non-Direct Connect sites

• Auto-adjust non-Federal denials stuck in site’s queue after 3 months of no touch from the customer

• Coding Experts to provide recommendations on claims denied due to coding issues

• Denial Experts building out and managing clients’ Rules Engines through close monitoring of incoming rejections/denied claims

• View rejections broken down by reason, category, and owner

• View rejections grouped my month and reason

• Download rejections csv

• Bulk resubmit

• Write off claim

• Update encounter in Insights

• Mark rejections with tag indicating its status and owner

Features In Development

• AI calling bots that call insurance companies for more information on denied claims

• AI calling bots that call patients for updated insurance information on eligibility-related denials

Features Not Supported

• Athelas personnel calling patients directly for updated insurance information