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.

💡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.

✅ Walkthrough Solutions for the Most Common Issues in 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

• 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:

  1. Update invalid or missing portal login information

  2. Mark updated claims as Athelas Responsibility </aside>

  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.

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).

General

Features Supported

• Reconciling claims within SLA of 45 days

• Reconciliations through:

  • backend payer connections

  • ERAs (electronic remittance data from clearinghouse)

  • manual EOB pulls from portals

  • calling and requesting EOB Faxes

  • through 835 files (from portals or your old clearinghouse/ EHR)

• AI calling bots that call insurance companies for EOB faxes

Features In Development

• Agents that retrieve 835 files off Payer Portals

• Backend Integration with direct connections to Payers for real time reconciliation requests.

Features Not Supported

• Follow up on unreconciled claims after 3 touchpoints with insurance uncooperative with our reps