At a Glance

The Submission Errors page in Insights shows claims that did not submit successfully, within tabs delineating whether Athelas or your practice is responsible for reviewing and fixing them. It also allows you to dig into the details of each individual claim.

Tabs on the Submission Errors Page

• More Info Required

  This is the tab where you’ll spend most of your time. These claims require information that only your practice can provide in order to resubmit.

  In this example, we can see that the ‘Precheck Failed’ on a collection of claims. When we click into it for more details, we can see in the error message that the payer needs a referral or prior authorization to process claims.

  
  

  

  
  

• More Info Required: Select Submission Errors by Stage

  In the ‘More Info Required’ view, use the following tabs to find claims in a particular stage in the correction/resubmission process:

  
  

  

  • Not Started

    These are submission errors on which action has not yet been taken.

  • Updated in EHR

    These are claims where your staff has indicated that corrections have been made in the EHR. Once Athelas pulls in the corrections, these claims will automatically be resubmitted and disappear from this dashboard.

  • Blocked

    Claims enter this status when a member of your team indicates that they need assistance from Athelas to resolve the claim. If you’re stuck and need help, mark the claim as Blocked.

• Athelas Responsibility

  These are claims where the Athelas Denials Team is actively investigating the claim and attempting to resubmit or appeal it. You’re always welcome to review these claims, but know that our team has them queued for action.

• Not Workable

  These are claims that have been deemed unworkable by the Athelas team, but have not yet been reviewed by your team to be officially written off.

  There are two kinds of unworkable claims in this list.

  • Unavoidable

    Claims that land here generally ran into some technical issue. These are commonly duplicate claims and claims that have already been submitted by an external source.

  • Regrettable

    These are claims for which action could have been taken by either Athelas or your organization, but was not. For example, if a payer requires supporting documentation within a time frame and no documentation was sent in that time frame, the claim will land here.

• Written Off

  These claims have been marked by your team as irretrievable loss and require no further action.

Tracking Your Progress

As you work submission errors, you’ll most often take one of three actions:

• Update in EHR

  Because Athelas treats your EHR as the source of truth, all you need to do to trigger a resubmission is to update the claim in your EHR. We’ll automatically import the corrected data overnight to resubmit the claim.

  • This will be your most common way of working submission errors!

  • Once you’ve made a correction in your EHR, mark the submission error as “Updated in EHR”

• Mark as Blocked

  If you’re stuck and cannot determine the solution for a submission error with missing info, you can mark that claim as Blocked to request assistance from Athelas.

• Write Off

  Inevitably, some submission errors simply cannot be fixed. For these, you can mark the claim as ‘Written Off,’ indicating that you will not pursue further action on the claim.

To mark submission errors into these statuses, you have two options:

1. Select multiple claims and use the ‘Actions’ menu here, or…

2. Click into an individual claim and use the ‘Actions’ menu there.

Either way, the claim will move into the designated status to be followed up on as appropriate.

Correct & Resubmit

You also have the option to correct a claim directly from Athelas. In the case of simple corrections this is often the fastest path.

However, if there’s a persistent issue like a patient with ineligible insurance, you’ll need to make sure to make the correction in your EHR as well.

• Here’s how to correct and resubmit a submission error

  Click the ‘View Claim’ link on the right side of a claim row in the submission errors dashboard.

  
  

  

  In the claim details view, click the ‘Actions’ menu and choose ‘Modify and Resubmit.’

  
  

  

  Make any corrections needed, then click the “Save & Resubmit Claim” button

  
  

  

  Done!

Features Supported:

• View submission errors broken down by reason, category, and owner

• View submission errors grouped my month and reason

• Download submission errors csv

• Bulk resubmit

• Write off claim

• Update encounter in Insights

• Mark submission error with tag indicating its status and owner

Features In Development:

• Dry run the billing rules in the AIR chart note

In Conclusion

Using the Submission Errors page will help your prioritize your most actionable submission errors, giving you the best shot at reclaiming lost revenue for your practice.

As always, if you have any questions about this feature, don’t hesitate to reach out to your dedicated Athelas representative.