Rule of the Month: Split Claims
Welcome back to the Rule of the Month! This month, we highlight athenahealth’s unique “split claim” functionality.
What are split claims?
Medical claims are anything but straightforward.
We wish that all charges could go on a single form and be sent to a single payer, but the reality is that many charges are sent to different payers, and there are rules for how each type of charge gets paid.
For example, our clients experience these “split claim” situations:
- Institutional clients need their claims sent to both Medicare A and Medicare B.
- Some payers require immunizations on a separate claim.
- Some payers need Vision care or Radiology charges sent to separate insurances (carve outs).
- Medicare has separate Durable Medical Equipment carriers and their DME charges need to be sent to those carriers and not the Medicare B carriers.
- Some clients have custom formats they need accommodated.
How does athenahealth address this?
We split the claim for the practice! In athenaNet®, our clients enter charges on a single claim – no matter how many separate payers, formats, or forms are needed.
When the practice staff completes and saves the claim, athenaNet functionality takes over. athenahealth takes care of splitting the claim based on the direction from our rules engine. (Our rules engine is the largest database of health insurance rules – continually updated by our experts, and a state-of-the-art billing, collections, and service center.) We make sure the claim goes to the correct payer in the correct format, every time, no matter what the billing requirements are.
The result: Reduced staff time, faster reimbursement, and increased profitability!
Stay tuned for next month’s rule.