Kick Codes in Athena Collector
Kick codes, also referred to as “kick reasons”, are a communication tool used in Athena Collector to let others know what needs to be done with a claim. Anytime a claim is worked on, a kick code is required to put the work in action.
How do you find kick codes?
From a claim, choose the action tab and select “add kick code”. Scroll down to the kick reason field. You can search for kick codes by entering a period, instead of an actual “kick reason” in the kick reason field. That will bring up a search tool in a new window. At this point you can either search by term in the blank provided or view a list of kick codes related to a specific issue by using a drop-down menu. “View All Kick Reasons” is also an option in the drop-down menu.
How do you choose the right kick code?
Kick codes can be confusing. When trying to determine which one to choose, it helps to look at what the next status is: Hold, Manager Hold, CBO Hold, Drop, Billed. A sortable list of all kick codes can be found in the “Claims” drop-down menu on the main Athenanet tool bar. The columns can then be sorted to view by kick code, description, claim status, and balance behavior. Sorting by “claim status” is especially helpful for finding the correct kick code when you want to ensure Athena will be working the claim. (CBO Hold)
Helpful Kick Codes You Will Use
When submitting/resubmitting a claim:
DRPBILLING – Resubmitting a claim where billing information has been corrected (px codes, dx codes, POS codes, etc.)
DRPPATIENT – Resubmitting claim because patient information or insurance was either corrected or verified with the payer.
When adjusting off balance (no further payment is expected):
CAP – Patient/service is part of a capitated arrangement with this payer.
CONTRACT: Contracted provider; provider has agreed to accept as payment in full. Patient is not responsible for balance.
BADDEBT: Use for adjusting charges off for reason of bad debt.
To transfer the balance:
PTRESP – Charge is patient responsibility (this portion of the claim belongs to patient).
TERTIARY – Please submit the tertiary claim.
DEDUCT – These expenses are applied to your deductible.
COINSURANCE – Transfer the balance to the next payer if the EOB shows that balance is for Coinsurance
COPAY – Transfer the entire balance to the next payer if the EOB shows the balance is for a Copay
To move the claim to CBOHOLD:
ADNREVIEW – The payer has denied the claim for unspecified or complex additional information which requires review by the billing team. This code sends the claim to Athena to call insurance for clarification.
PLSAPPEAL – The claim has been reviewed and requires an appeal to the payer for reconsideration of payment. Sends the claim to Athena to appeal.
TERTIARY – Sends claim CBOHOLD for Athena to submit the tertiary claim.
To move the claim to MGRHOLD:
MGRHOLD – Forces the claim in MGRHOLD to be reviewed by practice manager – make sure to include a note why the claim is being moved
To close a claim with a ZERO balance:
RVCLOSE – Claim work is complete. No further review needed. (Claim balance must be $0)
For more help with Athena Collector, fill out the Contact Us request form.