Expanded Services – Unspecified – Others. Project requires Dell to contact the payers to review the claims denied due to inaccurate demographics entry of practice that are identified by Athena and tagged under Expanded Services project. Dell will contact the payers Confidential Materials omitted and filed separately with the Securities and Exchange Commission. Asterisks denote omissions. and verify the reasons for the claim being denied and make the appropriate changes to the claim to further process. Athena places claims in this workflow in a worklist daily, for processing by the Dell team. Prior to contacting the payer for claim status, claims must first be thoroughly reviewed through a detailed analysis of the claim history, including without limitation (i) review of all events visible from the claim edit page in chronological order to understand the processing to date of each claim, (ii) review of any payments posted or documentation attached to the claim which could impact the dialogue with the payer once contact is established, and (iii) review of all relevant demographic data prior to contacting the payer so that the call agent has a firm understanding of the types of insurance coverage the patient currently has or may have had in the past. The Denials Management team will follow documented workflows supplied by Athena. Whenever possible, reconsideration should be initiated over the phone. Team members must exercise any available opportunity to initiate action over the phone or a follow-up faxed resubmission, which may quickly re-start activity on the claim and to obtain payment. Details of the call and the relevant data points collected for each payer contact event will be updated in athenaNet through (i) direct entry in unique data fields and (ii) creation of an updated claim note, which contains a unique kick code to characterize the information received from the payer and to identify the specific reason for the call.
