Are insurance verification problems slowing your practice? Athenahealth users face specific verification challenges. Real-time eligibility failures happen frequently. Patient information errors cause verification to fail. Payer connections break without warning. Each problem delays patient check-in.
This guide reveals common insurance verification problems in Athenahealth. You’ll discover why each problem occurs. We explain step-by-step solutions. Stop wasting time on verification failures and fix these problems today.
Understanding Insurance Verification
Insurance verification confirms patient coverage. It checks if insurance is active. It verifies benefits and copays. Verification happens before appointments. This prevents claim denials later.
Problem 1: RTE Connection Failures
Real-time eligibility fails to connect. This is the most common verification problem.
Why RTE Fails
Payer not configured in the Athenahealth system. Internet connection problems. Payer system maintenance or downtime. Wrong practice credentials. Each cause needs a different solution.
How to Fix
Enable payer connections in Settings. Go to Practice Configuration. Select Real-Time Eligibility. Add missing payers. Test the connection after enabling.
Prevent Future Failures
Check the internet connection daily. Monitor payer system status. Keep practice information updated. Enable all major payers you see.
Problem 2: Incorrect Patient Information
Wrong patient data causes verification failures. This happens very frequently.
Common Data Errors
Insurance ID entered incorrectly. Date of birth doesn’t match records. Name spelling differs from the insurance card. Missing a suffix like Jr or Sr. Each error causes the patient not to be found.
Fix Patient Data
Ask the patient to show their insurance card. Enter ID exactly as shown. Verify date of birth verbally. Spell name exactly as on card. Include all suffixes.
Data Entry Best Practices
Always verify information with the patient. Don’t guess at spelling. Include dashes in ID numbers. Double-check before submitting. Train staff on accurate data entry.
Problem 3: Payer System Downtime
Insurance company systems go down. This prevents verification temporarily.
Recognize Downtime
The error message says connection timeout. Multiple payers fail simultaneously. Athenahealth’s status page shows issues. Pattern of failures at specific times.
Alternative Verification
Call the payer provider services line. Use the payer website portal. Verify manually and document. Schedule a callback for later verification.
Plan for Downtime
Keep payer phone numbers handy. Have portal login credentials ready. Document verification method used. Set reminders to reverify later.
Common Verification Problems
| Problem | Symptoms | Quick Solution |
| RTE not configured | Payer not found error | Enable payer in settings |
| Wrong patient ID | Patient not found | Verify ID with card |
| Internet issues | Connection timeout | Check network, retry |
| Payer downtime | Multiple failures | Use manual verification |
| Expired insurance | No active coverage | Ask the patient for the updated card |
| Wrong plan type | Benefits don’t match | Verify exact plan name |
Problem 4: Expired Insurance Coverage
Insurance lapsed or changed. Patient doesn’t know coverage ended.
Identify Expired Coverage
RTE returns no active coverage. Patient insists they have insurance. Coverage end date passed. The patient changed jobs recently.
Handle Expired Insurance
Ask the patient about recent employment changes. Request updated insurance card. Offer a self-pay option for today. Reschedule if an insurance update is needed.
Prevent This Problem
Verify insurance at every visit. Ask about changes at check-in. Update insurance quarterly for regular patients. Send appointment reminders requesting insurance updates.
Problem 5: Wrong Insurance Plan Selected
Patient has coverage, but the wrong plan was selected. This causes benefit mismatches.
Why This Happens
Multiple plans under the same carrier. Staff selects the wrong plan type. Patient has an individual versus a group plan. Plan name changed, but the old one was selected.
Correct Plan Selection
Ask the patient to show their insurance card. Note the exact plan name. Search Athenahealth for an exact match. Verify member ID format matches plan. Update to correct the plan.
Verify Plan Type
Confirm if group or individual plan. Check if HMO, PPO, or EPO. Verify plan effective date. Different plans have different benefits.
Problem 6: Missing Authorization Requirements
Verification succeeds, but doesn’t show authorization needs. This causes claim denials later.
Authorization Information Gaps
RTE doesn’t always return authorization requirements. Some services always need authorization. Specialist visits may require referrals. Patient’s specific plan has unique rules.
Check Authorization Needs
Verify authorization requirements separately. Call payer if RTE doesn’t show. Check the payer website for policies. Document authorization requirements in the system.
Create Authorization Workflow
List services requiring authorization. Train staff on the authorization process. Obtain authorizations before appointments. Track authorization status in Athenahealth.
Problem 7: Slow Verification Process
Verification takes too long. This delays patient check-in.
Causes of Slow Verification
Running verification manually each time. Slow internet connection. Complex insurance requiring multiple checks. Staff unfamiliar with the system.
Speed Up Process
Verify at scheduling, not just check-in. Use batch eligibility for multiple patients. Upgrade the internet if consistently slow. Train staff on efficient workflow.
Optimize Workflow
Create a verification checklist. Set up quick verification templates. Use keyboard shortcuts. Minimize clicks needed.
Problem 8: Staff Training Gaps
Staff don’t know how to use verification tools. This creates ongoing problems.
Training Deficiencies
New staff are not trained properly. Features updated, but staff not informed. No standard verification procedure. Each person does it differently.
Implement Training Program
Create written verification procedures. Train all staff on the standard process. Update training when features change. Have experienced staff mentor new hires.
Ongoing Education
Monthly verification training sessions. Share common error solutions. Review new payer connections. Discuss problem cases.
Problem 9: Multiple Insurance Coordination
Patient has multiple insurance policies. Determining primary and secondary is confusing.
Coordination Challenges
Both insurances show active coverage. Unclear which is primary. Patient unsure of coordination. The benefits information is conflicting.
Determine Correct Order
Ask the patient which insurance is primary. Verify with the birthday rule if needed. Call payers to confirm coordination. Document primary and secondary clearly.
Birthday Rule
For dependent children with two parent insurances. The parent whose birthday comes first in the year. Their insurance is primary. The other parent’s insurance is secondary.
Problem 10: System Performance Issues
Athenahealth is running slowly. Verification times out frequently.
Performance Problems
System freezes during verification. Takes minutes instead of seconds. Browser crashes. Multiple errors are occurring.
Troubleshoot Performance
Clear browser cache and cookies. Close unnecessary tabs and programs. Restart the computer. Try a different browser. Contact IT for help.
Prevent Performance Issues
Keep the browser updated. Don’t run too many programs. Ensure adequate computer memory. Restart the computer daily.
Conclusion
Common insurance verification problems in Athenahealth include RTE connection failures and incorrect patient information. Payer system downtime and expired insurance cause issues. Wrong plan selection and missing authorization information create problems. Slow verification and staff training gaps reduce efficiency. Multiple insurance coordination and system performance affect workflow. Regular monitoring prevents recurring problems.
FAQs
What is the most common verification problem?
RTE connection failures are most common. Missing payer configurations and wrong patient information are close seconds. These three account for 70% of verification problems.
How do I fix patient not found errors?
Verify insurance ID is entered exactly as on the card. Check the date of birth matches. Confirm name spelling is identical. Include all dashes and letters.
What if the insurance company system is down?
Use manual verification by calling the payer. Use their website portal if available. Document verification method. Reverify when the system is back up.
How often should I verify insurance?
Verify at scheduling and again at check-in. Coverage can change between appointments. Monthly verification for ongoing treatment patients.
Can I verify multiple patients at once?
Yes, Athenahealth has a batch eligibility feature. Upload the patient list for verification. System checks all at once. This saves time for scheduled appointments.
