Needs Air. Only for practices running Air as their EHR.
Setup & Admin
Practice, providers, and access
| Capability | What it is |
|---|---|
| Roles & permissions | Roles with page- and action-level permission gates, scoped by site or facility. |
| Facility & location setup | Locations, hours, and facilities. |
| Provider credentialing | Payer enrollment and credentialing status per provider, in one place. |
| Provider profiles & credentials | Provider configuration and credentials. Schedules and prescriber nomination when you run Air. |
| Appointment type & calendar setup | Appointment types, templates, and provider hours. |
| Athelas Assistant | AI copilot that answers plain-English questions about your live billing data. |
| EDI & ERA enrollments | Every provider registered with every payer, handled by Athelas at onboarding. |
| Stripe account & card reader setup | Athelas sets up your Stripe account and gets your card readers live. Reader hardware is purchased by your practice. |
| Coaching & training | One-time onboarding and training during launch. |
Charge Master
| Capability | What it is |
|---|---|
| Charge Master editor | Full fee-schedule control with bulk edits and live preview. |
| Facility & non-facility rates | Both rates on the same code, each adjustable without disturbing the other. |
| Payer-specific rates | Payer-specific rows, with every name variant mapped to one canonical payer. |
| Scheduled rate changes | Prices flip live on schedule, with no overlaps. |
| Bulk rate copy & rescale | Stand up a new facility’s fee schedule from an existing one, as-is or scaled to a different rate. |
| Charge audit history | Every change, with before and after values, who made it, and when. |
| Self-pay fee schedule | A separate cash-pay price list alongside your insurance rates. |
| Benefits summary PDF | Auto-built summary of a patient’s verified benefits. |
Pre-Visit & Check-In
| Capability | What it is |
|---|---|
| Appointment reminders | Automated text and email reminders at your chosen offsets, with intake links. |
| Scheduled eligibility (VOB) | Batch pre-visit verification across primary, secondary, and tertiary coverage. |
| Real-time eligibility check | On-demand check that returns parsed benefits in seconds. |
| Plain-English coverage detail | What the payer returns on an eligibility check, in plain English. |
| Suggested Charges | Expected copay, coinsurance, and deductible per appointment, with the math shown. |
| Pre-visit payment rules | Request deposits, prior balances, or copays up front. |
| Text blasts | Send batched texts to patients. |
| Patient eligibility report | Coverage-status roster with CSV export. |
| Prior-auth tracking | Worklist for authorizations, referrals, and their statuses. |
| Workers’ comp & self-pay registration | First-class registration paths for workers’ comp, self-pay, and missing insurance. |
| Digital intake | Patients complete intake and update insurance before they arrive. |
| Check-in & copay collection | Counter preflight checks, plus collection on every payment rail. |
| Kiosk check-in | Patients check themselves in on a lobby tablet, confirming their details and insurance and paying what they owe. |
| Athelas card reader | In-person card reader at the front desk. The hardware is purchased by your practice. |
| Cards on file | Charge a stored card at the counter. |
Rules & Submission
| Capability | What it is |
|---|---|
| Billing rules engine | Scrub, split, hold, or block claims, and view, toggle, and prioritize the rules that do it. |
| Rule drafts & activation | New rules stay inactive until you deliberately activate them. |
| AI rule generation | Describe a rule in plain language and get a working draft. |
| Rule impact preview | The claims and appointments a rule would affect, before you launch it. |
| Rule audit trail & rollback | Every version kept, with one-click restore. |
| Plain-language rule view | A human-readable summary next to each rule, with internal IDs resolved. |
| Test a rule against past claims | A before-and-after comparison of what the rule would have changed. |
| New-rule safety sampling | New rules apply to a sample of claims first, then expand. |
| Pre-submission claim scrubbing | Build and validate a claim without sending it. |
| Electronic claim submission | Validated, verified, then transmitted on the right route per payer. |
| Payer name mapping | Every insurance name in your EHR mapped to one payer record, so claims route to the destination that payer expects. |
| Claims workspace | One unified worklist for rejections, denials, and claim details. |
| Claim assignment & grouping | Assign claims to individual billers and group a worklist by owner, so each person works their own list. |
| Bulk actions | Multi-select claims and act at scale with 20+ bulk actions. |
| Claim deferral | Defer with a reason, to capture work done outside Insights. |
| Corrected-claim resubmission | Proper correction coding, in bulk, duplicate-guarded. |
| Claim notes | Comments on claims, single or bulk. |
| Supporting records delivery | Send supporting records by fax, email, mail, or electronically. |
| Assistant bulk actions | Ask anything and act across one claim or every claim you selected. |
| Unified claim view | Submissions, remittances, payments, and attachments side by side. |
| Automatic NDC coding | Correct NDC, units, and drug details filled in automatically on drug claims. |
| EHR integration & data sync | Scheduled pull of appointments, encounters, charges, and records from your existing EHR. |
| Eligibility refresh at submission | Eligibility is refreshed and attached to the claim before it goes out. |
| Manual claim entry | Build a claim from scratch, with the same rules and validation as any other. |
| Payer claim status | Payer-reported status on the claim and its timeline. |
| Claim voids | Void a claim in product, with proper payer void coding. |
| In-claim eligibility check | Run eligibility against any insurance on the claim. |
| Claim activity timeline | Who or what changed the claim, and when. |
| Submission block overrides | Release a single encounter past a submission block, with documented justification. |
| AI filters | Describe the view you want and let AI sort, group, and filter. |
A/R & Denials
| Capability | What it is |
|---|---|
| Automatic 835 intake | Remittances pull from every clearinghouse, with codes translated to plain English. |
| AI EOB transcription | Scanned EOBs extracted line by line and confirmed against the image. |
| Posting preview | Preview any posting action before it takes effect. |
| Adjustment code management | Standard adjustment codes, viewable and mappable per site. |
| Working denials | Denials grouped by reason, payer, and type, with dollars at risk per bucket. |
| Denial categorization | Plain-English CARC and RARC views, with worked and recovered-revenue KPIs. |
| Bulk denial actions | Assign, tag, defer, and resubmit denials at scale. |
| Appeal supporting docs | Attach records to any claim, any time. |
| EOB creation & payer-portal checks | Manual remittance intake for anything that never arrives as an 835. |
| Bulk EDI (835) download | Download raw 835 files in bulk for external accounting or posting systems. |
| Automatic remittance posting | Balanced remittances post with no manual touch; only exceptions are held. |
| Contractual adjustments | Automatic write-offs, tagged regrettable or expected. |
| Appeals | AI-drafted appeal letters, packet assembled and filed on the payer’s channel. |
| Appeal status & history | Per-claim appeal status, interleaved with full submission history. |
| A/R aging | Bucket to payer to patient to claim, exportable as CSV or PDF. |
| KPI dashboards | First-pass rate, collection rate, days to paid, and provider productivity. |
| Metric drill-down | Every number opens to the claims behind it. |
| Payer mix & performance | Your whole book of business, broken down by payer. |
| Report templates | Roughly 20 configurable templates plus saved views. |
| AI report builder | Ask a plain-English question and get a live report you can save. |
Patient Billing
| Capability | What it is |
|---|---|
| Patient responsibility calculation | Works out what the patient owes, then creates the charge. |
| Recurring patient statements | Statements on your cadence across text, email, and mail, each with a pay link. |
| One-off statements | One-off statement to one patient, on any channel. |
| SmartPay pay-by-link | One-tap pay page supporting every payment method, posting instantly. |
| Payment plans & patient subscriptions | Auto-charged plans, plus recurring memberships and wellness plans. |
| Per-visit PR breakdown | Per-visit detail of billed, paid, adjusted, credits, refunds, and remaining. |
| Contact & address validation | Address, phone, and email in one place, auto-validated and tracked. |
| Failed-payment detection | Detected and recorded the moment a scheduled charge fails, so nothing goes quietly unpaid. |
| Patient-facing balance explanation | A line-by-line breakdown of the balance, charge by charge. |
| Financial guarantor records | Responsible-party setup with duplicate detection, reusable across patients. |
| Gift cards | Pre-funded credits with a unique code and tracked running balance. |
Reconcile & Refund
| Capability | What it is |
|---|---|
| Bank deposit verification | Auto-ingest bank deposits and match them against ERAs and payments. |
| Reconciliation reports | Deposits, ERAs, and postings, with match review and export. |
| Patient refunds | Refund on any rail, with item-level re-allocation and permission gating. |
| Month-end close | Month-end summary, A/R aging, reconciliation exports, and cash-drawer recon. |
| Card transaction ledger | Charges, refunds, disputes, and payouts, all written as they happen. |
| Lockbox & sweep setup | Lockbox accounts configured together with you. Optional. |
| Payer clawbacks & reversals | Payer takebacks handled automatically, as reversals that preserve history. |
| Secondary & tertiary COB forwarding | Automatic COB forwarding after the primary pays. |