Create/Load Payment Detail is manually entered using information from the Remittance/EOB.

Patient Details Displays patient information from the General Demographics section and Patient/Family Balances from the Patient Ledger

Claims Lists Outstanding/Unpaid insurance claims for the Patient, the status of the Claim and details pertaining to the claim. To include paid claims in the list, place a check mark in the box next to Show All Claims

Claim Details Populated with information pertaining to the claim. Payment information is manually added with information from the remit/EOB

Charges Breaks down the individual charges/services that are included in the selected visit/claim. Double Click on a line item to view Charge Details

Outstanding claims are listed in the Claims section of the Posting window. If a claim is highlighted, the lower section of the window displays each line item/charge that makes up the selected claim. Details in both the Claims and Charges sections can be sorted by Clicking on the column headers.

1. Click inside the Claim grid to select a claim for payment.

2. Details of the selected claim will display in the Charges section of the window.

The Claim Details section displays various details entered when charging the selected claim, including miscellaneous accident/illness info. This information cannot be edited.  Payment information is entered using details from the Insurance Remittance.

3.  Type Total Payment amount for the selected claim. An alert will show if an amount more than the remaining amount of the check is entered

4. Type Claim Control number from Remit for informational/tracking purposes

5. Enter total amount that is the responsibility of the insured/patient as shown on Remit

The payment is ready to be applied to the charges. Note that the Remaining Balance amount is the same as the Payment Amount and will decrease as payments are applied to the line items. When the last payment is applied to the final charge, the Remaining Balance should be zero.

6. Match the remit payment to the correct charge by verifying Begin and End dates, Procedure code and Amount Billed.

7. Click on the line of the charge inside the Allowed Column and enter the amount shown on the EOB as the Allowed amount.

8. Tab to the next column and enter any amount that was applied to the deductible, CoInsurance, etc.

9. Enter the contractual adjustment amount in Other Adjustment column, and Payment amount in Provider Paid column. Repeat until the remaining Balance is zero, all charges for the selected claim have the correct information applied and the Save Claim button is activated.

10. Verify the  Next Action. This will determine whether a secondary claim is generated, If the Primary insurance crossed the claim over to the Secondary payer, and no secondary claim is needed, or if the balance is patient responsibility.

Patient Responsibility: Claim status will change to Processed and the balance for this visit will be moved to patient responsibility.

Crossover-Pending Secondary: A secondary paper claim will not be generated and the balance will remain showing as pending insurance payment.

File Secondary-Paper: A secondary paper claim will be generated and placed in the On Hold section of the Claims Manager ready to Rebuild, Scrub and Print.

Refile: If claim is partially paid and you need to refile any unpaid charges, this option will place the claim in the On Hold section of the Claims Manager ready to Rebuild, Scrub and Print.

Wait for Additional Payment: Claim will remain in the insurance pending status until additional payment is applied.

11. Click Save Claim.  A pop up message will verify payment was saved. Click OK.

If Cancel is clicked, a confirmation box asks if you want to close the Patient and lose changes. If Yes, the patient window will cancel all data entered for the active patient and close the account If an amount is remaining on the remit, Select Patient dialog displays to choose a new patient.

Note: A payment can be edited after Save Claim, but cannot be edited if the remit has been Posted to ledger.

If the Insurance EOB is for a single patient payment, and the Remaining Balance in the upper section/Remit details is zero, the Remit/EOB will need to be posted to the patient ledger and closed. If the Remit/EOB is for multiple patients/payments, you will be prompted to select another patient and will repeat the previous steps until the entire check is applied.

1. Print Payment (optional). generate a report to verify all payments and how they were applied for the active remit/check. Make any corrections/edits prior to Posting to remit.

2. Click the Post Payment button to Apply payment(s) to Patient Ledger. Payment will not be reflected in Patient ledger until it is Posted