Introduction to Insurance Payment Posting
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. This section is collapsed upon opening the claim, but can be expanded to view details.
Payment Details Breaks down the individual charges/services that are included in the selected visit/claim. Double Click on a line item to view Charge Details.
Additional Adjustment options Allows user to add Claim Level Adjustments or Provider Level adjustments in order to bring remit Remaining Balance to zero and activate the Post Payment button.
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 Payment Details section of the window.
The Claim Details section display various details that populate when charges are originally posted to the account.This information is read only, and cannot be edited. Payment Details section is manually entered using details from the EOB.
3. Type Total Payment amount for the selected claim. 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 transaction is applied, the Remaining Balance should be zero, and Save Claim button is activated. An alert will pop up if an amount more than the Remaining Balance on the check is entered, and the transaction cannot be saved.
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.
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.
Note: If applying a secondary or tertiary payment and not taking an adjustment, leave the Allowed amount blank and click inside Provider Paid column. (Step 10.)
8. Tab to the next column and enter any amount that was applied to the deductible, CoInsurance, etc.
9. Tab to Adjust Codes column and the total adjustment amount is displayed on the first line of the Adjustment Codes dialog. Adjustments can be broken down by manually changing the amounts, selecting the Adj Group and Code and tabbing to the next line, as needed. ESC to close dialog.
10. Tab to Provider Paid column. Type payment amount. If payment is zero, put 0 in Provider Paid to activate the Save Claim button.
11. Tab to Remark Codes column and begin typing the code shown on the remit. As you type, the list will sort to the code you need. When the code is highlighted, pressing the enter key will place a check mark in the box and clear the search for the next code, if applicable. To view Remittance Advice Remark Codes dialog, click here.
12. Notes can be added to identify specific payment/adjustment comments, if needed. Notes can be viewed in payment details from ledger by clicking on the note icon.
13. If there are any additional adjustments that have been applied at the Claim Level, click the ellipses button open the Claim Level Adjustment Detail and add Group, Code and Amount. Each column has to be completed before it can be saved. Click OK to save and exit. To view further details, click here.
14. 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.
File Secondary-Electronic: A secondary electronic claim will be generated and placed in the On Hold section of the Claims Manager ready to Rebuild, Scrub and Print. Primary payment information will be saved to the claim when it's rebuilt.
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.
15. Click Save Claim. A pop up message will verify payment was saved. Click OK.
16. When Remaining Balance is zero, or to view applied payments, click Print Payment. Report must be printed or saved to a file prior to Posting Payment.
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.
Generate a report to review payments applied for the active remit/check at any time prior to posting the remit. This report can be previewed and printed, or saved to a file on your computer for future reference. Make any corrections or edits, if needed before Posting.
When 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 Remaining amount is applied.
16. Click the Post Payment button to Apply payment(s) to Patient Ledger. Payment will not be reflected in Patient ledger until it is Posted
Note: The payment(s) will be included on the End of Day report for the Date Posted. If the Date Posted is a different month than the Check Date/Date Entered, the ledger and month end reporting will be reported by the Post date. The Payment Posting date cannot be changed.