Create an Insurance Payment

Q: How do I create an insurance payment?

1. Open the Post Insurance Payments Dialog

1. Open the Post Insurance Payments Dialog

To create a new Insurance Payment, click on the Billing menu then select Post Insurance Payments.

2. Create Payment/Select Existing Insurance Payment

To create a new payment:

  1. Select the Payer using the drop down menu.
  2. Ener the Check Number.
  3. Select the Payment Method.
  4. Enter the Check Amount.
  5. Click Create.

To load an existing payment, select the payment from the "Select Existing Insurance Payment" list and click Select.

3. Enter EOB Remit Information

Add the remit information as shown on the EOB.

  1. Group: Select the billing provider/pay to information using the drop-down menu.
  2. Check Date and Production Date: Select the check date and the production date. This date is for internal use and remit will show on End of Day Reporting on the date PostedCheck.
  3. Date Entered: Select the date of receipt/deposit. In order to balance for the day the check was deposited. Run the Payment Summary Report for the date entered here.
  4. Check Amount: Enter the amount of the check.

5. Select the Claim for Payment

5. Select the Claim for Payment

Next, select the first claim that the payment will be applied to:

  1. Click the Select Patient button.
  2. Enter the claim number (or click the Chart Rack button if you do not have the claim number and wish to select a specific patient account).
  3. Click the Select button.

After clicking Select, the Patient Details and Claim Details will be displayed.

6. Select Claim To Apply Payment

Outstanding claims are listed in the Claims section of the Posting window. Details in both the Claims and Claim Details sections can be sorted by clicking on the column headers.

  1. In the Claims tab, select the claim that you will be applying payment.
  2. When the claim is selected, the Claim Details will be displayed.

7. Enter Claim Payment Amount

Enter the claim information using the details from the insurance remittance:

  1. Payment Amount: Enter the payment amount for the selected claim.
  2. Claim Control #: Enter the claim control number from the remit for informational/tracking purposes.
  3. Patient Responsibility: Enter the total amount that is the responsibility of the insured/patient as shown on the remit.

8. Apply the Payment to Charges

The payment is ready to be applied to the charges.

  1. Remaining Balance: Note that the Remaining Balance amount will start out 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.
  2. Match Payment to Charge: Match the remit payment to the correct charge. Verify the begin and end dates, procedure code and billed amount.
  3. Enter Amounts from EOB: Click in the Allowed column and enter the allowed amount from the EOB, then tab to the next columns and enter the Deductible, Co-Insurance, Co-Pay, Late Adjustment, and Other Adjustment amounts.
  4. Enter Provider Paid Amounts: Tab to the Provider Paid column and enter the amount of the payment. *Note: If the payment is $0, you must populate one of the other fields in order to activate the Save Claim button.

Repeat the above entry steps until the Remaining Balance is $0.00.

9. Save the Claim

9. Save the Claim

Next Action: Verify the next action to perform with this claim. One of the following options may be chosen:

  • Patient Responsibility: The balance for the visit will be moved to patient responsibility and the claim status will be changed to "processed".
  • Crossover-Pending Secondary: A secondary paper claim will not be generated and the balance will remain showing as "insurance pending".
  • File Secondary-Paper: A secondary paper claim will be generated and placed in the On Hold section of the Claims Manager.
  • Refile: If the 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.
  • Wait for Additional Payment: The claim will remain in "insurance pending" status until additional payment is applied.

Click the Save Claim button, then click OK.

10. Continue Posting Insurance Payments to Claims

Repeat steps 4-8 until the Remaining balance of the Insurance Payment is $0.00.

11. Print & Post Insurance Payment to Ledger

  1. Print Payment: Generate a report to verify all payments and how they were applied for the active remit/check. Make any corrections/edits prior to posting the payment.
  2. Post Payment: Click the Post Payment button to apply all payments to the patient ledger. *Note: The insurance payments will not be reflected in the patient ledger until it has been posted.  

The insurance payment has now been successfully posted and will be reflected in the corresponding patient ledger.