Finalize the Insurance Payment
Finalizing an insurance payment attaches Received Claims on an EOB to a payment. It is imperative that you attach all received claims to an insurance payment so that payments show in the Payment Report, Production and Income Reports, and Deposits.
This page explains how to finalize a payment from the Edit Claim window. To finalize payments from the Batch Insurance Payment window instead, see Batch Insurance Payments. Limit where users can finalize payments in Manage Module Preferences.
- Open the 'received' claim. The Edit Claim window will open. If there are multiple claims on the EOB, the payment can be created on any 'received' claim on the EOB. Usually you will create it on the last claim received.
- Click Finalize Payment.
Some fields will be pre-filled.
Hint: The default Amount is automatically calculated based on the combined total of all 'received' claims not attached to a payment. It should match the amount of the EOB. If you have been receiving claims, but not finalizing them, the amount may be larger than the EOB amount. See Troubleshooting below.
- Enter or change payment information as needed. Some information is optional.
- Clinic: If using Clinics, this will default to the patient's clinic as set on the Edit Patient Information window. Click the dropdown to change.
- Payment Type: Options can be customized in Definitions: Insurance Payment Types.
- Payment Group: Typically used to group payments when multiple people are entering payments at once. Options can be customized in Definitions: Claim Payment Groups.
- Payment Date: Defaults to today's date.
- Issue Date: Optional.
- Amount: The total amount of the EOB. The amount is auto-calculated based on total of all 'received' claims not attached to a payment.
- Check# and Bank-Branch: Useful for reporting.
- Carrier Name: Auto populated with the claim's insurance carrier.
- Virtual Credit Cards: If payment is via a virtual credit card and X-Charge or PayConnect is enabled, you will see the X-Charge or PayConnect buttons. Click a button to process the payment. See X-Charge Windows. When the transaction is complete, the Edit Insurance Payment window will still be open and transaction details will show in the Note.
- Click OK to save and proceed.
Note: If you click Cancel instead, transaction details are not saved.
- Verify that all attached claims apply to this payment.
- Payment Details: Information entered on the previous window. Click Edit to change.
- Attached to this Payment: All 'received' claims not attached to a payment. By default, the list is sorted in the order claims were entered. To change the sort order, use the Up/Down arrows. To open a claim, double click on the row. To remove a claim, highlight it, then click Detach.
Note: Once detached, claims cannot be reattached without deleting the payment and starting over.
- If desired, Scan the EOB.
- When the correct claims are attached to the payment and the Total Payments equals the Payment Details Amount, click OK.
If there are any secondary claim, a new window will show listing the claims. See Secondary Insurance.
The insurance payment will list in the Account module. If you reopen any claim attached to the payment, the Insurance Payments area on the Edit Claim window will show the payment.
Delete: If you delete an insurance payment, received claims will remain unattached until a new payment is created. Payment splits are not affected.
Problem: When entering the insurance payment, the default amount is too big and doesn't match the EOB amount.
Solution: This occurs when claims have been 'received', but not tied to an insurance payment. All claims not tied to an insurance payment are automatically included in the total amount calculation, and you will see the claims listed in the Attached to this Payment grid.
- For this claim, manually change the amount, manually detach claims not tied to this payment, then save the payment.
- For all 'received' claims that are not tied to a payment (those you detached), reopen the claim, then create the payment.
If you always 'receive the claim', then immediately 'enter the total payment', the amounts and claims will always be accurate and data entry will be reduced.
Insurance payments that haven't been finalized are indicated with a note:
Problem: A procedure has a writeoff, yet we received zero payment. When finalizing the payment, we changed the payment date to match when we received it. Now the procedure with the writeoff and zero payment incorrectly shows the date we entered the payment instead of the date we received it. There are two entries for the payment in the Patient Account since they have different dates.
Solution: You must manually open the procedure on the claim and change the payment date to the receive date. This will merge the two payment entries into one since they will have the same date.
Questions & Answers
Q: What if I cannot enter (receive) all of the claims that make up my bulk check/payment and I need to leave for the day?
A: Do not finalize the payment until you finish receiving all the claims. This way all claim payments will have the same payment date.
Q: I have a bulk payment but the carrier is taking back money from a previous claim. How do I enter the claim?
A: If the carrier is requesting the refund via check:
- On the previous claim, highlight the procedure that they are requesting a refund for, then create and finalize a negative supplemental payment for the refunded amount.
- Write the check and send it. No further steps are required.
If the carrier withheld money from a different claim to account for the refund:
- Follow step 1 above to create and finalize a negative supplemental payment on the previous claim.
- Open the claim they are withholding the money from. Receive the claim by procedure and finalize it for the full amount (combine the negative supplemental payment and the positive amount paid on the new claim). The finalized payment should match the physical check/payment.
Also see Insurance Refunds.