Finalize Insurance Payment

In the Edit Claim window, in the middle, is the Insurance Payments area.

Finalizing a claim payment is the important second step after Receiving Claims for an EOB. Entering the payment information is the only way for these payments to show in reports and deposits.

For large batches of claims or larger offices, there is a Batch Insurance Payment feature. The buttons described here are only for small batches or single claims. You can limit where users can finalize payments in Manage Module Preferences.

Before finalizing an insurance payment, receive all claims associated with the EOB. Open the Received Claim. This window may already be open if you are working off the last claim received. Click either Batch or This Claim Only. If you have been receiving claims, but not finalizing them, then Batch payment amount may be large. See Troubleshooting below

Enter or change payment information as needed. Some fields will be pre-filled. Some information is optional. Required fields are marked with a * (see Required Fields). If user clicks OK and required fields are incomplete, user will have option to return to the window or proceed.

Click OK to save and proceed to the Insurance Payment (EOB) window

Note: If you click Cancel instead, transaction details are not saved.

Verify that all attached claims apply to this payment.

View ERA: Click to view associated ERA. See EOB Claim Details.

Scan EOB: If desired, scan the EOB. Click in the lower left of the Insurance Payment (EOB) window. See Scan 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 claims, 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.

Troubleshooting

When entering a batch insurance payment, the default amount is too big and does not match the EOB amount.

This occurs when claims have been received, but not finalized. All received claims not finalized are automatically included in the total amount calculation, and you will see the claims listed in the Attached to this Payment grid.

  1. For this claim, manually change the amount, manually detach claims not tied to this payment, then save the payment.
  2. For all received claims that are not tied to a payment (detached), reopen the claim, then finalize.

If you always receive the claim(s), then finalize, 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:

A procedure has a write-off, 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 write-off 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.

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.

What if I cannot receive all of the claims that make up my bulk check/payment and I need to leave for the day?

Do not finalize the payment until you finish receiving all the claims. This way all claim payments will have the same payment date.

I have a bulk payment but the carrier is taking back money from a previous claim. How do I enter the claim?

See Insurance Refunds.