Finalize Insurance Payment

Finalizing a Claim Payment attaches received claims to payments. It is imperative that you attach all received claims to an insurance payment so that payments show in the Daily Payments Report, Production and Income Reports, and Deposits.

Follow the instructions below to finalize a single claim or small batch EOB from the Claim. If finalizing a large batch EOB payment, use the Batch Insurance Payment window instead. You can limit where users can finalize payments in Manage Module Preferences.

  1. Receive all claims associated to the EOB. See Receive Claim.
  2. Open the received claim. This window may already be open if you are working off the last claim received.
  3. To finalize a single claim EOB click This Claim Only. The amount entered for the claim will automatically default to the payment amount.

    To finalize a small batch EOB payment, click Batch. The default payment amount will automatically calculate based on the combined total of all received claims not attached to a payment. If you have been receiving claims, but not finalizing them, the payment amount may be larger than the EOB amount. See Troubleshooting below

  4. 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.
    • Clinic: Default to the patient's default clinic (Edit Patient Information). Click the dropdown to change.
    • Payment Type: The type of payment. Customize options in Definitions: Insurance Payment Types.
    • Payment Group: Typically used to group payments when multiple people are entering payments at once. Customize options in Definitions: Claim Payment Groups.
    • Payment Date: The date of the payment. Defaults to today's date.
    • Issue Date: Optional. The date the payment was issued.
    • Amount: The total amount of the EOB. If the amount auto populated does not match the amount on the EOB, enter the EOB amount manually and refer to Troubleshooting below.
    • Check #: Useful for reporting.
    • Bank-Branch: Useful for reporting.
    • Carrier Name: Auto populated with the claims insurance carrier.
    • Virtual Credit Cards: If payment is via a virtual credit card and XCharge (OpenEdge), PayConnect, or PaySimple is enabled, you will see the XCharge, PayConnect, or Paysimple buttons. Click a button to process the payment. See XCharge Windows. When the transaction is complete, the Edit Insurance Payment window will still be open and transaction details will show in the Note.
    • Auto Deposit: Only visible if Insurance Payments: Show Auto Deposit is enabled in Manage Module Preferences.
      • Date: Date used on the deposit.
      • Amount: Amount of deposit. Will match check amount.
      • Batch #: Optional. Used to track deposits.
      • Auto Deposit Account: Select the deposit account. Customize options in Definitions: Auto Deposit Account.
  5. Click OK to save and proceed to the Insurance Payment (EOB) window.
    Note: If you click Cancel instead, transaction details are not saved.
  6. 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.
  7. If desired, scan the EOB. Click Scan EOB in the lower left of the Insurance Payment (EOB) window. See Scan EOB.
  8. 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 doesn't 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.