Finalize Insurance Payment

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

See our Webinar: Claim Payments.

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. Office can limit where users are able to 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 a user is working off the last claim received.

Batch: Click to finalize a bulk insurance payment attached to multiple claims. Only click this button after entering payment information for all claims attached to the EOB.

Note: If users have been receiving claims, but not finalizing them, then Batch payment amount may be larger than the payment being finalized. See Troubleshooting below

This Claim Only: Click to finalize payment for a single claim.

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 Cancel is clicked instead, transaction details are not saved.

Verify that all attached claims are correct.

Detach: Select claim(s) not associated with payment and click to detach from the payment.

Note: Once detached, claims cannot be reattached without deleting the payment and starting over.

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 any claim attached to the payment is reopened, the payment will be listed in the Insurance Payments area on the Edit Claim window.

Delete: If an insurance payment is deleted, 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 other claims have been received, but not finalized. All received claims not finalized are automatically included in the total amount calculation, and users will see the claims listed in the Attached to this Payment grid.

  1. For this payment, manually change the amount to match the EOB. Select OK on the Edit Insurance Payment window.
  2. Click OK on the warning that pops up.

  3. Manually detach claims not tied to this payment by selecting claim(s) and clicking Detach.

  4. Once only the correct claims are attached, click OK to finish finalizing the payment.

Note: Users should go back to detached claims and ensure payment is finalized. Run the Unfinalized Insurance Payment Report to find received claims not attached to an insurance payment.

If payment is always finalized immediately after receiving claims, the amounts and claims when clicking Batch will always be accurate, reducing data entry.

Insurance payments that haven't been finalized are indicated with a note in the account module:

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 all claims have been recieved. 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.