Finalize an insurance payment after receiving claims for an EOB.

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. If Finalize claim payments in Batch Insurance window only is enabled in Preferences, users must finalize insurance payments from the Manage Module using the Batch Insurance Payment feature.

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.

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.

• Clinic: Default to the claim's clinic (Edit Patient Information). Click the dropdown to change. Determines where the money is received (e.g. Deposits).
• Payment Type: The type of payment. No default type is selected if the preference Claim payments prompt for Payment Type is enabled. 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 Posting Date: The date of the payment. Defaults to today's date.
• Check EFT Issue Date: Optional. The date the EFT 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. For EFT, use this field to enter the EFT number.
• 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), Edge Express, PayConnect, or PaySimple is enabled, users will see the corresponding payment buttons. Click a button to process the payment. When the transaction is complete, the Edit Insurance Payment window will still be open and transaction details will show in the Note.
  
  Note:

  • Clinics only: the payment processor credentials used will be that of the clinic selected in this window.
  • PaySimple users: the Carrier Name will be sent to PaySimple when processing a credit card transaction.
• Auto Deposit: Only visible if Insurance payments show auto deposit is enabled in 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.

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

Verify that all attached claims are correct.

• Payment Details: Information entered on the previous window. Click Edit to change.
• Attached to this Payment: When clicking Batch, all received claims not attached to a finalized payment will be listed. 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.

Detach: Select claim(s) not associated with payment and click to detach from the 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 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 trying to finalize a $0 payment I get a warning.

If the preference, Show claims received after days (blank to disable), is blank, users will be unable to finalize any $0 payments. Enter a number into this preference in order to finalize $0 insurance payments. Insurance payments can be finalized for the number of days entered into the preference.

After that time, the preference must be increased (not recommended) or a $0 supplemental payment can be added to finalize if needing to scan an EOB.

If finalizing a $0 payment using the Batch button, this message does not appear if there are other outstanding unfinalized payments. Users must ensure the $0 is listed in the Attached to this Payment grid before finalizing.

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.

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.