Encounter Policy Breakdown Panel

Encounter Policy Breakdown Panel

Access to Add/Modify Insurance Policy is controlled by User Permissions.
  1. Insurance Management: Add a new Insurance Profile or make a change to an existing Insurance Profile.
  2. Claim History: View Claim Status changes, Claim Submission History, and Timely Filing documents which can be sent to a Worklist.
  3. Payment History: View Payment details and view and print EOBs.


Insurance and Patient Responsibility (Encounter Specific)

  • Name of the Responsible Party (Payer Name or Patient)
    • Hover-over shows Payer information
    • Click the Payer Name Link to go to the Add/Modify Policy screen where Policy information can be edited.
  • Card Received/Scanned: *This is a Premium Add-On Feature.
  • Policy Number
  • Group Number
  • Status of the claim: These are two of the most common.
    • Ready for Submission/Resubmission: If the Reference Batch is closed the claim will be in the next Claims Batch.
    • Hold Coordination of Benefits: Holding for current Responsible Party to pay. This status will automatically change when the payment is posted for the current Responsible Party.
  • Responsibility Date: The date that this payer became responsible.
  • Days that this payer has been responsible
  • Bill Date: The date the claim was last billed
    • If the Responsible Party is a Collections Agency, the Bill Date will reflect the date that the Encounter was sent to Collections.
  • Days: Days since the claim was last billed
  • Verify (Eligibility): Shows the Eligibility Status and date it was last checked for the Payer. If there is not a date link, Eligibility has not been checked on the Encounter Level.
  • Balance: Shows the Balance that is in the payer's responsibility

Learn More  



    • Related Articles

    • Claim History

      Claim/Encounter History On the Claim Status History screen, you can see Claim status progression from the beginning to the end. The oldest date defaults to the bottom of the list but can be resorted by clicking on the column title. On the Encounter ...
    • Timely Filing

      System Settings for Timely Filing A Timely Filing Default number of days can be set up in System Settings. This setting applies to all Insurances in the System. Individual Insurances can be set up with their own Timely Filing criteria. Use the ...
    • Encounter Dashboard Overview

      Encounter Dashboard Overview Access the Encounter Dashboard Select the Encounter Number link on the Patient Dashboard, or Enter an e + Encounter number (e12345) in the Navigation Shortcut box. You can go to the Patient Dashboard from the Encounter ...
    • Charge/Claim FAQs

      Charge/Claim FAQs Attachments How do I indicate there is attached paperwork? Attending What is an Attending Physician? An Attending Physician is the one who is responsible for the overall care of a Patient in a hospital or clinical setting. When is ...
    • Encounter Balance Panel

      Encounter Balance Panel The Encounter Balance panel shows a high-level breakdown of the Encounter balance by Insurance, Patient, and Collections. Balance Panel links: Cases, Receipts, ERAs, Post Payment, Post Copay, Post Adjustment, Mass Write Off, ...