Map a Crossover Insurance To an Existing Insurance

Map a Crossover Insurance to an Existing Insurance

Insurance Mappings for Crossover Remits

This applies to any Insurance where the Claim is a crossover to a secondary or tertiary Payer. Examples: Medicare and HSA plans.

Insurance Plans that electronically send the claim to the Secondary or Tertiary Payer (Crossovers):

Frequently, the Secondary information is not on the Patient's Insurance Profile in the PM System.
When the Claim has been forwarded by a Payer to the next Payer, it is received in the PM System as Forwarded to Secondary or Tertiary.
When the Remit is Applied in the PM System, the balance cannot be moved to a Secondary Payer that is not on the Patient's Insurance Profile.

If you do not want to use Crossover Mapping for HSAs and want to manually add the Secondary/Tertiary and manually post, select this link: Post an HSA/HRA Payment.

System Settings Activation

This feature is controlled in System Settings.

Admin > System Settings > Payments > CROSSOVERMAPPING

Yes is the default.
Select No if you do not want to use the Mapping feature.

Map the Payer

By default, these Remits are assigned the status of CM and do not post.

Use the Mapping feature to add the Insurance automatically.

The Secondary/Tertiary Crossovers can be mapped to the correct Insurance and will add the Payer to the Patient's Insurance Profile, which will eliminate adding it manually and is a time saver when posting ERAs.

Apply the ERA & Map

Apply the ERA.

All Remits that were forwarded to an additional Payer and do not have that Payer on the Patient's Encounter will be statused as CM
CM displays in the Status column on the ERA Remit Items screen
The Mappings button will display the number of Remits with no mappings. (Red Font).

On the ERA List Screen a number link will display in the CM column.

Map the Insurance to an Existing Insurance

Select the Mappings button.

This screen displays each Payer that has a Remit that crossed to a non-existent Secondary or Tertiary Payer and Payers that have already been mapped.

Choose the option to apply to this Insurance.

Insurance Mapping: Select the Lookup icon to map to an existing Insurance in the Insurance Library.
Do Not Map: Select the checkbox to exclude this Insurance from being mapped.

Select Save [F2].

If you mapped the Insurance, the Remit will automatically apply when saved.
If you choose Do Not Map, the Remit will be re-statused to Hold (H).

Validation Warning

A Policy will be generated automatically for the Insurance that was mapped. The Insurance will be added to the Patient's Insurance Profile for that Encounter and all future Encounters unless changed.

Selecting Save & Continue creates a Policy on the Insurance Profile with a Policy number of “UNKNOWN” with a note showing the related ERA number.

When the subsequent (Secondary or Tertiary) ERA Payment is applied, the Policy number will automatically update from UNKNOWN to the Policy number in the ERA.

Do Not Map

If you do not want this Insurance to go on the Mappings list going forward, select the checkbox for Do Not Map and Save.

This Insurance will be prevented from going on the Mappings list going forward.

Populate Again on the To be Mapped list

If you want it to reappear on the To be Mapped list, delete the Do Not Map entry for that Payer.

On the next Crossover Remit with that Payer, it will reappear on the Mappings list to be mapped.

If you mapped a Payer by mistake and do not want it mapped, you can delete it. When it reappears on the Mappings List, mark it as Do Not Map.

Add, Change, Delete, or View Crossover Mappings

Adding, Changing, Deleting or Viewing Crossover Mappings can be done from the Insurance Dashboard or the ERA List Screen.

Access the Crossover Mappings:

Select the Individual Insurance from the Insurance Library.

This link only shows if it has already been linked from an ERA;

Open the ERAs List screen and select the Crossover Mappings button to see all of the Crossover Mappings.

Add a Crossover Mapping

Access the Insurance Mappings as documented above.

Select the Add button to enter a mapping manually.

Forwarded To: Enter the name of the Insurance that is being crossed over.

This is the Insurance name that came in on the ERA.

Insurance Mapping: Use the Lookup icon to search for the Payer in the Insurance Library. This is the Insurance that already exists in your Insurance Library.

Example: Medicare sent the crossover Claim to AARP United Health. You might have this as AARPUHC in your Insurance Library.
AARP United Health would be entered for Forwarded To, and AARPUHC would be chosen from the Insurance Library.

Select Save [F2].

Modify an Insurance Mapping

Select the Crossover Mappings link on the Insurances screen

On the Insurance screen, select the Insurance ID

Select the Crossover Mappings link.
Select the Modify icon.

On the ERA List screen, select the Crossover Mappings button.

Select the Modify link.

Make the change to the Mapping.

You cannot leave the Insurance Mapping blank.

Select Save [F2].

Delete a Crossover Mapping

Highlight the Insurance line to be deleted.
Select the Delete button to delete a mapping.

Enter a Reason.
Select the Delete button.

ERA Payment is coming by Paper Check but is listed as EFT

Add/Modify Insurances in the Insurance Library > Insurance Settings Panel > #16 Payment Method

Manually Post an ERA

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Map a Crossover Insurance To an Existing Insurance

Map a Crossover Insurance To an Existing Insurance