Map a Crossover Insurance to an Existing Insurance

Map a Crossover Insurance to an Existing Insurance

Insurance Mappings for Crossover Remits (HSA/Medicare)

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.

Map the Payer

By default these Remits are put on Hold with the message: Insurance on Remit does not Exist on Profile.

Use the Mapping feature to add the Insurance automatically.
  1. The Secondary/Tertiary Crossovers can be mapped to the correct Insurance which will eliminate adding it manually and is a time saver when posting ERAs.

System Settings Activation

This feature is controlled in System Settings.
  1. Admin > System Settings > Payments > CROSSOVERMAPPING
    1. Yes is the default.
    2. Select No if you do not want to use the Mapping feature.

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 a Payer is marked as Do Not Map, it will be prevented from going on the Mappings list again.

  • 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; OR
  • 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.

  1. Select the Add button to enter a mapping manually.

 

  1. Forwarded To: Enter the name of the Insurance that is being crossed over.
  • This is the Insurance name that came in on the ERA.
  1. 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.
  • For 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.
  1. Select Save [F2].


Edit an Insurance Mapping

  1. Select the link:
  • On the Insurance screen, select the Insurance ID link.
  • Using the ERA Crossover button, select the Edit link.

    

  1. Make the change to the Mapping.
  • You cannot leave the Insurance Mapping blank.
  1. Select Save [F2].



Delete a Crossover Mapping

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


  1. Enter a Reason.
  2. Select the Delete button.



    • Related Articles

    • Incoming Mappings

      As charges are created in your Clinical Documentation, the clinical terminology may need to be mapped to the correct items in the Billing Libraries. This may occur frequently after initially going live on the System, but should taper off quickly ...

    • Add/Modify Insurance Profiles on an Existing Patient

      Add an Insurance Profile on an Existing Patient From the Patient Dashboard, click Insurance Management in the Active Policies panel. Click Add New Insurance Profile. Default is automatically checked. If this is not a default insurance, see Default ...

    • Move Existing Encounters to a New Insurance/Self-Pay Profile

      When a new Insurance or Self-Pay Profile is added, you may need to move some of the existing Encounters to the new Profile. This most often occurs when a claim is denied for not being covered, and a new Insurance Profile needs to be added and ...

    • Post an Insurance Payment Manually

      Before posting, add an Insurance Receipt for the full amount of the check. Manually Post a Primary Insurance Payment Using the Receipt that was created for this payment, select the Post button. Enter the Encounter number preceded by an e (e1234) and ...

    • Add/Modify Insurances in the Insurance Library

      When adding Payers to the Insurance Library, the System automatically creates numeric Insurance IDs unless you have elected to create your own. Create Your Own Insurance IDs Go to Admin > System Settings > General > INSAUTOASSIGN > NO. For example: ...