Policy Breakdown Panel: Encounter

Policy Breakdown Panel: Encounter

  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  



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