Post an Insurance Payment Manually

Post an Insurance Payment Manually

Before posting, add an Insurance Receipt for the full amount of the check.

Manually Post a Primary Insurance Payment

  1. Using the Receipt that was created for this payment, select the Post button.

  2. Enter the Encounter number preceded by an e (e1234) and tab or lookup the Patient using the Lookup icon on the Patient field and select the Encounter.

  3. The Post as Insurance field will default to the insurance chosen on the receipt.

    4. If the Insurance policy on the encounter is different, use the dropdown list to choose the correct insurance.

  4. If a Secondary claim paid as a Primary, use the Post As Responsibility field to choose Primary. All fields for a Primary payment will display.

  5. Check the Crossed to Secondary checkbox on the Primary Payment screen when they are automatically crossed to the Secondary Payer. (This is usually Medicare or RR Medicare.)

  6. The system automatically defaults to the Payment button. If this is a Takeback, choose the Takeback button.

  7. The Post Claim Level button is used for auto accidents and other claim level adjudications.  Most clients will not use this button.

  8. Enter the Allowed amount. (The CO45 is auto calculated when the allowed amount is entered.

  1. If there is not an allowed amount on the EOB, leave the field blank, and it will auto-populate after entering the paid and CO45 amounts.

  1. Enter the Paid amount.

  2. The CO45 field auto-populates when the Allowed Amount is entered. If the CO45 field did not populate, enter the adjustment amount.

  3. Copay (PR3):  Enter the Copay amount on the EOB

  4. Deductible (PR1):  Enter the amount that is being applied to the patient's deductible.

  5. Coinsurance (PR2):  Enter the coinsurance amount from the EOB

  6. Other Codes:  Enter other adjustment codes in the Other Code field, such as sequestration, CO253.

  7. Other Amount:  Enter the dollar amount for the Other Code that you entered above

    • To add additional adjustments, select the plus symbol (+) beside Other Code.

  8. Note:  For interoffice communication.  There is an option on the Patient Ledger to display this note.

  9. All Distributed displays in this field if the lines are posted correctly.

    • Undistributed and the amount displays if the lines are incomplete or incorrect. All money must be distributed before this page can be Saved.

  10. Balance To:  If the claim was paid, it automatically defaults to the next responsible party. Using the dropdown, it can be changed to leave the balance with the current payer or move to another payer or to the patient.

  11. To Worklist:  Send the encounter to a custom worklist for review. (The Custom Worklist must be set up first.)

  12. Save [F2].


 

Example of Undistributed

The Post Insurance Payment(s) screen will display to post the next payment on the EOB.

As you post the Encounter Payments on the EOB against this receipt, the Escrow on this Receipt will decrease.  When the Escrow amount reaches 0.00, all payments have been posted. If there is any money left in Escrow, the Receipt has not been completely posted.

After completely posting the Receipt, you can start a new Receipt using the Navigation Search box shortcut "nr" or select Payments on the Left Side Menu and then select the Post Payment button.

Post as Note for Denials

For Remits that have denials that you do not want to post the $0.00 Allowed, Payments or Adjustments, you can use Post as Note to record the Payers denial on the Encounter.
  1. This keeps the Claim balance with the same Payer.
  2. Changes can be made and the Claim resubmitted without affecting the balance.
  3. This feature is also available when posting ERAs.

A PR Transaction Code was Posted in Error

If a PR Transaction Code was posted in error, you need to use Post Expert to reverse it. PR Transaction Codes cannot be used on the Post Adjustment screen.

For example, a PR45 was posted in error instead of a CO45.

  1. Find the original Receipt.

  2. Select the Receipt number.

  1. Select the Post (Expert Mode) button.

  1. If you were on the Patient Dashboard, the Patient ID will auto-populate. If it did not, use the Lookup icon to search for the Patient.

  2. Select the Encounter where the change is to be made.

  3. Transaction Code and Amount

    • In the Transaction Code field, enter PR45.

    • Amount: Enter the negative of the original amount and Tab.

    • In the Transaction Code field, enter CO45.

    • Amount: Enter the positive of the original amount and Tab.

  4. Select Save [F2].


The PR45 can also be mapped to CO45 using the CARC Crosswalk in ERA Management.

Post a Secondary Payment Manually

Follow the first 7 steps above for Primary. Complete the Secondary Payment as follows.
  1. Enter the Paid Amount. (The Allowed Amount on most Secondary Payments is the Amount that the Primary Paid, therefore, is not entered on the Secondary.)
  2. Enter Deductible, Coinsurance, and/or Copay.
  3. Other Code: Enter any other Adjustment Codes that need to be posted, such as CO253 sequestration adjustment.
  4. Enter Other Amount if applicable.
  5. Save [F2].


Posting a CO45 on a Secondary Payment

There are times when the Secondary Remit has a CO45 Transaction Code. Most of the time, the CO45 is not posted for a Secondary claim, but there are exceptions to this as follows:
  1. When the Secondary pays as the Primary
    1. To post a Secondary Payment as a Primary Payment using the Secondary, choose Primary for Post as Responsibility. This will open the Primary payment fields to post the Secondary Payment and Adjustment.
  2. The Secondary pays $0.00, and you want to write off the balance.
    1. Use the Other Code and Amount fields to enter the Transaction Code, CO45, and the Amount; or
    2. Use the Post as Responsibility field and choose Primary to open all the fields.

Crossover Claims on Manually Entered Payments

If a Primary Payer sends the Claim to the Secondary Payer automatically, there is a Crossed to Secondary checkbox on the Primary Payment screen. Selecting this checkbox changes the Claim Status of the Secondary Claim to Crossed from Primary (EPX) which prevents the claim from being submitted to the Secondary. (Medicare and RR Medicare are the two Payers that use this the most.)



Learn More

  1. Insurance Receipts

  2. Delete or Modify a Receipt

  3. Crossed to Secondary

  4. Insurance Crossover Mapping

  5. Post as a Note Manually

  6. Post as a Note on an ERA

  7. Secondary Pays as Primary

  8. Worklist Suggestions and Examples


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