Post DW (Denial Worklist) or On Hold (H) Remits
When an Encounter Remit has issues where it cannot post automatically, the System places the Payment in the Status of DW (Denial Worklist) or On Hold (H) for manual review.
The Holds and DWs may have Payments or Denials that need to be posted or worked.
Payments on these Remits will remain in Escrow until posted.
After the ERA Remit has been Applied, review/work the Holds and Denials before moving to another ERA Remit.
The Denials can be moved to a Custom Worklist for follow-up before saving the Remit.
Example: ERA 1535 was Applied. All Encounters posted except Remit 7988, Encounter 7001, which went On Hold because posting it would create a credit.
The Denial Worklist can be accessed:
From the the ERA List screen by selecting the number in the DW Column;
On the ERA File Dashboard by selecting the number in the DW box;
On the Home Dashboard by selecting the Denial button; or
By entering dw in the Navigation Search Box.
The On Hold items can be accessed:
From the ERA List screen by selecting the number in the H column, or
On the ERA File Dashboard by selecting the number in the H box.
If there is money in Escrow, it must be posted and cannot be posted as a Note.Posting the DWs and Holds
From the ERA Remit Items screen, use the Status filter for DW or On Hold.
Select the Remit number to access the Manage Electronic Remittance Items screen.
Choose a Claim Action or Post Manually
Claim Action Options for Posting:
Do Not Post/Transfer Balance: Does not post anything for the current insurance and moves the balance to the next responsible Payer. This should only be used when the Patient is the next Responsible Payer. You cannot send a Claim to a Secondary Payer without a Primary Payment being posted first (It can be a zero dollar payment).
Post as Note/Leave Balance: This posts as a Note on the Encounter Dashboard, and leaves the Balance with the current Payer. This is used if the payment is $0, and the user wants to resend the claim to the same Payer.
Post as Note/Transfer Balance: This should only be used if the Payment is $0, and you want the balance transferred to the patient.
Post as Remitted: Posts the payment exactly as remitted, and the remaining balance is transferred to the next responsible party. (Not available for Secondary and Tertiary payments)
Procedure Specific: Gives the option to choose a Claim Action for each line item.
You also have the option to post the Payment manually using the Manual Post button which opens a pop-up screen for posting.
Change Remit Status/Worklist dropdown:
Posted: If a Claim Action is chosen, the Claim Action defaults to Posted. If no action is taken, the remit can be marked as Posted (For $0 payments that you do not want to post, but want the balance to remain on the current Payer).
On Hold: Remit put in the Hold status (still needs to be managed).
Custom Worklist: Add Remit to a Custom (user-defined) Worklist.
Denial Worklist: Add Remit to the Denial Worklist (System delivered). There is no option for assigning or putting notes on a remit in the Denial Worklist.
Old System: Charge was generated from an old practice management system.
Note:
Contains a System delivered reason for why an item is on Hold or in DW. The user can delete, add to or enter a new Note. This Note appears on the Worklist, and the option to Save as a Billing Note makes the Note viewable on the Encounter Note Panel.
Select Save (F2).
On Hold for Transfer to Non-Existent Secondary/Tertiary
The Remit is on Hold because there is not a Secondary or Tertiary on the Insurance Profile and the Primary Insurance has forwarded the Claim to this Payer. This may mean the Patient did not provide their Secondary or Tertiary Insurance information.
If it is an HSA/HFA Payment, it is posted to the Primary Insurance if it is the same as the Payer that paid as the Primary.
Add the Secondary/Tertiary to the Insurance Profile
Select the Insurance Management link on the Manage Electronic Remittance Item screen.
Select the Default link.
Select Add New or From Existing.
Enter Policy information. Enter Pending for Policy Number if it is not available.
Select Save [F2] to save the New Policy.
Select Save [F2] to save the Profile.
Select the Manage Electronic Remittance Item link above the Title Bar to go back to the ERA screen.
Choose Post as Remitted for Claim Action.
Select Save [F2].
Hold: Insurance on Remit does not Exist on Profile
The Insurance is actually on the Profile, but a different ERA Payer ID is in the System than the one that came in on the Remit.
This is common when there are more than one option for the same Payer on one Remit.
The Insurance Plans may have several different names with a different ERA Payer ID than what we have in the System.
Add the ERA Payer ID to the Insurance that already exists in the Library.
If there is already an ERA Payer ID, enter a comma after it and add the second ERA Payer ID (no space in between)
Example: 63314,54879
The Remit will post as remitted in the future.
Hold: Post an Insurance Remit to a Zero Balance or will create a Credit Balance
Case: The Patient Paid in full but asked you to send to the Insurance.
The Patient Payment was posted which brought the balance to Zero.
The ERA Remit was received where it was applied to the Deductible.
It went on hold because it would create a credit.
The Insurance allowed $115.08, but the Patient Paid $221.00 and is owed a refund of $5.92.
In this case, the Manual button can be used on the Manage Electronic Remittance Item screen.
Learn More
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Contents Denial Worklist Overview Post DW (Denial Worklist) or On Hold (H) Remits