Guarantor Balance = The sum of all Encounter Patient Balances who are under the same Guarantor.

Statement Balance Logic

Statement Balance Logic

• If the Guarantor Balance is less than the Escrow Balance, a Statement will not be generated.

• If the Guarantor Balance (combination of all Patients' Balances under this Guarantor) is less than the Minimum Balance setting, a Statement will not be generated.

• The Patient Balance will always take precedence at the Guarantor level.
  

• If the Guarantor Balance is equal to or more than the Minimum Balance setting, a Statement will be generated.

• When the System Setting is chosen for Patient and Insurance Balances, both Balances will show on the Statement, but only if there is a Guarantor Balance that meets the minimum Balance requirement. (Admin > System Settings > Statements > STMBAL - Type Balances on the Statement > Patient and Insurance)

• This Setting works in conjunction with HASINSBAL
  

• Hold Statement if any Charge line has an Insurance Balance.
  

• Hold Non-Employer Only: Encounters with a balance out to Insurance will not be included on Patient statements, but Employer invoices will be sent.

Example 1:

• Parent 1 is the Guarantor of Child 1 and Child 2

• Minimum Statement Balance is $5.00.

• Child 1 has an Encounter Patient Balance of $1.00 and an Insurance Balance of $150.00.

• Child 2 has an Encounter Patient Balance of $2.00 and no Insurance Balance which was on the last Statement.

• A Statement will not generate because the combined Guarantor Patient Balance of Child 1 and Child 2 is $3.00, and the minimum Statement Balance is $5.00.

Example 2:

• Patient is their own Guarantor.

• Minimum Statement Balance Setting is $10.00.

• Encounter 1 has a Patient Balance of $5.00.

• Encounter 2 has a Patient Balance of $4.99 and an Insurance Balance of $450.00.

• A Statement will not generate because the combined Guarantor Encounter Balance of Encounter 1 and Encounter 2 is $9.99, and the minimum Statement Balance setting is $10.00.

Example 3:

• The Patient is their own Guarantor

• System Settings: Patient and Insurance Balance has been chosen for STMTBAL, and Send has been chosen for the HASINSBAL System Setting.

• Minimum Statement Balance Setting is $10.00.

• Encounter 1 has a Patient Balance of $5.00.

• Encounter 2 has a Patient Balance of $5.00 and an Insurance Balance of $450.00.

• A Statement will generate because the combined Guarantor Encounter Balance of Encounter 1 and Encounter 2 is $10.00, and the minimum Statement Balance setting is $10.00.

• The following will be shown on the Statement.
  

• Encounter 1 Balance of $5.00.
  

• Encounter 2 Balance of $5.00.
  

• The Insurance Balance of $450.00.