Statement Balance Logic
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.
Related Articles
Statement/Invoice FAQs
Statement/Invoice FAQs Delete a Statement Batch How do I delete a Statement Batch? How do I upload a Statement Batch again? Description How does the System know which Statement Description to pull? Dunning/Statement Count What is the Dunning Count? ...Statement Exception Batches
For the System to create Exception Batches, the System Setting must be set to Yes, which is the Default. (To change: Admin > System Settings > Statements > EXCEPTIONSBATCH) The Exception split option provides easy accessibility to Statements that ...Statement/Invoice Profiles Setup
Statement/Invoice Profiles must be set up before Statements or Invoices can be batched. If the Statement Profile is selected as the Default, it will be attached to new patients automatically. Other Statement/Invoice Profiles can be created to be used ...Old PM Patient Balances: Balance Forward
Most groups have Patient balances to bring forward from their old system. The benefits of moving the balances are reducing time spent in two systems and the ability to send just one Statement to each Guarantor. The balance should be written off in ...Place a Statement on Hold
There are times when you might want to put a Statement on Hold for one or more Encounters or never to send a Statement to a specific Patient/Guarantor. There are several ways that you can prevent a Statement from creating: Encounter Dashboard: Use a ...