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Training

Training. Remittance Posting. Overview. Designed to take all the information on an EOB (Explanation of Benefits) or ERA (Electronic Remittance Advice) and use it in a grid –based form. Concept. Centered around an ERA or EOB. What is an ERA?.

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Training

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  1. Training Remittance Posting

  2. Overview Designed to take all the information on an EOB (Explanation of Benefits) or ERA (Electronic Remittance Advice) and use it in a grid –based form.

  3. Concept Centered around an ERA or EOB • What is an ERA? • Electronic Remittance Advice – File downloaded from clearing house • What is an EOB? • Explanation of Benefits – Mailed to clinic • What does it look like? (Next Slide) • How it works • All claims on one form • All detail from the same grid • The grid won’t let you apply a batch until it balances

  4. Sample EOB

  5. Remittance Posting Grid • Accessing Remittance Posting from Application Button • Billing Menu, Remittance Posting • Insurance Menu, Remittance Posting • Quick Launch, Remittance Posting

  6. Anatomy of the Form The Remittance Grid Header Information Related to Green area on sample EOB image Carrier Information Check Information Claims Information Related to Orange area on sample EOB image Individual Claim Charges Related to Blue area on sample EOB image Write-Off / EOB Reasons sub-grids Totals Row

  7. Anatomy of the Form Actions Apply Posts batch Creates transactions Open / Pause Batch Can review completed batches, but cannot change them Can delete unapplied batches Recode CPT Uncommon. Accounts for insurance recodes, bundles, and unbundles. Assign Allowed Values Should be done before batch is applied Clear Form Does not affect transactions View 835 Files Electronic remittance

  8. Posting a Remittance Batch Heading Information Check Information Posting Date Payment type Only used within PS X10, so there is no associated value on the EOB / ERA Carrier Information Managing Claims within the Grid Adding a new claim Will receive warning if claim is associated with a different carrier Searching for an existing claim Removing a claim from the grid

  9. Posting a Remittance Batch Claim with a Single Charge Allowed Automatically calculates the adjust amount. Adjust can be used to calculate allowed instead. Does not create a transaction. A write-off or other type of entry must be created. Paid W/O (write-off) Accounts for adjust amount. A transaction will be created for the write-off. Write-off grid designed for speedy entry. Don’t have to search for known codes Amount automatically filled Enter or Tab can be used to progress through fields EOB (EOB reasons) Right click on field to select MRU. EOB combinations included in MRU. Right click within grid to create new EOB reason. Resp for Remaining Network Status Responsible Party

  10. Posting a Remittance Batch Claim with Unpaid Deductible Allowed Paid Insurance not paying for anything since deductible not yet met Still requires $0.00 balance. Blank Paid amounts will not generate transaction records. W/O ERA / EOB PR-1 – Deductible not yet met. PR-2 – Co-Insurance PR-3 – Co-Pay CO-45 – Contract Obligation Applied Deduct (applied deductible) Full amount of charge Resp for Remaining Patient responsible for full amount Remain Shows that patient portion is not yet paid.

  11. Posting a Remittance Batch Claim with Secondary Insurance Allowed Paid W/O Accounts for Allowed amount discrepancy EOB Two reasons for discrepancy between Paid and Billed Lower allowed amount Unpaid Co-Pay Resp for Remaining Secondary insurance is responsible for the remaining amount. Remain Shows that insurance portion is not yet paid.

  12. Using Actions Apply - Posts validated payments, write-offs, EOB reasons, and deductibles. Validations are as follows: When a Payment Amount of greater than $0.00 is entered, the Check Number must be supplied. The Balance field of the claims grid must be $0.00 before the batch can be posted. You must specify a Payment Type for the batch.  The batch must contain at least 1 claim. You will receive a warning for claims where a service line within the batch has a negative balance or a warning if an unapplied credit currently exists on a patient's account. Pause Batch – Suspends batch for later entry. Recode CPT – Used to account for recodes, bundles, and unbundles. Assign Allowed Values – Used in future postings to predict expected payments. Must be used before batch is applied. Valid for specified time period. Insurance carrier specific. Doctor specific by default. Clear Form – Clears all data from heading and grid. View 835 Files – Used in electronic remittance.

  13. Electronic Remittance Overview How it works Retrieve X12 file Place in Inbox Review and post Electronic Batch Configuring Inbox Location Server console Path Must be UNC (Universal Naming Convention) File pattern

  14. Electronic Remittance Posting Electronic Batch Retrieve X12 File Copy from FTP or Web Place in Inbox Automatically picked up Review electronic batch Grid layout and function identical to manual batch Fill out Payment Type Confirm details Apply batch

  15. Electronic Remittance 835 Viewer Entire 835 file stored in SQL Date Range Reprocessing batches Won’t let you unless batch is erroneous Duplicates existing batch Remove Removes SQL source record Breaks auditing trail View details View raw 835 file Email to M4 Support

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