Posting a Payment From Insurance Company
Posting an Insurance EOB
Once the insurance company has been invoiced and an insurance EOB (Explanation of Benefits) has been received, you are ready to enter the payment.
- Click on Daily Activity on the left and then on Payments Received and Adjustments.
- Click on “Enter a New Item”. It is not necessary to change the date on the date selectors to enter a payment. The date selectors are used strictly to review past payments that have been posted.
- Choose the source of the payment from the drop-down box (choose From Insurance).
The source would be the responsible party that received the last invoice generated (primary insurance first, unless this was a private pay client).
- Click None and choose the appropriate insurance payer from the next drop-down box. Once the insurance payer is selected all client sessions billed to that payer, that have not had a payment posted to them, will be listed.
- Click in the box next to Check Date and select the date of the check from the calendar (mandatory). Enter a Check Number (optional, but highly recommended), a Reference (an optional note you can add for yourself) and the Total Amount of Check or Payment. The “Remaining Amount to Apply” block will show how much of the Total Amount remains to be applied to a session.
- Choose the appropriate Client Session by clicking on the HAND icon next to the Billed Charge. Enter the payment as indicated on the insurance EOB. The typical insurance payment will require the following entries:
- Enter any non-allowable amount (the difference between the billed charge and the allowed amount) in the Insurance Adjustment box.
- Enter the client co-pay, deductible or co-insurance amount in the appropriate box according to the EOB, regardless of whether the client has already paid it or has not yet paid it. This is your opportunity to tell the system what the insurance company says the client owes.
- Click Apply Payment after each DOS.
- Each time a payment is Applied to a session, the “Remaining Amount to Apply” box will update with the payment amount that remains to be applied. A payment for multiple sessions and clients may be entered in a single insurance EOB.
- Continue applying the payment to the sessions until the total amount of the check has been applied. When the Total Amount has been applied, the amount showing in Remaining Amount to Apply will be $0. A screen that says “Nice Job Everything Balances” will pop up. At this point, you may click “Close” to review or edit the payment or you may click on “Update Account Balances”.
- You MUST click on “Update Account Balances” to post the payment. If you click “Close” to review or edit the payment, simply click on the “HAND” icon next to one of the Billed Charges and click Apply Payment to get the option to “Update Account Balances” again. Clicking on “Update Account Balances” will post the payment to the Client Balances and the payments can be viewed in the Reports screens.
- After you click “Update Account Balances”, you will see that the system is now prompting you to create new invoices for the next responsible party. You’ll see the invoices on Invoice Clients and Insurance under Daily Activity. You can see how many invoices are waiting to be created on the Home Screen.
Once the 2nd set of invoices has been created, the system will accept payment from the entity that was invoiced (secondary insurance where applicable or from the client if no secondary insurance).
Screen definitions – Payments Received and Adjustments
Insurance Adjustment – Enter the non-allowable amount by the insurance company (the difference between the billed amount and the allowed amount).
Ins Adjust Other – Enter any other amount that is not covered by the insurance company and needs to be written-off.
Client Co-Pay – Enter any co-pay that the client is responsible for, as indicated by the insurance EOB, whether the client paid at session or not.
Client Deductible – Enter any deductible that the client is responsible for as indicated by the insurance EOB.
Client Co-Insurance – Enter any co-insurance that the client is responsible for as indicated by the insurance EOB.
Client Write-Off – This column is used when a client accommodation is necessary.