Billing: Apply an Insurance Payment Manually (Primary)

This help page provides the steps involved in manually applying an insurance payment to a claim. An insurance payment can be applied from a patient’s chart, from the Charge Entry page, or from the Payments Overview page. This help page reviews the process from a patient’s chart.

Note: It is assumed that the payment has already been posted prior to beginning these steps.

Search for the Insurance Payment

 

• Hover your cursor over Billing and then click Payments.

 

• Click the Payment ID.

 

• Enter/search for the Claim ID. The HF Claim ID is the patient’s account number on the EOB/ERA. Enter the number and click Get.
• Note: DO NOT USE the Claim ID on a secondary crossover EOB payment. The Claim ID on the secondary crossover payment is the Primary Claim ID. Use the Search option described below for secondary crossover payments or when the Claim ID does not match in our database.

 

• When the patient account number does not match the HF Claim ID, use the Advanced Claim Search located next to Get.
• Search by patient name, provider, payer, service date, created date, or charges. Only one search criteria is required.
• Click the Claim ID under the Payer column.

 

• Scroll down to the Claim Details section and adjudicate according to the EOB.

Basic Adjudication

• Enter the Ins Pmt.
• Enter Patient Responsibility in Copay (PR3), Co-Ins (PR2), and/or Other PR (defaults to Deductible).
• Enter Ins Adj (defaults to a contractual adjustment – CO-45)
• Click Post Payment.
• Note: The Insurance Balance Column must be $0 for the payment to be posted correctly.
• For information on applying an insurance overpayment, go to Apply an Insurance Overpayment.

Advanced Adjudication

 

• The Claim Processing Status can be selected. If Denied is selected, the claim will be available in the Denied bucket on the Claim Status Dashboard.
• The Expected Fee Schedule can be used to confirm that the correct payment was received and autofills the allowed amount.
• When the allowed amount is entered, press Tab on your keyboard to tab out of that field. The Ins Adj autofills. The formula used to calculate this amount is: 
  Charge – Allowed = Ins Adj.

Note: The use of the allowed amount is not required.

 

• Links are available to Post at the Claim Level and Post Claim Level Adjustment (not recommended).
• The adjustment categories can be changed to match the EOB.
• By default, Other PR defaults to Deductible (PR1) and Ins Adj defaults to a Contractual Adjustment (CO-45).

 

• Click Edit Adj.
• Click  next the adjustment category that needs to be edited.

 

• The adjustment code on the EOB can be entered (example CO29).
• Use the drop-down menu for a preestablished list of options.
• Click Save Adjustment.
• Note: If a note is entered, that note will be exported to the Production – Adjustment Reports.

 

• After the payment is successfully posted, expand the Claim Search screen to find the next claim on the EOB that needs to be posted.