Combine Multiple Insurance Payments

This article guides you through how to combine partial payments from the same payer and successfully finalize the claim.

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Partial Payment Description

When a clinic disputes a payer’s initial “small” payment, the payer may re-adjudicate, paying an additional amount(s) towards the claim. The result is that the claim has multiple small payments that together total what the payer is sending them.

FOR EXAMPLE: Let's say a payer may send $75, which you dispute. Rather than doing a reversal for their first adjudication and sending one payment of $100, the payer sends an additional adjudication of $25 instead. The initial payment ($75) plus the second payment ($25) equals the total amount the payer is paying ($100).

Since Fusion requires one final adjudication to complete the claim, the user will need to combine payments in order to finalize the claim.

Combine Payments

Locate the Partial Payments.

1. Open the claim in question.
   
    
2. Above the 1500 form, click on the Adjudications tab.
   
    
3. In the lower-left, click the Print Adjudications button.
   
    
4. Locate the adjudications where the payer made both/multiple payments.
    
5. Print, copy or jot down the adjudication information that needs to be combined. You’ll need to know how much should go into Not Allowed, Other Insurance, Paid Amount, Co-Pay, Deductible, Co-Insurance, Other Liability, and Non-Covered categories.
   
    
6. Click the “X” to close the Print Adjudications pop-up.
   

Create the Combined Payments Remit.

1. Go to Billing → Remittances → Received.
   
    
2. In the lower right, click the + Remittance button.
   
    
3. Fill in the information about the remit as desired.

   NOTE: You could call it ‘Combined Payments’ and put the paid amount as $0.

4. Click the Save Remittance button.
   

Add the Claim to the Remit

1. Open the remit you just created.
2. Follow the steps to Post a Manual Remit.

Combine & Reverse Payments

1. On the remit, locate the line with the attached claim. To the right of it, click the View Claim icon.
2. On the 1500 form, click the Adjudications tab.
3. Click the adjudication you just added and manually post the combined payment totals and adjudication.
   • The Charges Paid amount should be the sum of all payments received on the claim.
   • Add any patient responsibility amounts and adjustments (if applicable).
   • Adjust the Not Allowed (CO45) field as needed to balance the line.
     
      
4. Click the Save Adjudication button.
   
    
5. On the Adjudications tab, locate the partial payments and to the right of it, click the reverse icon.
   
6. In the pop-up, select the Combined Payment remit that you recently created. In order for the original remit to have a green dot, we need to reverse it to the combined payment remit, not itself.
7. Repeat steps 5 & 6 for the other partial payment(s), as needed.

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